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E18: TM: Where time gets wasted, and what to do about it

[00:00:00] 

Intro: Let's hear from GPs, GPNs & PAs

[00:00:06] Munir Adam: Hi guys. It's Munir Adam here and great to have you back with us and this is our final episode in the time management miniseries. In previous episodes, we discussed why there's a problem, what the problem is, its impact, and we heard from some who have dedicated a lot of time and experience and have insight on this topic.

[00:00:27] They've published works on it as well and provide guidance, which I think is very helpful as well. I tend to call them the experts. But actually work as working clinicians, we all have experience and in a sense we're all experts, or at least we all have ideas that, you know, that we potentially could share.

[00:00:44] So for this episode, we decided to find out from actual working, GPs, GPN, and PAs in terms of how they feel they can manage their time better, how do they deal with the pressure of time, and what tips would they be willing to share. And to present this to you even better, I have with me, 

[00:01:03] Marium Hanif: My name is Maryam. I'm a Physician Associate, so I'll be joining Munir today in the discussion on time management, on what sort of resolutions and tips we can provide today for everyone. 

[00:01:13] Emma Borders: And hi there. I'm Emma Borders. I previously was ITU Nurse, but I've been a practice nurse now for 10 years, but work as a Educator Trainer for the Cornwell primary care training hub.

[00:01:24] And I also have a podcast as well.

[00:01:27] Munir Adam: Yeah, and we should let the audience find out a little bit more about your podcast at the end of the discussion. It's great to have you Both Our different professions I think will allow us to provide a much broader perspective. And actually, even though we don't cover all the professions in primary care, I think there's a lot of overlap.

[00:01:43] And by having three different professions discussing this topic, it probably covers quite a lot of the types of issues that people might face, or at least the solutions that they put forward. Cuz this is what it's all about. It's all about solutions. So brought to you in partnership with Integrated Care Support Services, this is season two of Primary Care UK.

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[00:02:17] Munir Adam: In previous episodes, we've made the point that this is a big problem, time management in primary care and some of the problems that this leads to: stress, disgruntled patients, having to apologize repeatedly for running late, how efficiency goes down and the impact on one's own wellbeing. It's clearly a big problem that has to be dealt with, and certainly there's a lot of GPs complaining about not having enough time, but how is it for the other professions, Marium, what's it like for PAs? 

[00:02:46] Marium Hanif: So, well, it's actually a challenge for them. Newly qualified PAs, they tend to run one hour, two hour delays behind because they don't know the demographics of the patients. They don't know the areas or use of the systems like EMIS one and System one. They also having to wait around for the GP knocking on the doors for getting prescription sign off and X-rays imaging, even for experienced qualified PAs, they struggle with patients' expectations during the consultation.

[00:03:15] So patients may come with three, four different problems and. Every clinician would like to try the best and manage as much as they can, but again, we're always challenged with the time and we're running behind and it can have a knock on effect with other patients as well. People often think PAs have 15 minutes, half an hour appointments, but it's not the case actually. There are some PAs on 10 minutes and for example, when you have complex patients, like mental health related cases, you have 10, 15 minutes. So it can be a big challenge for them and. You wanna do the best as much as you can for your patients. Emma, what are your thoughts?

[00:03:49] Emma Borders: Yeah, I mean, lots of similar things to what you've just said. I think one of the biggest challenges that's facing practice nurses is there was a survey that was done about five years ago now I think that showed that about 30% of practice nurses planned on retiring in the next few years, and we're actually at that point now.

[00:04:05] So we have lots of new nurses hitting the workforce . So that's a big knowledge and skill gap we've got when they're leaving. Lots of new members of staff who aren't as skilled need that bit more time. And then post covid, there's just so much more demand trying to catch up and, you know, appointments are getting squeezed. There's more people to see, more to do, less staff. So lots and lots of challenge. 

[00:04:26] Munir Adam: And, and that's actually a, a really important point that you remind us about, Emma, cuz it's not just about the staff feeling burnt out and struggling. It's about the staff are not actually going to be there in the first place if we don't do something about this problem.

[00:04:39] An important problem, it certainly is then. But of course there is no perfect solution to this. And actually the truth is, when you look at time management, only very limited research has actually been done. And that's why it's really useful to have some experts who have dedicated and written on this.

[00:04:54] But even so, there is so much we don't know. And because of that, I just wanna make the important point that the issues and the the tips that we're discussing today, Are really just tips shared by colleagues and thoughts that have come up, either ourselves or others that we've asked. And these have come from WhatsApp messages.

[00:05:12] They've come from personal experience that maybe they've come from live in-person conversations and so on. They are not the result of extensive research and the truth is that different things work in different situations. We can't accept responsibility if any listeners find that they hear something here, they apply it, and their consultation goes pear-shaped, or a particular strategy doesn't work because nothing's gonna work in every situation.

[00:05:37] And so let's move forward with this. The first part is going to be to discuss consultation related time management tips. Then after that we'll look at possible ways of saving time outside of the consultation itself, but at work. So let's go through with the suggestions. 

Not listening at the start 

[00:05:53] Munir Adam: Right. So here's one: 

[00:05:55] Somebody has said: it's important to allow time for processing, but to hold back judgment. Actually actively listening rather than just showing that you're listening, although both are important. The point that's being made here, I think I kind of get it. One is that you have to show that you're listening because that's important. But also sometimes we can show that we're listening, but actually our mind is somewhere else.

[00:06:20] I dunno if you've ever had that feeling. 

[00:06:22] Emma Borders: Yeah, definitely. I think there's a big push now with personalized care and I think actually, well, from a nursing perspective, we are terrible. The most of us, for trying to be fixers and fix people and actually, You ask powerful questions and you need to give them time to answer and actively listen.

[00:06:38] Instead, you're always trying to offer a solution or fix someone. And actually the best thing you can do is actually just be quiet and actively listen. And I think we don't always work that way. 

[00:06:47] Marium Hanif: I think for me, it's like when you have patients come in and you do give 'em that few minutes to talk and they'll just don't stop.

[00:06:55] See, they'll carry on talking for five minutes and then they'll carry it and you just feel like, when do I interject and say, okay. Can I just ask a few main questions like the red flags or your main presenting complaint today? And you just like, then they're having to repeat all over, like all over again.

[00:07:10] And then this doubles up your consultation. So like, yeah, it can be very difficult. 

[00:07:15] Emma Borders: Well, you've opened up that can of worms. I think that's what we are worried about, isn't it? When you ask a question, we're always telling people in our training, if you are asking powerful questions where you're trying to elicit sort of an answer from, you do need to target.

[00:07:27] So rather say, You know, what's the thing that matters to you most or what you most concerned about? Cuz they'll start talking about the knees. But this is a diabetes appointment. You need to sort of be that little bit more targeted and try and, yeah, keep that focus really. 

[00:07:40] Munir Adam: It is tricky, isn't it? To, to try and do the listening bit, but also you still keep control of the time. Yeah. 

[00:07:47] Marium Hanif: So the second point, what I was just saying earlier on:

[00:07:50] Let the patient tell the story at the beginning. So most people will talk for themselves out in the first two minutes and then they tend to feel like satisfied when they had their say after three minutes. But I think they are unusual and I'm justified in stopping them. 

