Implementing Workflow – The pains and gains of changing the status quo

An interview with Dr Catherine Bryant

Understanding how ‘working at scale’ works best for general practice

We interviewed Dr Catherine Bryant, one of the GP Leads for Practice Unbound. As a GP Lead, Catherine introduces the concept and application of Workflow to GPs across the UK, giving them an understanding of responsibilities and protocols, so that they can go back to their Practices and work with their teams to implement Workflow.

Here she tells us some of the things that have been learnt during the four years we have been doing this valuable work.

Supporting GP Practices through challenging times

As a GP, it can take courage to admit if you are experiencing an unmanageable workload and yet we have found that GPs across the UK are facing similar struggles. When we meet new customers, we often find that they are holding many questions and even concerns about the effect that adopting a new way of managing clinical correspondence will have on their GP Practice.

So, we encourage them to share their concerns early on in order to explore the potential barriers and how we can overcome them together.

We have found that some GP Practices, especially smaller ones, may feel dubious about implementing Workflow due to fears around having little or no ‘back-up’ if it doesn’t go to plan. Paradoxically, it is the GP Practices who have the least time and resource to try new ways of working that can benefit the most from Workflow, due to its immediate ability to release GP time and ease the pressure across whole Practices. We understand that sometimes a leap of faith is needed, and that it is not to be taken lightly – nor on your own.

This is why we offer continued support and our work involves enabling Practices to build networks and support each other during these crucial times of change.

Dr Catherine Bryant, GP Lead

cathy bryant quote

Workflow Administrators can be employed to work across multiple practices – one of the benefits of GP Practices forming networks in their local area.

What Workflow means for your Practice team

Of course, there are many practicalities to consider when implementing Workflow. Firstly, you need to identify someone who can do the work – a Workflow Administrator. This creates the challenge of how to integrate Workflow processing into your existing team, whether it can be absorbed by the current team or is there a need to bring in a new member of staff. All of those involved require training to ensure consistency and to build confidence in their skills. There is no set blueprint, because we know that each practice will have its own way.

A lot of people, especially in small Practices are already multitasking, so will find that incorporating a new role comes as second nature. Alternatively, Workflow Administrators can be employed to work across multiple practices (one of the benefits of GP Practices forming networks in their local area). We recognise this way of working can feel like a big shift from usual practice, especially as it may involve working more closely with other local Practices in order to ensure change can happen positively and is implemented robustly. This naturally means shared decision-making with other Practices, which for many is a new way of operating. We have seen the benefits that this can have for GP Practices, though, in terms of economies of scale and skill sharing.

Working at scale with Workflow

Building the foundations for working at scale across multiple GP Practices will enable robust processing and encourage a shared responsibility for ensuring that patients receive the care they need. Workflow provides the perfect starting point to build these working processes to transition to an ‘at scale’ way of working. Practice Unbound’s, Workflow Network solution gives Practices the tools and support to implement Workflow, helping them to realise their ambitions of working at scale and creating a communal process.

Alleviating concerns from GP Practices:

Safety & Auditing (including accuracy of read coding)

Practice Unbound invited the three Medical Defence Union’s (MDU, MPS and the MDDUS) to learn about and look at our Workflow processes, protocols and training materials.

These were then reviewed by the underwriting teams and it was agreed that there would be no increase in the indemnity for a GP Practice who follows Practice Unbound’s Workflow implementation and processes. The Workflow teams work with Practices and offer ongoing support around the implementation of robust auditing processes to ensure accuracy and consistency of read coding.

Loss of real-time continuity and not getting to see the letters as they come in

Workflow requires a shift in the way GPs are updated about their patients’ healthcare journeys, when outside of their direct care. Due to the nature and purpose of Workflow, a GP will only see letters when they need to. This means they may not see a letter first hand until the patient’s next visit, unless they choose to.

Workflow enables correspondence to be processed more efficiently so with this shift, a greater consistency is created when having all the information at hand when the patient is in front of you. Complex letters will still be processed by the GP in real time.


Some GP practices employ a Pharmacist who is able to check medication changes, however for those who do not, we have a medication protocol whereby any medication changes are cross-checked before being sent on to avoid errors.


Workflow is designed in a way that enables GPs to experience the time-saving benefits immediately, due to the instant decrease in paperwork. It will require the designated GP Lead to invest time in supporting their Workflow Administrators and the rest of the Practice team to adopt a way of working that best suits. However within a matter of months, the time invested in getting this right is significantly outweighed by the GP time released across the practice.

What if something goes wrong?

We can of course never guarantee that everything goes perfectly first time, but then what is to guarantee 100% accuracy using the old methods – especially as we work in a time where GPs are experiencing a higher workload than ever before? How realistic is it to expect busy GPs to trawl through mountains of paperwork at the end of a day not missing a single read code or action? Workflow Administrators have the required training to process correspondence and also the dedicated time to do this.

Why choose Workflow?

Practices have not only reported that adapting their Workflow processes is more effective than anything they’ve tried previously, but that the input to outcome ratio is huge and the time-efficiency it achieves is dramatic.

It’s a way of future-proofing General Practice, as paperwork is only set to increase. In a perfect (and indeed a past) reality all GPs would be able to see their own letters (and of course if they choose to they still can – even after Workflow is implemented), but with changing times come changing needs and ways of working.

After all, Workflow has been pioneered in response to a national crisis around GP capacity. We do appreciate, though, that there is no ‘one-size-fits-all’ solution which is not only why we offer a range of packages, but also work with GP Practices to realise how Workflow can best suit the needs of your team.