The massive workload with which all GP practices are struggling will not ease in the near future and the difficulty in recruiting staff (particularly partners, salaried GPs and locums) is adding to the burden. Meanwhile, most partners and managers are taking a long, hard look at protecting profits and controlling expenses.
Part of the coping strategy involves effective delegation. Not only will this make best use of time, it will save money, since it is not cost-effective to have tasks done by a staff member whose hourly rate and level of skill is higher than necessary for the job in question.
There is a range of benefits to delegation and most people could delegate more than they do currently.
What are the potential benefits?
- The job is done by the most cost-effective and appropriate team member.
- The delegator is able to focus on something else (though they retain overall responsibility for the outcome of the task).
- The staff member to whom the task is delegated will (if they are briefed and supported adequately) feel valued and you will have a motivated team member who is progressing in their role and learning new skills.
Could we delegate more?
Multiple team members contribute to a patient’s journey through the practice. How can you check that processes are undertaken by the most economic, competent team member? The following must be first be analysed:
- What tasks are we doing?
- Who does these tasks?
- How many tasks do we do?
- What is the hourly rate of the person doing the task?
- How much does that cost the practice, per task?
- Could the task be delegated safely?
- Would delegating a task increase the value-for-money?
Ensure team members are fully consulted about why you are gathering data and keep them involved.
Delegation versus dumping
Effective delegation is an act of leadership and gives junior staff members a chance to learn and progress in their careers. Its key features are: a manageable deadline; clear instruction; support along the way; and regular progress check-ins (without micro-management). Ultimately, it will reap rewards.
By contrast, ‘dumping’ workload on staff is an act of desperation, characterised by a tight (even impossible) deadline; minimal instruction regarding requirements; little or no support from senior colleagues; and few progress checks. It may lead to the task being done poorly or late, with patient care affected adversely, while the person to whom the task is delegated feels overburdened and demotivated.
So what are the golden rules of delegation?
- Define the task/project clearly.
- Ensure the staff member to whom the task is delegated understands what is required.
- Check they are comfortable taking it on.
- Define their level of authority: when can they make an autonomous decision and what must they refer back to a senior colleague?
- Clarify where the responsibility lies: with the person delegating or the person to whom the task has been delegated?
- Identify potential barriers: does the staff member have the time and resources to take on the task? If not, is there something they could delegate in turn or training they could receive?
- Define the timescale – by when do you want this task done, is there a deadline? Should it take priority over other activities?
- Clarify processes for decision-making and progress reports – what, how often, when, how, with whom?
- Provide clear, constructive feedback on how the task has been performed and any improvements that could be made next time.
Establishing a culture of development through delegation will empower team members to offer feedback ‘upwards’ as well as ‘downwards’ and to suggest improvements.
Poor delegation carries an inherent risk to patient care. If you decide to reorganise your team to make better use of skill-mix, you should ensure your plans fit current guidance, as outlined by the GMC and Nursing and Midwifery Council (NMC).
Professional resources are also provided by the BMA and defence organisations. Key points to bear in mind are:
- GPs must ensure that staff to whom they delegate are suitably qualified and competent to fulfil their role in a safe manner.
- GPs must satisfy themselves of the competence of staff and take care to avoid inappropriate delegation.
- The GP who delegates clinical tasks to nursing staff retains accountability for the patient’s care.
- The nurse also has professional accountability for the care of the patient.
- Nurses are answerable for their own actions or omissions, regardless of advice or instruction from another professional.
- A nurse cannot be required to take on a new role or task if the nurse themselves feels they are not competent to carry out the task.
The fact that a nurse has a professional responsibility for a patient does not absolve the delegating GP of their own responsibility. If a GP delegates a task to them inappropriately and patient safety is compromised, they may both face disciplinary action.
The RCN website offers detailed guidance on delegating clinical tasks to healthcare assistants (HCAs). For example:
- Have a clear job description.
- Ensure induction training is documented and all skills are assessed and signed-off when complete and competency is assured.
- Deliver training on health and safety, including risk assessment and putting in place control measures and monitoring processes.
Equipping staff with knowledge and skills
Immediate delegation of tasks to junior colleagues may not be possible; first, you must ensure the team member to whom you are delegating has the necessary training, skills and experience to ensure competence.
Assess skills required: Consider the skills required for the task; the gaps in knowledge and training that need filling. How can you know whether somebody is competent to fulfill a task? Think about how you will provide ongoing support and mentoring. For more complex tasks, further/external training may be needed.
Keep comprehensive records: Training records may be vital if something goes wrong. Agree what to record and where it will be kept. This should include:
- The format of the training
- When and where you undertook the training
- Who delivered the training
Assess competence: This is easy to integrate into the training session. You should assess competence personally and keep a record of that assessment.