[00:08:04] Again I think it's really good. It's a tactic. A lot of clinicians do use first one or two minutes, let 'em just say what they need to say and then start trying to take the history and take control of the consultation, which can be helpful.

[00:08:18] Munir Adam: In fact, we often use the phrase golden minute, don't we? And one of the things that I say to my trainees is that golden minute means keep quiet for a minute, but it also means keep quiet only for a minute. Maybe a little bit longer than a minute's, okay? But it doesn't mean keep quiet forever, ever until they stop.

[00:08:34] But I think it's true that the majority probably would talk themself out in two minutes. But you always get the exception, don't you? Not everyone. Not everyone. 

[00:08:44] Marium Hanif: And you might get somebody who just sat there very quiet, waiting for you to initiate the consultation. So it doesn't always work that way. 

[00:08:52] Munir Adam: So, Yeah, that is a challenge, isn't it? What if they don't talk at all and they're just waiting for you to take the lead? 

[00:08:57] Emma Borders: It's probably a sign that as someone like a patient's come in and they've got quite a lot on their chest, are a lot that they need to unpack, and it might not be that you can do that all in that one appointment and setting those sort of expectations is important. And sounds like you've got a lot going on here. We can address this today and maybe I'll need to get you back to see one of the new ARRS, roles or somebody else, or myself again. And it's, it's just trying to manage expectations, isn't it, of what you can do in your 10 minutes.

[00:09:24] Munir Adam: Yeah. Yeah. And that acknowledgement actually goes a long way, doesn't it? That at least you're acknowledging they've got a lot going on then, even if you don't have a chance to discuss it all. Yeah. 

[00:09:32] Marium Hanif: Normally I tend to do the ice at the start of the consultation. I know we tend to do it towards the end, it helps me to manage the patient expectations.

[00:09:39] And it's really good way of opening the consultation just to see what their thoughts are and what they would like. Also, this is quite interesting. Some patients have booking their appointments with completely something different just to get the on the day appointment. And then they come in and they expectations come like completely different.

[00:09:55] Munir Adam: Yeah. Oh, it's frustrating, isn't it? Yeah. When that happens. 

[00:09:59] The next point there is actually follows on from what we were discussing and it, somebody has said it's important to interrupt.

[00:10:06] So it's quite a short message, but it's such an important one. We sometimes can get confused into thinking that active listening means that it might be impolite if you were to interrupt, but actually sometimes it is necessary. 

Squeezing in multiple issues

[00:10:19] Munir Adam: Then there's a mention about a one problem policy. What do you think about that?

[00:10:23] Emma Borders: Probably necessary in that you only do have so much time. So I suppose it goes back to what I said earlier in that if somebody does have, they come with this long list of things, you have to sort of be able to manage that well, we need to deal, let's, what's the most important thing that we need to manage today in these 10 minutes?

[00:10:39] And then we can get you back. I think in general practice we have to remember we, we are able to get people back for appointments. We don't have to fix people completely in a 10 minute appointment cuz that's just unrealistic a lot of the time, isn't it? 

[00:10:52] Munir Adam: Yeah, that's true. 

[00:10:53] Marium Hanif: I think for the peers, they will try to manage more than one or two problems in the list.

[00:10:58] It depends on the urgency. So normally if they present me with two things, I say, actually, I'm more worried about this. This could be quite more sinister. The other has been ongoing chronically . It's fine. So I think explaining that communication is really important. Explaining why we're focusing on one aspect rather than the other of the two problems. Again, patients might bring up like the MSK problems ongoing. That's already been consulted last week. Again, just explaining that, that look, a clinician has looked into that referral has been done. If we don't have communication skills with the patient, then again, there'll be a breakdown in relationship, and then they feel like they're not being heard.

[00:11:32] And again, interrupting is good because as a clinician, you're taking control of your own consultation. If you don't do that, then the patient will just go on and they will probably tell you the whole life story from the birth up until beginning to now. 

[00:11:46] Munir Adam: Yeah, and the problem of course there is that one might say, well let them say the whole life story, but actually they're gonna end up leaving without having the problem that they wanted addressed. We're interrupting them, but we're doing it for their own best interests and we're doing it to give them what they actually came for.

[00:12:01] Now occasionally they may well have just come to talk, but most of the time there is more to it than that. And we might not get around to their agenda if we don't retain some sort of control in the flow of the consultation. 

[00:12:12] Emma Borders: But it is really hard. I think it's just knowing when to interrupt people or like to, to manage that, isn't it? Like if people have all this stuff, I mean, I find that even after 10 years, really difficult, if somebody comes in, they've got all this stuff going on in say, a diabetes consultation and you, you are thinking in your head, oh, I really need to get control of this consultation back. I've hardly said anything.

[00:12:32] We're not getting anything done and it is really difficult. 

[00:12:36] Munir Adam: Yeah, it's a challenge, isn't it? It's, I think the principle is a good one, but actually applying it, and I make the mistake sometimes of thinking, oh, well I've still got a few minutes to go and, alright, let's just quickly deal with this second easy problem.

[00:12:49] Yeah. And of course it's never a, an easy, quick problem and then you end up running late. Yeah. I think we sometimes go a bit hard on ourselves and perhaps, I dunno about you. I do that because I feel a bit guilty that the patient's asking me a second problem and I've actually still got two or three minutes to go. So why shouldn't I deal with it? But actually, there's very few things you can deal with within a minute or two. 

[00:13:11] Emma Borders: Yeah, absolutely. 

[00:13:13] Munir Adam: Okay, let's have another one. 

Losing time documenting

[00:13:15] Marium Hanif: So a clinician has said, touch typing is not my skillset, but if a consult is complex, I will ask the patient if it's okay for me to type while they talk, to make sure I retain accurate notes and to make sure I don't miss any of their concerns. Again, most patients don't mind, but it's all about keeping the patient informed as to why you are doing something which otherwise may come across as disinterest from the clinician. 

[00:13:42] Munir Adam: And that's actually the point that you were both making, isn't it? It's about keeping them informed about why you're doing what you're doing.

[00:13:48] Marium Hanif: What are your thoughts on, or clinicians using dictator phones while they're talking to the patients? Because often I see that in practice, which is quite interesting, and it does save them a lot of time, I suppose, from typing. 

[00:14:00] Munir Adam: Yeah, I used to see that a lot in with consultants. They, they would dictate a letter to send to the GP to try and get things done there and then. There's pros and cons to it. I think the advantage is that you can get things done live while it's fresh in your head. And also, another advantage might be that if you are dictating something, it's also a way of acknowledging to the patient that you've heard them. And you're kind of reinforcing the action plan, so you you might say to the patient, this is what we're gonna do.

[00:14:25] And then you're dictating the same thing in the letter to the GP as well. And, and you know, in primary care we might also do the same thing, so, so patients can see that you've heard them. I suppose the negative is that you have to be very careful how you say those sentences. Because you might say in a technical way, PA patient might then say, what was that you said?

[00:14:42] So yeah, I don't know really. I've never thought about it too much. 

