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Everyone must learn fresh skills to make best use of contract

In the third part of our series on teamwork, Dr Sohail Butt looks at how each member of the practice team will need to gain new skills, and discusses ways to achieve this

In order to get the very best out of the new contract, GPs are going to need to look at how their practices are organised and the roles played by different members of the practice team.

To maximise income and improve quality of care, you will need to make changes. These will involve staff developing new skills and everyone challenging their attitudes and assumptions of how primary care is delivered at your practice.

The new contract pays for tasks to be done, not for a specific professional to undertake it. Practices that achieve the most cost-effective skill mix to provide the care they are contracted to provide will succeed and prosper in the next few years.

Dealing with such a lot of change effectively will be the key to success for most practices, and providing an appropriate learning environment is an essential part of managing this change.

Some of the key learning areas for individual members of your primary care team will include:

lreception staff learning extended roles in IT, data management, audit, basic clinical data measurement and tasks such as measuring height and weight, taking blood pressure and performing phlebotomy

lhealth care assistants taking on extended roles in chronic disease management

lpractice nurses and nurse practitioners taking on more patient diagnosis and management roles in chronic care clinics

lGPs taking on additional specialist roles

lmanagement staff taking a leadership and change management role in developing new services

lall staff having educational sessions in basic life support skills, handling complaints from patients and devising learning points, and significant events reviews.

Here are some key steps to start you on the road to being a learning organisation.

Get everyone involved and interested in practice-based learning at the outset

It is best to involve the whole practice to look at why a new approach to learning is necessary for the new contract, to find out what ways of learning suit the team and how it can be accomplished. You might like to do this by holding a series of one-hour meetings at the practice.

The benefits of involving the whole practice team in these decisions are:

lyou get more information about what people feel their learning needs are

lyou get the staff to commit to participating in the initiative

lthere will be better co-ordination between the different teams (GPs, nurses, managers, receptionists, administrators).

This may initially look quite time-consuming, but it is time well invested. Your staff will be more productive and more likely to stay with you as it will help them cope with the changes you need to make to implement the new contract.

It is worth contacting your PCO or a pharmaceutical company about funding for cover and other costs. It is definitely worth creating no-cost protected time for learning.

Important learning usually happens in the practice, not in the classroom

Most staff will learn most effectively if they are given education and training on a new task, and then allowed to try it with support and feedback.

This means that GPs, nurses and managers need to plan for time to allow this support and feedback process. Most staff will find this process rewarding, and this helps with recruitment and retention of staff. It is most cost-effective to arrange training and education just before you want someone to take on a new task.

Moreover, though the staff will learn the rules, policies and procedures from educational meetings, they will learn from their supervised practice work the very important tacit things like intuition, judgment, interpersonal skills and common-sense which are part of daily general practice.

Use the information you obtain from

new contract staff appraisals

The new contract quality framework gives you three points for appraisal of non-clinical members of staff and five points for practice nurses having annual appraisals and a personal learning plan.

It will benefit most practices to carry out this work. Usually it can be done by a practice manager and perhaps a GP with management responsibility for staff and nurses.

The information can be collated to identify the key learning needs required to help you achieve maximum quality points – for instance additional practice nurse training on diabetes so that extra diabetes clinics can be run, or reception staff training on phlebotomy.

Once you have this information you can approach the PCO to find out what training it will provide free; alternatively you may find that pharmaceutical companies will sponsor training events.

Sohail Butt is a GP in Ashford, Middlesex

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