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At the heart of general practice since 1960

It's naked hypocrisy in RCGP's manifesto

Practice managers and members of the management team have been at the hub of nGMS ­ Deb Farnworth-Wood explains how her team coped and plan to move forward

GMS2 could not have come at a worse possible time for our practice and turned out to be just one of many large projects we had to manage. April 2004 saw us midway through a £2.5 million premises development, in the middle of negotiating a seven-surgery dental suite, and working up proposals for new models of care at the centre which would include direct-access physiotherapy, extended use of nurse practitioners and increased practice nurse responsibilities.

We were also re-evaluating our admin teams and systems in preparation for the move to the new building and fighting the local bus company which, having promised a bus route to the new surgery, withdrew it without warning.

Anticipating a substantial loss of payments following the move from a town-centre site next to the bus station to a site on an industrial estate half a mile away, we also opened our lists for the first time in years. Our patient population rose by more than 1,000 in less than nine months as a result and we had to cope with the associated increased in workload.

In April 2005, pharmacies also had a new contract so throughout 2004 we were monitoring the likely affects that would have on our pharmacy business!

Being such a diverse practice we need a strong management team and one that incorporates leads in nursing, pharmacy and administration. Our practice manager is a strong manager and is not only able to organise the day-to-day practice workload, but also takes the lead in some of the new projects.

The GP partners each have 'Cabinet posts' that cover such things as the patient group, nursing issues, training, pharmacy/formulary and so on while I tend to oversee the whole organisation. Our pharmacy superintendent and lead practice nurse are both invaluable in terms of seeing progress through at the sharp end. Without this structure it would have been impossible to make it through the year.

We started out with 900 points in April 2004. This great achievement was the result of closely following the GMS2 contract negotiations for the whole of the previous 18 months, benchmarking ourselves against targets as information was made available and putting systems in place to ensure that data was collected accurately.

It also helped considerably that we had been paperless in our clinical practice for more than 11 years at that time and our IT infrastructure and usage was as good as it could be.

From day one we were determined to aim for full QOF points and set several mechanisms in place to ensure we would be able to achieve them. We appointed a small team comprising of two GPs and the practice manager who met regularly ­ often weekly ­ to assess progress, check the quality of information and to keep each other up to date on any developments.

Between them they led a data-cleansing exercise to ensure our disease registers were accurate and prioritised clinical areas for action. IT was not a problem for us but several practices locally discovered that they were unable to extract meaningful data from their systems and this placed them at a distinct disadvantage.

It was important that we treated the new contract as a full team effort, so we arranged staff training sessions and produced a 'GMS2 control sheet' that identified contract targets that each department in the building needed to contribute to.

We also promised the staff a 7.5 per cent bonus if we achieved 1,030 points but because we were certain we would do this with ease we paid this in instalments during the year.

Virtually all of the organisational points were covered but, even so, we gave the administrative staff areas to contribute to and these included updating the practice leaflet, organising life-support training, the practice survey and other patient communication areas. We also trained admin staff to summarise notes. Nurses and health care assistants were asked to contribute to opportunistic BP checks and recording of smoking status.

Receptionists were also trained to undertake BP checks and offered a direct-access BP service to patients that wanted it. We also installed a patient self-test BP machine and asked patients to take the printed slip to the receptionists for checking and recording on the patient record. Any worrying results were rechecked by the recptionists and referrals made to GP if appropriate.

It was a difficult year for the whole practice, not necessarily because of GMS2 but because of the many other things that we had going on at the same time. Staff morale had its highs and lows but everyone in the practice worked together incredibly hard and only one or two people rowed against the tide!

Throughout the year we gave running updates of our QOF progress via our weekly staff newsletter and we made sure that new staff knew exactly what was required. I'm not sure if I heard a cheer or a sigh of relief the day an e-mail went round to say we had the full 1,050 points!

And for 2005? Workload is a real issue for us both clinically and administratively. We are a partnership of nine (eight GPs and myself) and we are reluctant to increase the partnership size due to concerns that difficulties in communication may arise. But we do have plans to work smarter.

We have recruited a second nurse practitioner and a trainee nurse practitioner and we are also about to increase our practice nurse team too. We are also looking closely at GP triage following impressive results from a nearby practice.

QOF targets will continue to be a key aspiration of the practice and an ongoing emphasis for staff. We are currently evaluating the merits of practice-based commissioning and have developed several proposals for enhanced services. Luckily we have sufficient space to accommodate many more services.

The pharmacy continues to grow from strength to strength and has just commenced the new pharmacy contract. In February the pharmacy started a home-delivery service to help patients that were disadvantaged by the loss of the bus service. Ironically the bus service was reinstated the following week.

We are also training up our second technician checker to help free up more pharmacist time to become involved in enhanced services.

All staff are soon to be offered training sessions aimed at putting the greater NHS picture in context and at giving insight into our complementary therapy centre. They are also to be offered a refresher on QOF. All of these were requested by the staff themselves and we continue to seek their input on improving our services.

Deb Farnworth-Wood is managing partner, New East Quay Medical Centre, Bridgwater

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