[00:14:46] Emma Borders: Yeah, I mean, good record keeping. I mean, best practice to do it as soon as possible after a consultation, isn't it? So I suppose you would be sort of moving a bit away from best practice if you were to dictate, and I'm always that person who's thinking about worst case scenario, but like, what if something happened to that recording for the day and all you recordings got lost, or I don't know, recorded over or just seems like there's, I dunno if the time saving value of that would be significant enough for the risk of things that could potentially go wrong.

[00:15:14] Marium Hanif: I would like to add on to this . One of the PAs mentioned a very good, in good tip for this in particular when we're typing notes. So on emis, I'm not sure about system one, but you can use the configuration tool and that gives you a mini shortcuts for like safety netting or any advice.

[00:15:30] Like you may see repeatedly upper respiratory tract infections or MSK commonly, so it just saves them time.

[00:15:36] Munir Adam: Absolutely. 

[00:15:37] Emma Borders: Using tips like that are really good because actually, like with Emis, for nurses, we use loads of different templates and having a template set up that sort of, you know, cuz these can all be modified and adapted if you speak to whoever's your IT person at your surgery. But you know, you can have them set up however you want. So that can really speed things. 

[00:15:55] Munir Adam: It, it's probably true that templates and automatic processes could probably be exploited a lot more in primary care than they are. Primary care hasn't always made the most use of technology has it. And I think the latest thing that we're actually seeing is AI coming on.

[00:16:10] And if that works well, then it may save people, for example, typing up things that have been dictated. But when there are mistakes, it can look really quite weird. When you read a letter and it says this was automatically typed and then half of it doesn't make sense. So , it's a double-edged sword, isn't it?

[00:16:25] Yeah. Right. 

Waffling

[00:16:26] Munir Adam: Let's see what else we've got here. So here's another quote:

[00:16:30] Practice brief to the point explanations of why we cannot deal with this one today. Waffling on and permitting an argument will kill more time and lead to the patient accusing you of potentially being able to deal with it in the time that you've wasted.

[00:16:47] Oh my God, that has really happened to me a few times. I've ended up spending a few minutes explaining to them why it's not possible for me to deal with their second problem. You could have dealt with it instead of giving me this long explanation.

[00:16:58] Emma Borders: Yeah, definitely. Yeah. That just goes back to managing patients expectations; it's all about that, isn't it?

[00:17:02] Sort of finding ways to be explained things. I always think a good one is to put it in the other patients shoes. Usually, you know, I have other people waiting . Other people are waiting just reminding people that it isn't just them. There is other appointments and we've reached the 10 minute mark and we can get them another appointment booked in.

[00:17:18] But that, that's it for today. Yeah. 

[00:17:21] Marium Hanif: I don't know if anyone has been in a scenario where they come in and present something and you tackle all of that and give a management plan. And then actually this one was not the main concern actually, our main concern was something else. Oh yeah. And I'm like, Like when I asked you what brought you in today and how can I help you?

[00:17:40] So they do this, and it gets really challenging, and then you're like, okay, actually this is quite urgent because they may have a chest infection for all I know, and they're saying they're very unwell. It's been going on cough and stuff, but they didn't mention it because they brought the ongoing leg pain .

[00:17:55] So I was like, oh dear, what do I do here now? Because you have to prioritize what's really urgent. Yeah. So it gets very tricky. 

[00:18:02] Munir Adam: It's a difficult one. It's really frustrating when that happens. You've dealt with everything. You think you've done a nice consultation and while they're leaving, oh, while I'm here. Now you've gotta deal with that.

[00:18:11] So I dunno, how do you deal with it? 

[00:18:13] Marium Hanif: So suggesting another appointment. So if it's urgent, acute, then I'll try to get them booked in with a, another clinician, a PA, ANP, or a doctor. If it's something that's been ongoing, then I'll just book a routine appointment for them. If I do have some time left. I'm not always running late. I have 15 minutes appointments. If I have like seven minutes or five minutes, then I'll try to deal with it and try to take a history from that. 

[00:18:36] Emma Borders: Okay. From a nursing perspective, I think we're quite lucky in that most of our appointments. We know exactly why the patient is there.

[00:18:42] So if I know I'm doing a diabetes consultation and they come in... and it is always that the complaining of the knees or hip pain, because that's the, that's the thing that's bothering them because it's a thing that's affecting their day to day, you know, they're in pain. 

[00:18:52] Whereas I wanna talk about how the hba A1C is 115, you know? Cause I know that that's the real problem, for me. So, because I know they're coming for a diabetes appointment, I can quite quickly get them back on to that. Well, I'm here to deal with your diabetes. We can book you for something else. I suppose that's much more difficult for PAs and GPs Cause I suppose you don't know what people are coming for necessarily, do you?

[00:19:13] Munir Adam: Yeah, you're right. 

Failing to delegate

[00:19:14] Munir Adam: And something that newly qualified doctors sometimes find difficult is saying anything that's gonna make you look like they, they don't know everything.

[00:19:21] Emma Borders: Right, yeah.

[00:19:22] Munir Adam: And but I've come to a point where I'm very happy to say that, oh no, this is an area that so and so knows about and deals with much better than me.

[00:19:29] Cuz patients might say, well, your GP, you deal with everything, don't you? I say, well actually I can manage it, you know, jack of all trades. But yeah, but actually, if you've got a master of the trade somewhere into surgery, isn't it better to see that person? And that person might be a GPN, there might be a PA, there might be a clinical pharmacist.

[00:19:44] We have a first contact physiotherapist who can deal with various problems far better than I could ever do. And so I'm very happy to share my limitations with the patient so that they get better care ultimately, and it allows me to keep to time as well. 

[00:20:00] Marium Hanif: Yeah, I think that's a very valuable point actually.

[00:20:02] Delegation is really important and collaborative practice in general practice. Mm-hmm. For example, diabetes nurse specialist, she will know ins and out really well. She'll manage it, like she'll have time for that in particular. So I'll say to the patient, look, I'm gonna book an appointment with the diabetes nurse and she'll be able to start you an appropriate management plan.

[00:20:22] Again, I would not feel comfortable starting any patients on insulin. Because I've not done any specialist training on that. So yeah, and again, we have health and wellbeing coaches and social prescribers, and if they have any issues in regards to housing or benefits or, you know explaining about diet and lifestyle activities, they're better off with a health and wellbeing coach because they have the time.

[00:20:43] They have half hour appointments, 40 minutes appointments, and they can give more support to them. 

[00:20:47] Emma Borders: Yeah. Well there's 11 different ARRS roles, additional roles now that have entered, entered primary care to sort of support their sort of classic GP nursing team. And I think one of the biggest barriers to using them is our knowledge of what they can do.

[00:21:00] So I think a really good time saving tip would be to go and meet those members of the team that your PCN has. What can they do? I did a podcast episode with a dietician. And I before then would be like, how would a dietician be used in primary care? I, I couldn't really see it. And then I did the episode and she talked to her and I was like, wow, there is so many ways and so much that she could do, but until you actually speak to them or find out what odd roles you have, you wouldn't know that.

[00:21:27] Munir Adam: So there's a really important point coming out, isn't there? Which it's, although this is about time management for us, which. In a way might even be interpreted as a kind of selfish act, although that's probably quite a strong term to use. It's actually in many ways, ways of improving the care that patients ultimately get.

