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Annual calendar of practice management

What practice managers need to review or address during a year.

There are many tasks practice managers must address each year (Picture: iStock)
There are many tasks practice managers must address each year (Picture: iStock)

I sat down for the first time last year and decided to make a list of all the different things that I needed to address in our practice throughout the year. I decided to schedule this into an annual calendar, with the aim of planning as many heavy duty tasks as possible into the summer months so that I am not frantically trying to tick these off the list at the end of the year.  

It turns out there is a quite a number of annual tasks in the practice manager calendar.  Below is a summary of the main issues that all practice managers will need to address within the year:

Strategic

It is worth reviewing the practice development or practice business plan and updating this on at least an annual basis. What are the aims and objectives for the business this year? What services will the practice be providing? Are the partners aware of how profitable different services are? Have the contract and funding changes for this year been taken into account?

Risk assessments

HSE guidance says that risk assessments must be kept up to date but doesn’t specify a time frequency. However, it is good practice to repeat risk assessments at least annually and if you are inspected, the CQC will want to see these.

Fire risk: The HSE provides guidance on conducting a fire safety risk assessment. Based on the findings of the assessment, the practice needs to ensure that adequate and appropriate fire safety measures are in place to minimise the risk of injury or loss of life in the event of a fire.

Health and safety: Employers have a duty to ensure the health, safety and welfare of their employees at work. There are a number of requirements in health and safety regulations covering all manner of the work environment, including ventilation, lighting, cleanliness, work stations, equipment maintenance, hazard warnings, drinking water and facilities to rest and eat meals. More information can be found by clicking the link below.

Premises and disabled access: Walk around your premises to check that everything is in a good state of repair. It is also worth checking that a wheelchair or mobility scooter can access reception, the disabled toilet and a consulting room. What modifications have you made for those with a sensory impairment (sight and hearing)? Do you have a hearing loop? What happens if a patient cannot read or hear the call board? Since July 2016 it has been mandatory for practices to ask and record whether patients need accessible information and have a policy for making this available to patients that need it.

Infection control: Check your policy is up to date. Are cleaning schedules being carried out regularly? Spot check a clinical room to ensure it meets the requirements.

Disaster recovery: Is your plan up to date? Do all staff know what to do if there is an emergency. It is worth going over this annually with everyone as a refresher.

Workplace stress: The world of general practice can be a stressful one, there are regular changes, new services, demanding patients, reduced time and so on. It would be worth undertaking a risk assessment to see how the practice rates in terms of stress. Even the act of doing the assessment will highlight what simple steps can be taken to reduce stress and allow people a chance to talk about what they are feeling.  

Although you may feel you are too busy (and stressed) to undertake this, the benefits if done properly can be a reduction in stress or at least an opportunity for everyone to recognise where the main stressors are and take steps to minimise them.

Information Governance toolkit

Practices need to undertake an annual review of their information governance (IG) policies. It can be painful, but the penalties for getting it wrong are stark, fines of up to £500,000 are possible.  

As we move towards a more online presence for general practice it is worth ensuring that your IG policies keep pace with these changes and that staff are aware of their responsibilities.

Last year the government published details of proposed new standards for data security, which you can find details of here. The government is currently analysing feedback from a consultation on these standards, but it seems likely that new standards practices will be required to meet will be introduced during 2017.

Online services

As part of the contract negotiations for 2016/17 NHS England and the GPC agreed to aim for at least 10% of registered patients to be using one or more online services by 31 March 2017. This is not currently a contractual requirement, however.

The services covered by this include online access to records, online appointment booking and electronic prescriptions. Think about how you will measure and monitor this. Clinical systems will have reports that you can run to find out how many patients are currently signed up and you could think about how to improve this. 

Quick ways to do this could be asking patients at point of registration if they wish to sign up, information on the call in board or putting a message on the automated telephone message when patients ring in.

Mandatory training

It is difficult to find hard evidence for how often these training sessions should be run so below are my suggestions if no actual written guidance exists. However, it is up to an individual practice to decide what training is needed and how frequently it should be run.  

Training Staff group Frequency

Basic life support including anaphylaxis

All staff

Every year if clinical , every 3 years if non-clinical

Cervical smear training

Clinicians who take smears

Every 3 years

Fire safety

All staff

Initial induction training and then refresher training once a year

Health and safety

All

At induction and repeated where appropriate

Manual handling

All

As appropriate

Infection control

All

At induction and annually thereafter

Information governance

All staff

Annually

Immunisation

Any staff undertaking immunisations

Annually

Safeguarding children

Clinical staff: level 2 training

Non-clinical staff: level 1 training

GP lead: level 3 training

Every 3 years

IUCD

Clinicians accredited to provide the service

Every 5 years after initial accreditation

Adult safeguarding

All

Every 3 years

Mental Capacity Act

Clinical staff

Every 3 years

Prevent (new training to educate NHS staff on how to recognise radicalisation)

All

No information available yet on how frequently this needs to happen

COSHH

All staff

Every 3 years

Conflict resolution

All staff

This is recommended by the CQC for all staff, there is no recommendation for frequency

Equality and diversity

All staff

Every 3 years

Chaperone training

Non-clinicians (if you use non-clinicians for chaperones, they need to be DBS checked)

Every 3 years

A spokesperson from the CQC has confirmed that the CQC does not require mandatory training courses to be completed in a set timeframe, but said it does 'need to be assured that staff have the knowledge, skills and competencies required in order for them to effectively carry out their roles in the practice'. Obviously one way to demonstrate this at an inspection is to show that staff have attended these courses.

You can read more about the CQC's view on mandatory training here.

Other training

The following training is not compulsory, but I think these are useful and worthwhile undertaking on a regular basis

IT: Are all your staff able to use office proficiently? Are you making the most of your clinical system? It is worth ensuring that staff have access to improve their IT skills and are encouraged to keep up to date with IT.

Customer care: Reception is the shop window of the practice and receptionists are often unfairly maligned for preventing access to GPs or being unnecessarily awkward.  Make sure that your receptionists know how to refuse requests in a polite and non-confrontational manner. This is often as much about body language and voice tone as the actual words used. Receptionists have a hugely difficult job and it is worth investing in training that will help them to help patients in line with the practice requirements.

Staff annual appraisals

All practice managers will be familiar with the annual appraisal cycle and there are a few quick checks you can carry out at the same time:

  • Check personal contact details and next of kin
  • Check job description is up to date
  • Check DBS check is up to date
  • Check contract is up to date
  • Training needs – is mandatory training completed and are there any other training needs?

Regular meetings to build into the calendar

Below is a list of meetings you may want to schedule in over the year:

  • Patient participation group (PPG) meetings – It is worth mapping out meetings with your PPG early in the year so that you have a proper schedule and time to work on an action plan.
  • Significant event analysis
  • Child protection training
  • End-of-life and palliative care meetings
  • Multi-disciplinary meetings
  • Annual complaints review

Document updates

  • Staff handbook and practice protocols – these should be read and updated every couple of years to ensure that they are still up to date.  The CQC will want to see these at an inspection. More importantly, inspectors will want to talk to staff and ensure that what is written in the protocol matches what staff say. It is a good idea to bring some protocols to a staff meeting and encourage staff to know where they are stored and suggest changes as they become out of date.
  • Records retention policy – it is worth reviewing this annually to see what documents can be shredded and disposed of.

Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member.

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