Development and cohort study of an audit approach to evaluate patient management in family practice in the UK: the 7S tool.

Abstract

In the UK, there is increased pressure on general practitioners' time due to an increase in (elderly) population and a shortage of general practitioners. This means that time has to be used efficiently, whilst optimizing adherence to consistent, appropriate and timely provision of care. Create an audit tool that assists general practitioners and family practice staff to evaluate if patients are managed as effectively as possible, and to test the usefulness of this tool in a family practice. The '7S' audit tool has seven outcome elements; these broadly stand for what the actual and desired patient contact outcome was, or should have been. Terms include 'surgery', 'speak' and 'specific other' for an appointment at the practice, by telephone or with a dedicated specialist such as a practice nurse or phlebotomist, respectively. A very small, rural, general practice in the UK was audited using the 7S tool. Five hundred patient contacts were reviewed by an independent general practitioner and the decision made if the mode of contact was appropriate or not for each case; in one of the three cases, the choice of care provision was inappropriate and chronic disease cases contributed most to this. General practitioners instigated the majority of poor patient management choices, and chronic disease patients were frequently seen in suboptimal settings. Inefficiencies in the management of patients in family practice can be identified with the 7S audit tool, thereby producing evidence for staff education and service reconfiguration.