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Do you need more staff or more flexibility from them?

Train and incentivise your practice staff to cope with the new contract, says Dr John Couch

Are you worried about your new contract performance? Do you feel you cannot manage to reach your points aspiration without taking on new staff? Many practices are looking carefully at this option, but before you rush out and advertise pause for a moment. You may be overlooking the potential contribution from existing staff.

Not surprisingly there is disappointment (and anger) from most practices about the level of global sums, which now include staff budgets. The Review Body has awarded a less-than-generous rise of 1.4 per cent for 2004/5. What sort of pay increase is your staff actually expecting this year?

They know very well what the headlines were saying when you voted on the contract. It will be more difficult to retain staff if you offer 1.4 per cent.

In 2005/6, when the full Q&O framework kicks in, there may be no increase in global sums at all. Your staff will still expect a pay rise. The net effect is that the proportion of their salary you fund yourself (currently 25-35 per cent for the average practice) will rise.

There are two other factors to consider. The increase in employers' superannuation from 7 per cent to 14 per cent also applies to the above figure. Finally 'agenda for change' will provide more incremental steps in all NHS staff salaries. Even if you keep staffing at current levels your wages bill is going to increase.

Your existing staff will almost certainly have unused potential, skills and ideas if you can engage them. These may well cross traditional boundaries between staff categories.

This will not only save your costs. It will spread the new contract load more evenly, improve job satisfaction (and retention) and maximise performance across the contract from points to enhanced services.

What skills do you need?

Q&O requires measured and recorded data. Receptionists able to enter core data via templates, measure patients' blood pressures, inquire about smoking and even give standard cessation advice would certainly be an excellent start.

The nurse who not only runs an epilepsy service but also tracks and presents performance via spreadsheets would reduce GP workload. The secretary who can run a call and recall service for chronic diseases will free up nurse time for more clinical duties.

What about a health care assistant or even a receptionist who is prepared to take on phlebotomy to help you achieve your contract for INR and near-patient testing?

What's your current skill base?

Arrange a team meeting to discuss your ideas. Present this as an opportunity for staff to apply existing, underused skills and also expand their abilities if they wish. List all current skills and ask for ideas as well as interest.

Training needs

Good training will be vital, whether to brush up old skills or learn new ones. Invest in dedicated training time. Use in-house training wherever possible. We were able to train several of our staff to record blood pressure accurately in a couple of group sessions.

External training may be necessary for items such as phlebotomy. Your PCO can often advise suitable courses. Support and encourage staff who wish to work towards appropriate qualifications.

The snowball effect

Even if only one or two staff express an interest initially, it is very likely that this will set many others thinking. A snowball effect is very likely once the process has begun.

Within a year of our new health care assistant starting her NVQ two receptionists are starting a pilot reception NQV.

What's in it for us?

Increasing job satisfaction will not be sufficient to make increased staff flexibility work. Would you be prepared to improve your skills for no extra money?

So from the start you should factor in increases in staff pay. You may decide to simply raise base pay levels. Some practices are looking at performance-related pay, on top of a base salary, as a way to incentivise staff.

This can be linked to overall practice profits or to performance in a more defined area such as quality points. Do well and everyone benefits. It will certainly be cheaper than increasing staff levels.

John Couch is a GP in Ashford, Middlesex

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