[00:21:45] Ways of harnessing the expertise of the team. Yeah. So what we're doing is actually good for everybody. Yeah, definitely. And at the same time, saving us time, which is far better than trying to squeeze in and manage something really quickly. Mm. In a consultation and probably do a half-hearted job. 

[00:21:59] Which unfortunately is what often ends up happening, or has been happening, but hopefully it won't be happening anymore. 

[00:22:04] Emma Borders: Yeah. 

The list-bringer

[00:22:05] Munir Adam: Let's carry on. So where are we? If there's a hint of a list, grab that off the patient first and prioritize. If there's no list and they come in with something else at six minutes and that would normally take a whole consultation, be brutally frank and defer.

[00:22:24] Do not attempt to squeeze in more and more into less and less time. It's unsafe for both parties. Yeah. 

[00:22:30] Okay. We sort of discussed that, didn't we? Yeah. Should we carry on? Yeah, here's another one. So spread things across multiple consultations, which we did talk about, didn't we? Recognize that certain complex consultations will not be safely solvable in 10 minutes, and aim to make up that time elsewhere and stick to it ruthlessly. 

[00:22:48] Emma Borders: Ruthlessly, what a word. Yeah. Be ruthless. Yeah, I, I do think that's something I say to a lot of new practice nurses when I'm doing training and things, you know, we are a little bit privileged in primary care compared to when, like, when I worked in intensive care, that a lot of the things that we do especially when the nursing side of things might not be urgent and have to be dealt with on that day, and that we can get people to come back.

[00:23:11] And I think we put a lot of our pressure on ourselves, like we have to get everything done, all the QOF boxes. And it's not always realistic. It can be actually an unsafe way to practice.

[00:23:18] Marium Hanif: Okay. Yeah, I like this one. He who holds the list holds the power. List of problems? Get it at the beginning and limit the expectations of dealing with it all. It's a piece of paper. Take the piece of paper. 

[00:23:35] Emma Borders: Is that something that happens often with GPs? And do people come in with a, actual written list that they give to you? 

[00:23:40] Munir Adam: Yes, sometimes it does happen. Yeah. And, and they, they come with a slightly apologetic expression and say, you see, I forget, I, I brought my list. I don't forget to mention anything. And, and as a part of me kind of wishing that they do forget to mention some of it, not in a bad way, certainly I wouldn't want them to forget to mention anything too important. There's something about bringing a list and then expecting that this is what they're going to get through.

[00:24:02] And sometimes they even go as far as saying, I don't come off into the GP, so now that I have come after a long time, I've got these seven things listed that I want you to deal with. 

[00:24:10] Emma Borders: Just imagining one of those, you know, like a scroll that somebody comes out, drops to the floor and rolls out that floor and your just heart sinkingt? 

[00:24:18] Munir Adam: Here's another one. So somebody has mentioned: catch up slots to keep efficient. Similarly mixing with admin time. Use your time flexibly if you can empower the clinician how to spread their time. And then somebody has mentioned, I try to get bits of admin done in between patients to if I have a few minutes to spare, anything that is complex, I'll skip over and do it at the end so that I can give my full attention to what I'm dealing with. What do you think? 

[00:24:45] Marium Hanif: I have seen certain PAs, and some of them do not have catches slots at all.

[00:24:49] They just don't. So I dunno how they're managing one after another, after another. And then I had to speak to the clinical supervisor and then actually they said, you're right. They do need a catch-up slot to breathe. But some other PAs, they do have two catch-up slots in the morning and two in the afternoon equally spread out.

[00:25:06] And then we do have an admin time and that helps us a lot to catch up . We may not know the answers and we are always waiting for the GP to finish their clinic and then knock on their door and get the advice. So we are lingering around a bit, well midway of our consultation.

[00:25:19] . And , so catchup slots help us great deal, a lot. 

[00:25:23] Emma Borders: Can I just play devil's advocate a bit with a Catchup slot because I just think sometimes a catchup slot's a bit of an indication that your appointment time's that long enough. Mm, because with nurses, what happens to those catch up slots is admin.

[00:25:33] When you get an urgent dressing, they go, oh, get rid of that catch up slot, and we'll put an urgent dressing in there. And, oh, and I just always think it quite a sign, really, if you need lots of catch up slots that your actual appointment times aren't long enough.

[00:25:44] Say you have referral forms or other bits and bobs that you needed to do in your appointment thinking, I'll do those later at the end of my morning. Again, you're creating sort of a false sense of how long your appointment times take. You should be able to complete that task instead of task that patient before you move on to the next.

[00:25:59] So what you don't want I would say there's lots of stuff at the end of your clinic going, oh, we've got all of this stuff to do. Because I wasn't able to do it in my appointment time. And then then management, I think have a false sense of how long it takes you to do X, Y, and Z. Because really what you're doing is, in your lunch break, you catchups. 

[00:26:14] So the management are like, oh yeah, you get it done, you arrive them, saw them, and they left in 10 minutes, you go, yeah, but I had all this extra work. 

[00:26:21] Munir Adam: I can't remember who has written this, but it looks like it's a way of managing. Not so ideal situation. Yeah. But isn't really the way things should be running.

[00:26:32] In an ideal world, and I guess in a lot of sectors outside of healthcare, the appointments are probably long enough, that you can manage everything comfortably within that time. And so why would you need any catch up slots, isn't it? Mm-hmm. In primary care, we often find that we just don't have enough, and then we've got these bits to try and desperately catch up.

[00:26:49] And the worrying point that you are highlighting, Emma, because of the pressure in general practice, those catch up slots being abused. Yeah. And I think I'm right in saying that people who are focusing on things like lifestyle and wellbeing would probably say that catch up time and lunch breaks and things like that are supposed to be just that.

[00:27:07] Yeah, you're not supposed to be working in those times. It's not good for your wellbeing. 

[00:27:10] Emma Borders: Yeah.

Not using technology to your advantage

[00:27:12] Munir Adam: Let's move on to something different then. So somebody's mentioned here about technology, but although we touched on that a little earlier, using shortcuts, using keywords, accurx messages, text expanders, standard questions and phrases and advice.

[00:27:28] Automating things where you can, using short keys. And here's an interesting one, getting the patient to do things. 

[00:27:35] Emma Borders: Well, yeah, so asthma's a good one with your ACT score questionnaire. You know, you can text that out to the patient before they come in, ask them to bring it in, and then I don't have to go through that with them.

[00:27:46] They've brought it and I've got the score, and that's five minutes I've saved myself. So if there's anything like questionnaires or things that you would go through with a patient in the consultation, can that be something that you text them or send them before 

[00:27:58] Munir Adam: they come? 

[00:27:59] That's a really brilliant one, especially for things that are repetitive.

[00:28:02] Marium Hanif: Yeah. So the next key point on here, somebody said: when it comes to referral letters, we have an automated letter template, which can incorporate consultations, which means the letter does not need to be dictated at the end. It just takes two minutes of populating a template. That way you can attach several relevant, consults without having to summarize it all.

[00:28:25] This also means less work for admin and secretary. 

