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How to ensure your practice will thrive

You can prepare to tackle challenges ahead by giving the practice a health check, says Caroline Kerby.

Everyone working in general practice knows that we are living in uncertain times, especially if based in England.

Key challenges facing practices include financial constraints and achieving quality, innovation, prevention and productivity (QIPP) planned reductions; restricted income and increasing expenditure; aggressive list validation and extending choices for patients.

It does not end there, what with a potential new contract on the horizon, Care Quality Commission, GP contract management moving to the NHS Commissioning Board and competition from new healthcare market entrants.

So if your practice were an athlete preparing for the race of its life at the 2012 Olympics, what would it have to do to win the gold medal?

As well as providing excellent clinical care for patients, it would need to:

  • Take expert advice when needed.
  • Have a rigorous training schedule.
  • 'Eat for performance' by absorbing as much information as possible about NHS changes.
  • Ensure the practice team has a 'winner's psychology'.
  • Know its competitors inside out.
  • Have a development plan with milestone dates.

How does this translate into a practice that thrives over the next few years and wins gold?

Starting with our strengths, MORI polls show a 92% trust rating among the public for GPs and there is evidence of the cost-effectiveness of UK general practice.

But closer inspection of such data shows a wide variation on quality markers and on the financial inputs into practices.

Practice teams consist of committed caring staff, adept at adapting to change.

We have a stable management presence: practice managers tend not to move jobs frequently. They are also good at finding expert advice and they have a lot of experience and detailed practical knowledge.

But to thrive, a practice development plan and making time for the whole team to develop it is crucial. My health check for my own practice consists of three main components: the business, the people and quality management (see left).

A thriving practice competing at gold standard in 2012 will know and understand its business model.

It will have sound financial budgeting arrangements, a development plan projecting its performance, a training regimen to become leaner and fitter, a well-motivated engaged team and a consistent approach to quality.


The business

  • Do we fully understand and deliver the current GP contract requirements?
  • Are we demonstrating high performance in our core business? What do we want to achieve?
  • What are the practice's current income sources and how are they split between outside commitments and in-house effort?
  • What potential new income sources are there? Are they worthwhile in cost-benefit analysis terms?
  • Is there a robust system to budget effectively and manage income and expenditure?
  • How well do we understand our 'customer base' (patients)? Do we fully utilise the information in our IT systems to enhance the services the practice offers?
  • How do we know if our practice services meet our population needs?
  • How good are we at marketing services to patients?
  • How professionally does our organisation project itself?
  • Do we have a good understanding of our use of NHS resources? Will we effectively manage practice-level commissioning budgets?
  • How well do we understand the external factors that will impact on our business?
  • Do we have a plan that maximises our strengths and opportunities and minimises weaknesses and threats?
  • Do we have the key relationships we need in place to facilitate local networking?
  • Do we have a clear vision and strategy of where we want to be and has everyone in the team been involved in creating it so we have strong motivation to deliver it?

The people

  • Are there clear processes ensuring that the right person is doing the right thing at the right time?
  • Is our team skilled and motivated to work 'smarter' and more productively?
  • Is there sufficient clinical skill mix and a plan for staff development?
  • Are there clear lines of supervision and direction of staff activities?
  • How effectively does the team communicate?
  • How are decisions made and implemented?
  • What is the organisational 'culture' and what are the unwritten ground rules? Both should support productivity and achievement.

Quality Management

  • How do you know when the practice is operating well?
  • How do you know how efficient it is? Which regular management audits are done to monitor productivity and indicate where efficiencies can be achieved?
  • Are our processes as efficient as possible? Do we know how many stages specific processes have and how many hand-offs to different people they involve?
  • How are new staff inducted into how we work?
  • What are the mechanisms in place to ensure that our processes achieve required outcomes?
  • Can we demonstrate outcomes on a consistent basis?
  • Caroline Kerby is co-lead of the NHS Alliance's Practice Management Network (www.nhsalliance.org) and managing partner at a London practice

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Hold team meetings to gather opinions and ideas about the business, your people and quality management.
  • Produce or update the practice development plan including milestone dates and circulate it.
  • Review progress with the team every few months.

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