When faced with continuing downward financial pressure and hard-pressed for time, delegation is as an effective, vital tool and a real sanity saver.
Most practices are currently taking a hard look at protecting profits and controlling expenses. If a team member's work includes tasks that could be safely and competently performed by someone less skilled and on a lower hourly rate, you are wasting precious resources.
Identify suitable tasks
Your practice may already have teams that include nurse practitioners, practice and treatment room nurses, phlebotomists and healthcare assistants (HCAs)/healthcare clinical support workers, but when did you last review what everyone does? Find out:
- Which tasks each team member carries out.
- How much each task is costing the practice.
- Whether some tasks can be safely delegated to less highly paid team members.
Gathering the necessary data should be simple. Make sure, however, that team members are fully consulted and involved. Reassuring staff that you are not conducting a witch-hunt is important.
So explain you are looking at working more efficiently and that opportunities for career development could emerge.
Study the guidance
Delegation badly done carries inherent risks to patient care, so it is vital to be familiar with current guidance and make sure it is meticulously applied.
The GMC and the Nursing and Midwifery Council (NMC) offer clear guidance including:
- GPs must ensure that team members they delegate to are qualified and competent to fulfil their role safely.
- GPs must satisfy themselves about staff members' competence and take care to avoid inappropriate delegation.
- A GP who delegates clinical tasks to nursing staff remains accountable for the patient's care.
- The nurse also has professional accountability for the patient's care and is answerable for their actions and omissions regardless of advice or instruction given by another healthcare professional.
- Nurses cannot be required to take on a new task if they do not feel competent to do it.
Get it right
When delegating ensure that:
- Guidelines are used.
- Team members you delegate to have the necessary training, skills and experience.
- Comprehensive records are kept.
Time spent reviewing NICE and Scottish Intercollegiate Guidelines Network (SIGN) guidelines will reap benefits as they are delegation building blocks and educational tools.
Involve your nursing team in reviewing and implementing them. Many NICE and SIGN guidelines include standards which you can use when auditing quality of care.
Setting up a timetable for doing audits of delegated task delivery will protect you, your staff and patients. Nurses and GPs can include audit in their educational portfolios.
Fill training gaps
Training staff need not be costly as in-house training will suffice in many cases. Agree with the team how they will meet guidelines. For example, what stages must they go through when running a contraception clinic? Identify any gaps in knowledge and training,
More complex tasks may require a formal qualification but investment in this will benefit everyone. Consider how you will provide ongoing support and mentoring.
Keep training records
Training records may be vital if something goes wrong. Agree what to record and where the data will be kept. Records should include:
- Training format (if case study, in-house skills-based session, external event or course).
- When and where the training took place; who provided it and who attended.
Assessing competence can be built into training sessions. You should assess competence personally and keep a record of your assessment.
Use HCAs wisely
Patients and HCAs both need to be aware that HCAs are not trained nurses but have a specific role.
The RCN offers detailed guidance on the role of the HCA, including a useful delegation checklist, and the DoH recently announced that a new code of conduct and minimum training standards are to be introduced.
Your defence organisation can advise on the procedures HCAs can cover. In general, these will be simple and require no clinical skill or judgment. As with nurses, ensure there is regular appraisal and feedback and:
- Give HCAs clear job descriptions.
- Ensure induction training is documented and all skills are assessed and signed off only when complete competency is evident.
- Provide health and safety training including risk assessment and put in place control measures and monitoring.
Taking the time to delegate effectively will bring benefits in terms of efficiency, effectiveness and motivating individual team members.
- Fiona Dalziel is a practice management consultant, www.dlpracticemanagement.co.uk
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