[00:28:27] So, from my understanding, if we were to do a referral letter, we have to do it either way. Admin team cannot do it, . So like MSK letters and any referrals, two week week referrals. And then we just task admin to email it or forward it on, I dunno what your guys' thoughts are on this, but yeah.

[00:28:46] Emma Borders: If I have a referral letter or that standardized one for, for something that I do, I always make sure that it's get gets put onto emis and then pre-populated as much as possible. So I have to write as little, but I work in the same way as you. And I think most people read professionals do where you fill it out yourself.

[00:29:04] Munir Adam: Yeah. Yeah. Medical, legally, we have to be very careful from this point of view as well. I think the understanding is that it's been done by us. Mm-hmm. So yeah, potentially a solution. Yeah. 

[00:29:16] Learn to touch type so that you can look at the patient while you're writing things up. I can touch type, 

[00:29:21] Marium Hanif: I can as well.

[00:29:22] I learned that through my yeah. Clinics. It's really helpful. 

[00:29:26] Munir Adam: It's great, isn't it? So there's a good one. Well, 

[00:29:29] Emma Borders: just improving your IT skills. Like if you can raise your digital literacy, because we have so many things now that are available that will improve, like help us with time management. But you know, a lot of the workforce perhaps does need to sort of actively upskill themselves and perhaps there's a bit of a resistance there.

[00:29:44] But it will actually help you in the long run. Like if you, like you say learn to touch type or use Accurx or other systems and things, long term you're gonna feel the benefits of that. 

[00:29:56] Marium Hanif: I would like to say I love Accur X I use it all the time. Yeah. And I love my online like videos and telephone consultation.

[00:30:04] I'm all in for digital, like the technology side of things. It's helps your consultation so much to run smoother. For example, if I'm on telephone appointments, I'll ask the patient to send some images and obviously explain no nudity or anything like that for like dermatology related. And it's helpful with, obviously with patient consent, we can send it to like, the referrals for dermatology community.

[00:30:24] For like assessment technologies for me is brilliant. It says a lot of time, for example, mental health patients, if we'll ask them to do the templates for GAD scoring , so that's really, that's helpful as well. Yeah. 

[00:30:36] Munir Adam: And for those people who are a little bit resistant or unsure about it, I do you think that this is something that's being driven forward by the local systems?

[00:30:44] So I'm sure that anybody who's struggling, they can probably get some help from the ICS, or they can find guidance somewhere. 

[00:30:49] Emma Borders: Yeah, I actually have a bit of a a tip here. Unfortunately, I've applied for this funding twice now and never got it. But there's the Topol review was done, which is all about digital tech and things like that. And every year they put out sort of a Topol fellowship where you if you have a really good idea of how digital technology might improve stuff going on in primary care, general practice, and you have a. Project idea. You can get up to about 30,000 pounds to spend on that idea if you apply for this Topol review.

[00:31:13] And they come out with this funding every year and you can make bids and applications for it. So if you have a really good idea that you want to implement that you think will help save time or improve general practice, that includes digital tech. Have a, have a look at the Topol review and Topol fellowships.

[00:31:29] Munir Adam: Oh, there we are. But that's something useful . There might be somebody out there listening thinking that's it. Yeah, this is coming my way. I'm gonna do this. Yeah, finally my dream is gonna come true. Alright. Yeah

 Inefficent examinations 

[00:31:40] Munir Adam: Just a couple of other points here. Thorough, but focused examination.

[00:31:45] I know that's true often of GP trainees, sometimes they want to quite do a really detailed examination, but actually the key is to do what's actually going to make a difference, but to do it properly.

[00:31:56] And then: unnecessary investigations, which then have to be discussed. 

[00:32:01] That's a problem. Yeah. And then another one here is undressing. So if examination is likely, ask them to remove their coat while they're entering the room and. 

[00:32:12] Yeah, certainly time can be saved in, particularly more so in the winter, maybe not so in the lovely summer that we're now having. 

[00:32:19] Emma Borders: So we do our flu clinics when we're getting everybody to get your coat off, get your arm out before the queue, you know, you do a bit of that, don't you? So, yeah. 

[00:32:27] Munir Adam: That must be more difficult, isn't it? Because with flu, Cuz you, you only have very short appointments, don't you? 

[00:32:31] Emma Borders: . Like sometimes 2, 2, 3 minutes top sort of to do flu vaccines. 

[00:32:35] Unfortunately they got all the layers on, you know, and you just gotta get right up there in the deltoids, so.

[00:32:40] Yeah. Yeah. 

[00:32:42] Marium Hanif: Okay. I think for me it's really helpful because actually I eyeball them as part of my examination for MS care related. So if this complaining goes shoulder pain, but they're able to take the jacket off and without any pain or discomfort, then it kind of gives you a bit of an indication what's going on. So, yeah. 

[00:32:57] Emma Borders: Sherlock holmes. 

[00:32:59] Marium Hanif: Yeah. So like one of the doctors said go out and go call your patients rather than call 'em in through emis, because then in that way if they saying their knees are hurting you'd be able to see ob like observe the gait. So I know it's a bit of an additional time that can add onto your consultation, but then it just gives you more of a true, accurate examination of what's going on.

[00:33:17] Munir Adam: Yeah, very insightful. There's so much to pick up, isn't there, just by observation and planning ahead. Yeah. 

[00:33:24] Okay, somebody's mentioned history, examination, agreed. Plan, linear progression. Don't go backwards and revisit the history or examination. Hmm, yes. I think it's generally a good plan.

[00:33:36] Sometimes you do have to, but it's also true that sometimes you might go backwards and forwards several times and become very inefficient as well. Definitely some sort of logic in that. 

[00:33:46] Next one. 

Glued to the seat

[00:33:47] Marium Hanif: This is the last one on my list. Most useful seminar during my career, including how to end consultation.

[00:33:53] So strategies in order: to give patient piece of paper... break eye contact... stand up... move towards the door... hand on the door handle... open the door... step out of the room holding the door.

[00:34:06] Emma Borders: I have to admit I did. I have had that tip before and I have started doing that. You know, you start to make it very clear like that we're wrapping up and I'll get up and yeah, it works really well. Like people will follow those like nonverbal cues quite well actually. 

[00:34:20] Marium Hanif: So, One of the GP I knew, what she would do. I was really confused. I'm like... She was doing, had mixture of face to face and telephone appointments and then she would go into a different room and see the patient and then she'll leave and then come back into her own room.

[00:34:31] And I said, what are you doing? Why have you got what's going on? Are you in this room or in this room? She said, you don't understand if I take 'em into that room, they're not, they're able to leave much quicker, otherwise they will not move, they won't get up off the chair at all. I'm like, oh, that's interesting. I mean, lucky for you. You've got two rooms available today. 

[00:34:48] Emma Borders: Isn't that quite an old plan what consultants, they used to do, that at hospitals and stuff like have a separate little office where their office was and examine people, say stuff and then just leave. Like, I'm done. 

[00:34:59] Munir Adam: I know maybe we should have like a drive-through surgery or something, or, or just conveyor belts.

