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Balancing cost with stability of your team requires skill, says Dr John Couch

Value experience in your practice team

Last week a friend in the banking industry told me it was not unusual to bring in a round of redundancies toward the end of a financial year in order to balance budgets, only to rehire new staff in the new financial year.

We discussed how wasteful this was both in training terms and loss of experienced staff. It made me realise that in general practice we often take team stability for granted.

The degree of success practices have achieved in the last three years of change would have been nigh on impossible without a stable core of experienced GPs and staff. The next year or two will be a financial strain as the Government puts huge pressure on PCTs to balance their books. We will not be immune from this and may have to make difficult decisions over staff levels. A careful balance between financial necessity and core stability will be vital.

Consider the GP team first. If you have partners approaching retirement age you could be faced with losing your most experienced colleagues at the worst possible time. How can you make it more attractive for them to stay longer?

From age 60 GPs may draw their NHS pension and return to work with no loss of pension (provided pension plus drawings do not exceed pre-pension drawings).

Many older GPs would find it attractive to phase into full retirement by working part-time without significant loss of income. The pill could be sweetened further by modifying the range of work they do.

Practices employing GP associates have discovered that a fairly rapid turnover is common, although market forces have recently made it more difficult to job hop.

It would be prudent to ensure you monitor associates' job satisfaction and take measures to support and encourage their performance, development and training.

Meet regularly, have practice education sessions and promote special skills.

Key to success

Next, focus on the rest of your staff. Identify those whom you consider to be key to your continuing success. Use your own observations but also take advice from your practice manager who may well have extra comments.

Once again, assess key personnel job satisfaction and try to address issues to improve this further, within the overall limits of your practice development plan and budget. Monitor the situation regularly.

In undertaking this exercise you will inevitably identify team members likely to leave in the near future no matter what you do.

You will also identify

those who are underperforming with no realistic chance of improvement.

It already looks likely that a below-inflation pay increase will be the norm across the NHS next year.

It will be a challenge for GP employers to pass this on to staff while maintaining morale and performance. The campaign needs to start now.

John Couch is a GP in Ashford,


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