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10 tips to help you survive the next year

How can you keep your workload manageable while maximising profits as you wrestle with the introduction of the new contract? Dr Sohail Butt offers 10 tips that

should help you cope

Most GPs are expecting uncertain times ahead, and this might be the moment to suggest a few tips to help you cope ­ with the new contract, with quality points, with enhanced services and with whatever else the Government might throw at you.

1 Make sure you have a capable manager Most practices will need a manager capable of running a flourishing business and able to make changes to meet the challenge of the quality framework and enhanced services. The Blue Book has specified the competencies expected of practice managers, and it may be useful to show this to your practice manager and see any if there are any areas that need to be addressed. Many practice managers are mainly administrators, and it may be that training and support are required to develop some of the management, strategy and leadership skills required to help you get through the next 12 months.

2 Aim to delegate management and clinical work GP partner time is a very expensive commodity. You should aim to delegate as much work to your management and administration team as possible. Ideally the GP partners should act as board members formulating policy for the manager to implement. Issues relating to the quality framework would be a good case in point. You need to look at most of your clinical work and identify work that can be safely delegated to the appropriate grade of nursing or administrative staff. They in turn will need to shed some tasks that are no longer needed. Make sure the lines of clinical and management accountability are explicit and clear.

3 Manage your workload It is likely that you are going to have an impossible workload for the next year. Start each day by prioritising your tasks, and start with the things that are important and urgent. Handle your correspondence once and keep your filing systems

simple. Do not waste time on things you cannot control: far better to focus on the things you can actually do. Take

time out to allow your body and mind to recharge during the working day. You will be able to think more clearly having done so.

4 Distribute income fairly to keep partners focused It is important that partners feel that income fairly reflects new workload. It is important that GPs who work different hours and have different responsibilities should be fairly rewarded to keep them motivated. It is a good idea to have regular meetings at which workload and remuneration are reviewed and adjusted. This encourages GPs to take on the new roles required for quality framework and enhanced services. Points systems that allow for the complexity and diversity of GP work can be helpful to some practices when dividing profit.

5 Give each of your partners a defined new contract role

It is useful to look at your partners' strengths and weaknesses, to identify the specific management or clinical role that may suit. Myers-Briggs and Belbin questionnaires are useful tools that GPs have used for this purpose.

Identifying your partners' strengths allows you to allocate important objectives such as monitoring and improving key quality framework areas.

6 Have regular primary health care team meetings It is useful to have regular, formal, minuted meetings of the primary health care team. To maximise the opportunities of the new contract every member of your current team will be required to take on new roles and to change the way they now work. Well-run meetings are a good way of persuading and empowering your team to help you. It is worth running through each of the quality framework areas in turn, and updating people (on a monthly basis) about your quality point scores, and how the practice is progressing. Large meetings are useful to engender team spirit and to foster good communications, whereas smaller meetings are better to focus on tasks and get them done. You need to have a mixture of both.

7 Watch the cash-flow The flow of income is going to increase for most GPs in the next year. However, there are likely to be new expenses related to employment costs and equipment. It is important that you have accurate systems for predicting income and expenditure to avoid a cash shortfall

8 Look at how you use your IT systems You should ensure you have a range of templates with the new codes for use at chronic care clinics, in GP surgeries ­ and opportunistically. The whole primary health care team should provide training on how to use the relevant templates and how to maximise data input. Make sure you have admin systems for transferring data from letters into coded data. Make sure all members of your team have access to information on the current quality framework points ­ and what the target is ­ so they know how they are performing.

9 Improve your communication system A good communication system will help you make changes for the new contract. Providing computer access to everyone and providing training by e-mail will speed up communication. Noticeboards and newsletters to keep everyone informed of timetables and changes are useful too.

10 Don't do too much and get overloaded It is better to make a series of small changes over a period of months rather than several large changes at once. And it is best to start with small changes that everyone is positive about. This helps the practice team to learn about how to make change, and helps them to make further changes essential to maximising quality points.

Sohail Butt is a GP in Ashford, Middlesex, and has an interest in practice development

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