[00:35:05] I've only had one situation where I had a patient who just completely had no idea of the cues. And following all the steps, he would still stay sitting on his seat, even with the door open and me holding the door open. And it's quite embarrassing for me as well. There's a psychiatrist I used to know, and he, his line always used to be, at the end, he would say to patients, Thank you for coming.

[00:35:26] And most of them would get it and others would just say, you're welcome, and they'll still be sitting there. But I think it's a really useful point because sometimes we do exactly the opposite, even though we feel the consultation is coming to an end, our body language is actually inviting them to continue to talk and continue to mention more things and, and then we can't blame them if that's what they do.

[00:35:48] Yeah. Well, that's quite a lot. I hope that listeners found that useful and that some of those tips you'll be thinking, yeah, I've really gotta try this one. And there may be others that you're gonna be no doubt thinking, well, I've tried this and it doesn't really work for me, and that's fine. Shall we move on to the next part?

[00:36:07] 

Failing to plan and factor in all work

[00:36:10] Emma Borders: Yeah, so it was interesting actually cuz I think the way I approached this from a nursing perspective was quite interestingly different cause I was a lot more about sort of not looking at what's happening in the consultation, but what I can do before and after the consultation to, to save myself time and, and things.

[00:36:27] And when I was looking into it, this sort of came three important strands of that. So: organization prioritization and delegation. I think we've touched a little bit on most of these things as we me talking, but one of the sort of top tips, and I think that is probably the most important was like planning.

[00:36:44] So, Hmm. So I find it really, really useful in a lot of my nursing colleagues I spoke to found it really useful about having diaries, either paper diaries, I use Outlook. I also use Microsoft Note, which if you haven't used it, is really, really useful if you have lots of different work streams. So it's keeping those lists of important things to do.

[00:37:04] When I was Lead. I would make sure I had dates of things coming up, like pgs that were gonna lapse, mandatory training that was gonna lapse if there was audits or inspections that needed to happen, you know, making a note in the weeks prior that those things were coming up so I could make sure there was time allocated.

[00:37:22] So being really organized, I think the one downfall of that is if you write it down in a list, you have to then be checking the list. And that's maybe the bit that you can sometimes forget to do. 

[00:37:34] We've already touched upon it, but just ensuring that there's protected time for things that aren't necessarily patient facing sort of nonclinical tasks, particularly nursing. We have a lot of these like urines to process, fridge, fridges to check various stocking and other administrative roles, and it's important that there's actually time allocated to these and it's not something you end up doing in breaks or after work. You know that you are actually making time for these and management is aware that this is something you're doing.

[00:38:02] I think sometimes we can end up hiding this from management that these are things that we're doing and they can only just be looking at the patient's appointments. 

[00:38:09] Munir Adam: That is so true actually, and it's very easy to assume that just because we're doing something management are gonna know about it.

[00:38:17] Emma Borders: Yeah. And half the time I don't think they do know. Yeah. So I think it's really important to just be quite transparent actually about the things that we are doing and not hide those tasks in things like lunch breaks or catch up slots so that their management aren't aware. Cause you know, if we're not transparent and talk about the things that we're doing then they wouldn't be aware.

[00:38:33] I think as well, if things I mentioned earlier about catch up slots being booked by admin and things, that happens quite a lot with the nursing team. I assume it probably happens with PAs and everybody else as well. Yeah, I would always say to my team, you know, if that's happening, make a note.

[00:38:48] There's always a log on EMIS of who's doing that and just having conversations with the admin team about, you know, why are they doing that, you know, discussions about, you know, that it's important not to do that and that if something, urgent needs booking. What we need to do is cancel something not urgent.

[00:39:03] And the other thing that I had about planning really was to check your clinics in the days or week prior, particularly if you're new to practice and it's a new role, by the time you get there on the day or the patient's in front of you and you realize it's something that's been booked inappropriately or you haven't got enough time for it, it's a bit late then.

[00:39:21] But if you've checked that out a couple of days before and you see that you've got an asthma review booked in and that's not something you do, you have time to, you know, make sure that that person gets rebooked. 

[00:39:30] Munir Adam: I know a lot of GP trainees do that when, especially when they're first starting in practice, and one is, it gives you more confidence cause it can be quite daunting working in a place where pretty much anything can come through the door.

[00:39:41] And so it is a way of trying to save time during consultations by preparing beforehand. But also making sure that patients are being booked appropriately in the right place for the right person. I would agree with that. 

[00:39:52] Emma Borders: The other thing I've got in sort of organization is about being aware and realistic about how long activities do take you.

[00:40:00] And sometimes you might have to build a case for this. Immunizations is a good one. There's some really good guidance about, you know, 20 minutes being an appropriate gold standard childhood immunization appointment time. And then I always said to people when I was leading, you know, When the patient arrives, I press 'seen' as soon as I open up their notes and I'm looking and doing all the reading, and I don't press leave until I finish writing their notes and everything is complete. And then you have an accurate log of how long that truly took you, so you then you can build a case to management. Again, it's as transparency, I think, in using the systems to your benefit to build cases about how long appointments truly take.

Trying to do everything in one go

[00:40:40] Emma Borders: I think breaking down tasks into smaller ones we talked a little bit about delegation and using the wider team. You know, sometimes it might be that you can do certain parts of you might need to do the actual review, but can your healthcare support workers do the sort of observation taking and those parts of the tasks, then you have a shorter appointment cuz you aren't doing all of that. So that can be really useful. 

[00:41:03] Munir Adam: It certainly makes logical sense and people who are organized and people who are forward thinking will probably be thinking, yeah, this is something that I do. I'm also aware that there are some people out there who just want to do everything themself because they see that partly as being holistic.

[00:41:18] Yes. And to some extent, so do patients, they sometimes expect, this is my go-to person. Yes. So there's something to be lost there as well. But I think in the modern world of general practice, certainly in the nhs, I think we've got to work in that way, haven't we? Really? 

[00:41:31] Emma Borders: Yeah. I have said this many a time now. I think, in a perfect world we would have lots of time and say a nurse who works in diabetes would be able to see the patient from start to finish, take all their observations, do their foot check, you know, spend like a good hour with them. And that would just be wonderful. But as the person who sort of skilled in diabetes, it's not the best use of my time.

[00:41:52] I did a diabetes pilot project that sort of looked into this, cuz what you are finding is that you had the bloods and everything done, and then they would come and see me for the foot check and everything, and everyone would have a standard 20, 30 minutes. That's if you've got a diet control who has a perfect HbA1C and everything's lovely, and your person who's on insulin, who has a hba A1C through the roof and just tons and tons of issues, I have the same time.

[00:42:13] So you have one person, you'd be like, yes, everything's wonderful. You can have a lovely chat and off the pop and the other person you'd be like, oh my gosh, what am I gonna do with 20 minutes? That's nowhere near enough. So it's about finding new ways of working. That means you can prioritize your time with the people who most need it.

[00:42:28] I mean, in a perfect world, I could spend that time with everyone. Yeah. We don't have enough staff. 

[00:42:34] Munir Adam: Would you agree, Maryam, that it's probably quite important for perhaps newer PAs to be able to confidently say as well that this is not the area that I deal with and this is the bit that I do specialize in.

