When workload pressure is so intense and many practices are struggling to recruit, taking time out to plan seems like a ridiculous suggestion. However, the opposite is true.
A practice which has a plan will recognise opportunities when they arise and will not need to spend time deciding whether to act or not. In addition, if the original plan does not work out, then the practice is likely to have a Plan B and time to put it into action.
This does not, of course, mean that no crises will arise. It does mean that you will be in a stronger position to handle them and be less likely to feel victimised.
Practices often feel overwhelmed by the magnitude of a planning process, but this does not need to be very complex – it can just be as simple as having a planning day so that everyone with a stake in the practice understands the business objectives. What are the useful steps to follow?
Before the strategy day
Agree the purpose of the day
What do you hope to achieve? Lack of agreement at this stage may lead to a feeling of frustration after the event.
Who should be there?
Practices traditionally include partners and the practice manager in their planning process. Agree who the key people are and find a date to suit everyone; this may need to be well in advance.
Many feel that broadening team involvement carries risk of loss of confidentiality and lack of control. But team members have valuable contributions to make and it may be that the inclusion of a wider group of people in the process will reap unexpected rewards, not least a feeling of being valued.
External or internal facilitation?
Effective planning needs effective facilitation; you need someone with the right skills. If this is a key team member such as a GP or practice manager, remember that they are disempowered from contributing to the discussion because they are managing the process itself. Having this team member function in a different way from normal will impact on the decisions you make.
Whether internal or external, the role of the facilitator should be agreed in advance and made clear to the participants. A facilitator should establish ground rules and ensure that all participants stick to them.
An external facilitator will:
- Help plan and structure the event
- Support the practice in working through the programme
- Help the practice to agree a plan
- Ensure everyone contributes
- Manage conflict
- Ensure consensus and clarify agreement
After the event, someone back in the practice needs to make sure the plan is put into action, progress is monitored and communication is effective. After being facilitated, practices can revert to old ways of working and the expected change is not achieved or sustained.
Specialist facilitators with the right skill set, who also understand general practice, can be hard to find and there is an associated cost.
On the day itself
Check out values first
Discuss the following and record what you agreed:
- What does it mean to be a GP in this practice?
- What are the important values to which we all subscribe?
- What are our priorities of maximising profit versus developing services/investment in the business?
- What kind of behaviours fit with this value set?
What is our current position?
Use a SWOT analysis (strengths, weaknesses, opportunities and threats) to explore the following:
- Where do we stand on such important issues as standards of care, access, continuity of care, commissioning, maintaining income, workforce including expected retirements, safe systems/risk management, premises? (As these are mainly internal, these will be strengths or weaknesses.)
- What is on the horizon for us? This will mainly concentrate on external influences, so they are opportunities and threats.
It will be useful to conduct some information and data gathering before undertaking this exercise.
What are our options going forward?
Now that you have explored your current state, what options do you have for the future?
- Looking back at the agreed values, what do we need to prioritise?
- Looking back at the agreed values, what do we need to do less of?
- What do we need to investigate further?
What needs to happen next?
Having spent time looking in depth at the complex issues above, this should be a relatively simple process.
- What action areas do we have now?
- What is going to be the best sequence in which to tackle these?
- Within which timescales do things need to happen?
- Who will lead on each action area?
- How will progress and problems be reported back and to whom?
Make sure this is all written down and distributed quickly after the event.
This framework will help you structure your day and ensure it is time well spent.
- Fiona Dalziel is a practice management consultant.www.dlpracticemanagement.co.uk