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At the heart of general practice since 1960

All change in order to implement the contract

In the second part of our new series, Dr Sohail Butt looks at ways of analysing

and, where necessary, changing the way the practice as a whole operates

In the next 12 months you will need to look at how you can implement GMS2, the quality framework and enhanced services. In order to maximise income and improve quality of care you will need to decide on how you can best manage the new work within your practice.

To implement the new contract successfully, partners may well need to look at changes in:

lthe practice rules and policies on how you work

lthe practice objectives for the next 12 months and how you measure progress

lthe communication systems within the practice

lthe payment and reward systems for partners and employees

lpractice premises improvements to accommodate additional staff and services

lthe management structure of your practice organisation capable of delivering the changes listed above.

Dealing with such a lot of change effectively will be the key to success for most practices. Here are some practical steps you can take to help you make these changes work.

Make sure your partners and managers agree on the plan to implement the new contract

It's important that the leaders of the practice have a vision of where they want the

practice to go, and agree on the steps necessary to get there.

You may need one or two meetings or awaydays to achieve this, but this is time well invested. Having a group of doctors and managers committed to guiding these changes greatly increases your chances of success. You may be able to obtain PCO or pharmaceutical company funding for the meetings, and they may be able to provide you with a facilitator.

Facilitators are particularly useful if practices have previously got stuck on big issues when trying to make changes.

Make sure the partners establish and communicate well thought out reasons for implementing the new contract to the practice health care team

In order to get the practice employees to change how they work to embrace the quality framework and enhanced services, the partners need to communicate strong reasons for implementing the contract. Two strong arguments for the new contract is that the PCO and patients will judge the practice's quality of care by the quality points achieved, and that the income of the practice for developing services and employee salaries is dependent on delivering quality points and enhanced services.

Furthermore, failure to achieve significant income from quality points and enhanced services may lead to some practices becoming non-viable.

Keep the practice health care team informed of progress

The partners and managers need to keep sending information to the practice health care team on quality points achieved and developments in enhanced services. This makes staff feel more involved and therefore more likely to do the additional work to produce the data searches, data input, liaising with patients and clinical care which are crucial to the success of the practice in the next 12 months. Monthly meetings with an update slot for the changes are useful to motivate people.

Look for a quick win early on

You could pick an area such as CHD and devise and implement a plan to quickly improve the quality of care and gain points. It is then worth presenting this to the rest of the practice health care team. This will show everyone the practice can make changes to improve care and sets a template for action for other clinical areas.

Look at changing whole systems rather than tinkering at the edges

The new contract will have an impact on many different aspects of the practice. For example, when dealing with meeting

48-hour access targets, it may be necessary to look at the appointment system, reception training, GP rotas, and development of a nurse practitioner all at once. Failure to address all the issues may mean the planned changes fail.

Involve the whole practice in changes necessary for the new contract

It is best to involve the whole practice to look at why changes are necessary for the new contract, what the changes should be and how they can be accomplished. As we have seen, this can be achieved by awaydays or a series of shorter meetings at the practice.

The benefits of awaydays involving the whole practice team are:

lyou get more information exchanged

lyou get the staff to commit to the changes at the meeting

lthere is better co-ordination between the different teams involved – GPs, nurses, managers and reception/admin

lthe changes will happen faster and better

lplanning and making changes becomes part of your normal work.

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

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