[00:42:46] Marium Hanif: Yeah, I definitely agree and I do as an, an educator, my pcm, when I'm training my newly qualified PAs, I do say to them in the first meeting, like, catch ups and stuff, please just say you don't know. You don't have the answer. You're newly qualified PA and it's sometimes it's okay to say that you don't know and you do have a team around you and.

[00:43:06] Surprisingly, like even the group chats, PAs have said that they do consult with the nurses at the work out closely with their health and wellbeing coach or the doctors and, you know, they are aware of their own limitations as well. They see the ones that have been really experienced, but I guess with newly qualified, you do have to spend quite a lot of time with them to explain how general practice works and how important it is.

[00:43:27] You need to know who you need to contact. 

[00:43:29] Munir Adam: Mm. And it will help you save time. If you could, if you can be clear at the outset of that. I know I don't deal with every possible problem 

[00:43:36] Marium Hanif: In my experience, like the reason why nearly qualified run really behind like is because they're not reaching out for that support. They're not earning up and say, look, it's, I said it's okay. Sometimes you don't need to do it all on your own. 

[00:43:48] Munir Adam: Mm. So Emma, you mentioned a few minutes ago about those little extra bits that many nurses and others would do that are often not recognized or counted for. And I think similarly, Maryam, you're mentioning a point here about asking for help between appointments and how that isn't something that's time neutral because it does take time and that's something that needs to be thought about when planning clinics. 

[00:44:10] Marium Hanif: So for the Physician Associates, we have catch up slot. So it's not so much that we block in our sessions. So the admin team, they, they create that. Mainly because they are aware that because we have to work under the supervision of a doctor, we will need to knock on the door and get some further support. It's mainly there that if we need advice.

[00:44:28] And sometimes doctors do come in our clinics because they wanna have a look and assess the patient and is there to support and be safe for the patient and for ourselves. 

[00:44:36] Munir Adam: Yeah, and hopefully the doctor that you're asking, hopefully they'll have cash up time as well.

[00:44:40] Marium Hanif: Cause in our admin time we also do path labs and documents. So the admin time is there to do additional tasks like Emma saying as nurses they would do but is recognized for the PAs. They are aware. So they'll give us an hour time for admin to filter out Path Labs x-rays or in reading documents or any other additional things that we need to do.

[00:45:01] Munir Adam: So factor time for everything. Yeah. Okay. All right. 

[00:45:05] Emma Borders: The other one I've got, I mean this, this may very well just really apply to nurses, but it is a one to think about if you're not already doing this, about clustering care and having dedicated clinics. I think it's really just good for being able to focus on things.

[00:45:19] I think nurses, we might, you know, a clinic could be you have an asthma review, then you're giving medications, then you're in ems, then you're doing diabetes, then you know you're taking blood. 

[00:45:27] It can just be all over the place and it's quite a draining way of working. If you can where possible, have, say a smear clinic so you can get all your equipment out, be logged into the right systems, have your head sort of in that sort of space and.

[00:45:40] An argument for being able to do that is then you can have a slightly shorter appointment time. Cause you're having to go and gather equipment, log into systems, jump from one task to another. 

[00:45:48] The one caveat to that is that it shouldn't be a barrier to access and that you should be so rigid in those clinics that someone who can't attend on a, say a Wednesday morning for a smear appointment, that you're like, well that's the only day we do smear clinics. Cuz that's obviously not good for patients either. But yeah, if at all possible you can have dedicated clinics for things that's just a much better way of working, a more efficient way of working. And will save time for sure. 

[00:46:13] Munir Adam: This would be a benefit for, for GP Certainly as well. We have specific specialized clinics for certain things. Sometimes it's a case of rearranging accounts in a certain way depending on what sort of patients are coming in. Clustering in that way could help yeah. 

Disorganised and non-standardised setup

[00:46:27] Emma Borders: Probably not one for GPs. I think you're quite good at getting your own rooms, but we, nurses not. 

[00:46:33] Munir Adam: We're all hot desking now, 

[00:46:35] Emma Borders: Are you? Okay? And that's something that can really be a problem with time management.

[00:46:39] If you are working in an unfamiliar surroundings, unfamiliar room, and you dunno where your equipment is and your things are, that will absolutely slow you down. So if you aren't able to have your own room, I sort of think it's a good idea to have conversations about trying to stock the rooms in a particular way.

[00:46:56] You know, there's a common theme about where things are and where things are kept and that we restock at the end of the day so that it's ready for the next morning. And I worked at a surgery that had a really good system for nurses who moved around different rooms of that, where they had their own big metal trolleys.

[00:47:11] They stocked with their own equipment. It was their trolley they, you know, had ownership of, and it just moved on wheels with them to whatever room they were working in. So that was really helpful as well. But it just helps with that sort of organization and... 

[00:47:23] Munir Adam: Oh, that's definitely an unavoidable time waster, isn't it really?

[00:47:27] Yeah. 

[00:47:27] Emma Borders: Yeah. Yeah, I think the only other thing I was gonna say on that about organization was it setting up your computer in a similar way to like, you would set up your room trying not to print things out. I'm a big believer in not having loads of paper printed out and actually having favorites and things like that saved on toolbar.

[00:47:42] So if you're not already working like that, you know, having your formulary or the, the things that you use just there on your tool bar just so you can access them is really, really helpful. I don't like printing stuff off. Cause I think it could go out a date tomorrow, couldn't it? You could be working off some sort of old version of some guidance that you've printed off so, Using a toolbar, having a good favorite set up.

[00:48:04] Munir Adam: Do you know what? I would guess that the majority of listeners are gonna listen to you and say they totally agree. Mm-hmm. Have things in an organized, digital, easily accessible, logical way. Yeah. And there's gonna be a minority who are gonna be looking at their desk and looking at about 50 sticky notes all over the walls, paper everywhere, and saying, that's the way I've always worked and that's the way I'd like to work.

[00:48:26] Yeah. And as you said, Emma, if you haven't got your own room, then it's very difficult to organize. The digital stuff is easier to take with you, isn't it? 

[00:48:33] Emma Borders: I do immunization training and I say to people if, if you're printing off routine immunization schedules or things like that, they change all the time, you know, with, with updates and things.

[00:48:42] So if you've printed one off, that could change like the next hour. 

[00:48:45] Munir Adam: True. Yeah. That's really important. 

[00:48:48] Emma Borders: And I think the final point I was gonna make a a around this was about delegation. And I think we have already touched on this, that idea of using healthcare support workers wherever possible to sort of do certain tasks.

[00:48:59] Again, we would love to be able to do everything ourselves, but we need to sort of utilize the team, understanding it, ARRS roles and utilizing them more is really important. And also, I remember when I was lead, I, I was doing things and now in hindsight, I think, why was I doing that? And that wasn't an admin task.

[00:49:14] Like things like stocking or keeping up to date with the PGDs and things that were very logical ordered, things that an admin person would probably be much better at and would've allowed me to do clinical things.

[00:49:23] 

[00:49:23] 

How to make this work for you

[00:49:27] Emma Borders: I think it's actually just really important to sort of remember that time management, it is a skill that we can develop and improve upon.

