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How we made our team and practice stronger

Dr Jason Victory explains how the GPs and staff at his practice pull together to improve patient services.

Our For Young People team promotes chlamydia screening to 16 to 25 year olds
Our For Young People team promotes chlamydia screening to 16 to 25 year olds

In 2008 Bradgate Surgery took steps to realise its ambition to be the first choice for the local population, here in north Bristol.

There are 11 GPs and 9,370 registered patients, and we are a training and a teaching practice which is strongly involved in research. We used a ‘future state mapping’ process to generate a team business model with clear strategic objectives.

Future state mapping

Also known as value stream mapping, this is described on the NHS Institution for Innovation and Improvement website as a way in which ‘a cross functional team can produce a visual map of the "current state" (how things operate now), identifying all the steps in a patient's pathway - from service user to supplies used’.

The team then examines the ‘future state' (often this means significant changes how the team operates) and develops an implementation plan to turn what they want for the future into reality.This can result in streamlined work processes, reduced costs and increased quality.

Implementing future plans

We implemented this approach by forming small multi-disciplinary teams who meet regularly, enhancing communication within the practice and we have made rapid progress on a variety of projects, including improvements to:

  • Patient access
  • Marketing our services
  • Professional development
  • Teamwork
  • Efficient use of resources.

Patient access

Our patients regularly used to tell us that they could not book an appointment in advance. The patient care team listened and worked with the patient participation group to transform the appointments system to make this possible.

The nursing team merged the diabetic and CHD clinics for patients with both conditions, set up a new INR clinic and re-structured the smoking cessation service into a group meeting format.

Promoting our young persons group with team ‘champions’ in the reception, nursing and administration teams resulted in the practice achieving the highest chlamydia screening rates in 16 to 25 year olds in north Bristol.


Our marketing team engaged with the local community by using innovative methods:

  • Up-to-date, easy to navigate practice website
  • Sponsorship of the local football club
  • Regular articles in local newsletters
  • Participating in the neighbourhood forum
  • Links with local secondary schools
  • New interior and exterior signage at the surgery
  • Local leaflet drop.

Professional development

Our reputation for teaching and training excellence led to the practice being selected to educate two research scholars and to work with doctors in difficulty.

We have embedded research as a core activity, keeping clinicians up-to-date and benefiting patients. One recent project involved the nurses recruiting patients to a ‘txt2stop’ research study. This looked at smoking cessation support via mobile phone text messaging and significantly increased the rate at which smokers quit.


To improve practice teamwork we have run surgery team building events, introduced and supported 360-degree feedback for all team members and raised money for our link charity, 4 Ethiopia.

We took part in the Quality in the NHS study sponsored by Aston Business School. 

The study results showed that we communicate well within our own sections (GPs, admin, nursing and reception) but we do not always communicate across sections. We now a Monday morning 'huddle' meeting to discuss the week ahead. Someone from each section attends and the minutes are posted on the staff notice board.

Efficient use of resources

Bradgate Surgery has worked hard to eliminate unnecessary costs.  Efficiency savings have been re-invested to promote continuous improvement of patient-focused services.

We have increased nursing time by 45 hours a week by employing a practice matron, two nurses specialising in research and women’s health and a dedicated administrator. This has led to more effective working.

We review our team model annually, allowing the GP partners and staff to share views and work to the same objectives. Progress in strengthening relationships with our patients and achieving gold standard outcomes is reflected in a growing list size.

'Team Bradgate' has been inspired to achieve and succeed. We are ready, willing and able to rise to any challenge the future may hold.

External link NHS Institution for Innovation and Improvement

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