This site is intended for health professionals only

At the heart of general practice since 1960

10 steps to achieving the right skill mix

Is your practice a well-oiled machine or could it benefit from an overhaul of staff roles? Dr Peter Swinyard explains how to find out – and how to make real change happen

Is your practice a well-oiled machine or could it benefit from an overhaul of staff roles? Dr Peter Swinyard explains how to find out – and how to make real change happen

1|Look at your staffing

Familiarity breeds contentment. Coming to the surgery every day, we lose track of what is actually going on around us. We become used to coping with managerial systems that have no place in 21st-century general practice. Just for once, go into your practice with the eyes and nose of a stranger.

If you were starting from scratch to design your practice team, would it look like yours does? Move away from seeing your colleagues as people and step into your helicopter for an aerial view of your team. What needs doing and who does it? Is your practice manager so caught up in the daily grind that they cannot rise above to plan your business? Are the most suitable and cost-effective staff members running your enhanced services? Does your highly expensive nursing sister spend a morning bloodletting? Have you asked your accountant for an analysis of your staff costs per patient – and how they compare with neighbouring practices? If the accountant is a member of the Association of Independent Specialist Medical Accountants, they should have all the data. Spending too much hits profits – too little and you may not be offering as full a service as you could. In the current competitive world, your practice may not flourish.

2|Look at your management

This may need a complete redesign. At this point you could invest in a day's management consultancy as most of us in general practice do not have the skills to do this well. Use a specialist in healthcare. If you think it is expensive, think how many partner hours it will save and cost your own time into the equation. Management has evolved in general practice from the days when the practice typist became an administrator and was then renamed a manager. Even in a small practice, you may do well to have a business manager, a nursing/clinical manager and a customer services manager (see ‘A dozen practice roles you may not have thought of'). Now you're ready to go through your ‘plan, do, study, act' cycle – which could be the first of several.

3|Plan for change

Having examined your practice, what do you want to achieve? Would your business manager be better off out and about touting for new business for your practice? Have you and your team set aside regular chunks of time to work on expanding the business? Make your best nurse responsible for QOF performance. You will be amazed at how effective an experienced nurse is at persuading partners to complete computer templates. And don't forget customer service, the heart of the practice.

You may have to consider making some posts redundant – after all, no longer do we need our receptionists to pull out all the notes for each surgery and then file them again. Is the time freed up from that task well used?

It's no good coming up with great ideas if you can't take your team with you. Have an away day for the whole practice and structure it so that they come up with the ideas you've already had. It may seem like cheating but if they have ownership of the change it will work. If it is seen to be imposed from above, they could sabotage everything you try to achieve.

4|Think outside the box

Why does each practice do its own payroll, its own HR, its own typing and its own financial management? The time taken for these roles is disproportionate, they tend to be done by the overskilled (does it take a £35,000-a-year manager to act as payroll clerk?) and, as they are done in small quantities, they tend to be done poorly.

You need to think outside the box of your practice and consider contracting out the bookkeeping, payroll and admin. Perhaps your accountant offers a service, or there may be other providers – consider joining your local Chamber of Commerce or the Federation of Small Businesses. Join the Family Doctor Association for practical advice on your practice business.

5|Seek advice to do it properly

Take good human resources advice – a consultant can offer guidance on skill mix and advise on thorny issues such as job redundancies and the correct processes to follow. For useful HR software, I recommend iQ Practice Manager, available at discount for members of the Family Doctor Association, as it includes insurance cover for unfair dismissal claims costs if you follow the advice in full.

Also do ensure you take expert legal advice at all stages to avoid potential problems with employment legislation. This is especially the case if you are making redundancies or changing job descriptions and the terms and conditions of your staff's contracts.

6|Now just do it

You have worked out how you need to function and the changes to be made. Now be brave and just do it. Tell your staff how things are going to change. Always give a positive message about how this will make their working lives better and make the patients happier and better cared-for. You are looking at a complete culture change in your practice to make it vibrant and ready for the challenges of the next decade. Just good enough is not good enough.

7|Give staff the tools they need

Don't expect your junior receptionist to grasp the intricacies of Read coding on her first day. Make sure that your staff all have access to the correct training to carry out their new or extended roles. Allow them to get on with their jobs – there are few things more demoralising for receptionists than their senior partner hovering behind them while they are trying to deal with a patient and interrupting and offering the patient an appointment that the staff have been told cannot be used. Never make your staff look stupid in front of patients or colleagues – it is best for one partner only to communicate policy to staff and for all day-to-day fine-tuning to be done by the appropriate manager in the practice, not the doctor. Realise you employ managers to manage – let them get on with it.

8|Use IT to your advantage

There is much that we do in practice now that we could not have done before IT took over. However, always look at a task and decide whether it is better computerised or not. I remember the first computer at my school in 1971 and the maths master taking all night to mark an exam on it, which he could have done manually in an hour.

We are in a people business and many of our customers are agitated and ill. How much better for the phone to be answered with a friendly voice than Robowoman. How much better to be greeted at reception by a smile than be told to sign in on a screen. Such technology loses patients.

9|Study the results and act on it

Now that your staffing and role changes are in place, watch out for saboteurs and don't be afraid of challenging wrecking behaviour. We all know how easy it is to screw up in practice – and how irritating for GPs to find on a Friday afternoon that they are out of X-ray forms or couch rolls. Be vigilant, especially when dealing with the ‘old retainers' in the staff. Consider using performance procedures if staff members do not develop as you wish – study what is going on and act to get nearer to your goals.

10|Keep going – and reviewing

Faint heart ne'er won fair lady. Neither did it succeed in business. Yes, I know you trained to be a doctor, not a businessperson. But remember that a well-run practice will enable you to practise good medicine for happy patients with contented colleagues, all empowered to perform to their best. Continue to give your staff new responsibilities and allow them to flourish. Unless you challenge them you will never know how good they are. Don't be afraid to admit it if you have made mistakes. Correct, then do another ‘plan, do, study, act' cycle. Then you will know you are in control.

Dr Peter Swinyard is a GP partner in Swindon, Wiltshire, and honorary secretary and chair-elect of the Family Doctor Association

Practice team skill mix

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say