[00:49:33] So I think what we need to be remembering is reflecting on sessions where we have run lit or things haven't gone to plan, and what can we actually learn from them and how can we make changes or use some of these tips. What can we do? We not just accept that we are always gonna run late. 

[00:49:48] I did read a literature review that, it's something quite nicely about effective time management needs to be developed. It doesn't just happen. Every nurse must find the tools and resources which will help him or her be successful in managing time. And this also needs to be reestablished when a nurse changes jobs or there needs to be an adjustment to the new work environment or patient population.

[00:50:08] Marium Hanif: Change isn't always easy, Emma, and knowledge is just one factor. All of these things come through experience, I suppose, and the more exposure we have, we tend to learn over a period of time that there are additional other tools that we can use more effectively. 

[00:50:23] And it doesn't often get taught in university. How do you manage a difficult patient in the room? How do we get them out of the room? We just get taught the basic stuff, like do the history taking or examination. I mean, a couple of weeks ago for me, a patient wanted a fitnote and he would not leave my room without a fitnote, and he was there for good 25 minutes.

[00:50:44] And I guess I learned through, well, I went and go, spoke to the manager. I got a doctor involved. Otherwise, if I tried managing it myself, I wouldn't have found any resolution. 

[00:50:52] I. Today's episode, we have learned a lot, many tactics and strategies that we can implement, but I guess you have to try them first. A lot of people do not try any of these and say it's not gonna work for me, and they just rule it out completely. 

[00:51:06] So one of the other key factors people tend to have is bad habits. So useless talking, useless typing, repeating themself, unnecessary in consultation. But I guess people do that because they may have awkward silences. Or they may get nervous or they, they don't want to break away from the consultation. They feel like they have to say something throughout, but I guess it's just one way to move away from that and reflect and say, how can I do something different? 

[00:51:34] Sometimes what I tend to do is when I have a student in my clinic or a newly qualified peer observing, I would ask for their feedback. How do you think I went through today? Do you think I could have done anything better? Is there any way I could have improved? Do you feel like I was repeating myself? And that's really helpful as well. And I would ask them what have they learned during their journey here? What have they seen other doctors do?

[00:51:54] Have they done anything different? And 

[00:51:56] Munir Adam: Wow.

[00:51:56] Marium Hanif: I guess educating yourself or asking students or other professionals is really helpful to manage your time more effectively. Yeah. 

[00:52:05] Munir Adam: Very important. Yeah. 

[00:52:06] Emma Borders: From a educational perspective, like feedback and then reflection on that feedback is one of the sort of most valuable and useful learning tools that I think people don't appreciate enough actually.

[00:52:18] Yeah. Asking for feedback, taking on that feedback, and then like yeah. Reflecting and doing something with it, will improve practice and, in things like time management for sure. 

[00:52:27] Munir Adam: And that's worth emphasizing because when you're running late and you haven't got much time and you're trying to minimize your time, then you might cut out feedback as a way of trying to save time.

[00:52:35] But actually you might save a few minutes now, but if those habits don't change, and if those techniques don't improve, then in the long run you're not really achieving anything. We could go on and on, couldn't we? Yeah. 

[00:52:49] Okay. And here's another one, and that's about neglecting your own wellbeing. It might sound obvious, but it's probably quite a common mistake.

[00:52:57] See, the thing is when we're feeling resourceful, we might function a lot better than if we're feeling drained and tired and rushed and, and I've noticed time after time that I'll have a patient for whatever reason, we'll run really late. And then what do I do for the next patient? I just call them in really quickly and I say to myself, I'm gonna get through this one in two minutes.

[00:53:14] And of course it never happens. It might take an extra couple of minutes, but it might have been better for me to leave the room, go and make myself coffee or go for a little walk. And then come back and feel more refreshed. I may have lost a few minutes, but actually might save more time later on because I'm gonna be in the right frame of mind.

[00:53:29] I think that's quite an important point. 

[00:53:31] Emma Borders: Being a bit self-protective is actually a really important thing. I just keep cramming things in. Doing more, more, more, you know, getting things done, working through my breaks like long term, that's not sustainable. You're gonna burn out.

[00:53:43] You're probably not gonna last in the job. The best clinicians are the one who are that little bit self-protective and go, no, I'm gonna have my breaks. I'm gonna finish on time and I'm gonna like go for that walk on my lunch break. And they're gonna be a lot happier at work. They're gonna be in that career for longer.

[00:53:57] Marium Hanif: Initially, I was one of those clinicians. I wasn't taking any breaks and only thing I was having coffee and biscuits throughout the whole day. Then I learned, okay, this is not great. This is not sustainable for long term. If I'm not here, patients won't have access to care either. So you have to think of two sides perspective on this.

[00:54:13] Emma Borders: Yeah. 

[00:54:14] Munir Adam: I used to say, look after yourself. Give importance to yourself and your time so that you can look after patients better. It is ultimately about giving patients the best service possible, but we can't do that if we're not in the right frame of mind ourself.

[00:54:27] And so there are all these barriers. We can come up with a million excuses for not changing, or we can try and get over these barriers. As I mentioned at the start, we don't know it all. Who does? We present these ideas from a position of humbleness. These at their very best are simply ideas. Sometimes they'll work, sometimes they won't work.

[00:54:48] 

Final comments

[00:54:52] Munir Adam: So Emma, it'd be good to hear a little bit about your podcast then. 

[00:54:56] Emma Borders: Yeah, so I've got a podcast that I do with the Cornwell Primary Care Training Hub. I started that now January, 2022. So it's been going a little while. It's called Primary Care Spotlight. It's available on Spotify, wherever, get your podcasts.

[00:55:09] And the reason I created it, because we send out a lot of emails, lot of bulletins, a lot of information that way, and it's maybe not the best way to get messages out and I think podcasts are becoming more and more popular. So it's just a way of us getting some messages out about what we do at the training hub, because I would say if you dunno what your primary care training hub does, go find out.

[00:55:29] They do way more than just training usually. But also some information. We've done episodes of miniseries on infection prevention control, dementia, ARRS roles. Things like that, you know, and just as another way of getting information out to people. So that's my podcast. 

[00:55:46] Munir Adam: There may be some listeners who have things that they want to talk about that might not necessarily even fulfill the criteria of this podcast. There's quite a, a, a strict inclusion criteria for Primary Care UK and I have to say, I subscribed to primary Care Spotlight. I've heard a few episodes and found it useful. I'm sure others would as well. 

[00:56:04] Emma Borders: Absolutely. We'd be happy for people to get in touch and do an episode. 

[00:56:08] Munir Adam: Okay, so the aim of this Time management series was to help you listeners on your journey, not to beam you to perfection.

[00:56:18] Apply these principles, reflect on it, listen again and again if you need to, and your time management will improve. How's that sound? Emma? You're a podcaster. Does that a nice way to close it?

[00:56:29] Emma Borders: It's a very nice way to close it. Yeah. That's great. Yeah. 

[00:56:32] Marium Hanif: So that's it for today. I hope you enjoyed the podcast today.

[00:56:35] So definitely do Rate us on Apple podcasts. Leave us comments, do share the episode link with your friends contacts on social media. 

[00:56:43] Emma Borders: So thank you for listening. Until next time, keep well and keep safe.

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