Case Study - enhancing the role of Medical Secretaries

NHS Modernisation Agency's Changing Workforce Programme (CWP) ran an Accelerated Development Programme (2002-04) to roll out enhanced roles for Medical Secretaries.

The Need (Why did we do this?)
European Working Time Directive was beginning to impact on doctors' hours - whereas previously doctors could work any number of hours (helped by the "on call" shift not being particularly busy so the doctor could sleep) a combination of factors (including more call-outs at night) meant this position was no longer teneable. The result - anything that could be done by someone else should be done by someone else, to make the remaining hours as effective with limited resource as possible.

What did the Medical Secretaries start to do?
Instead of simply typing up notes and tapes, and taking phone calls often only to ask the doctor to ring the patient or GP back, Medical Secretaries began to join ward rounds with the consultant and doctors taking notes as they went around, and to make appointments/ change lists/ give diagnoses where the diagnosis confirmed what was expected by the patient or GP, and so on.

What difference did it make?
On doctors: the range of freed up time was between 0.5 and 15 hours extra time made available per week, showing how much time had been taken up with administration tasks some of which the doctor was ill-equipped to manage. For GPs this enabled between 4 and 27 extra patients to be seen per week. Result: proper rest and recuperation in time off.
On secretaries: apart from completing administrative duties much more quickly and with greater accuracy (often not having to undo the doctor's attempt at administration before doing it right), the development of the role provided more career opportiunties for this group of staff - applications per vacancy were noted to have increased.
On patients: although no quantitative studies were done, changes to appointments and adding extra patients could be done much closer to the time of appointment, and discharge letters were sent out to GPs much quicker with no systemic delays.
On costs: the numbers of administrative staff broadly remained the same, and as administrative staff developed their skills so their pay went up: however services continued to be delivered to the same number of patients at a time when the number of doctor hours were restricted back to 56 hours. The 46 sites that were involved in the ADP thought it very valuable and have continued to spread the enhanced role, though the actual cost per patient appointment for the whole team has not been possible to ascertain.