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At the heart of general practice since 1960

Managing and motivating staff to maximise new contract opportunities

Dr Sohail Butt concludes his series by offering advice on motivation

As the realities of primary care contracts begin to develop, GPs will need to manage and motivate their staff in a more business-like way. This will be necessary to compete with the Department of Health's vision of the diversity and plurality in primary care it wants to see offered by GPs, nurses, PCOs,

walk-in clinics, out-of-hours providers, pharmacy chains and private health care providers.

Staff costs account for a significant proportion of expenses for most practices. And so to maximise profitability and improve patient care GPs will need to give thought to improving the performance of their staff. This is achieved by increasing the value of staff work or reducing your employment costs – or a combination of the two.

Partners need to do the following:

Carry out performance and development reviews (appraisals)

When carrying out a review of a staff member you should compare their performance with the level you would expect from someone you regarded as 'excellent'. This will give you an idea of the potential for improvement for that individual.

You can look at any possible reason for a deficiency in performance. It may due to a person's motives (values, likes, preferences, needs), capabilities (mental or physical) or knowledge (education and skills). Alternatively, it may be that the practice has not given the staff member enough information on practice strategies, objectives and current performance expected.

Consider the following four best ways to improve practice staff performance

lGive your staff better information about the practices strategies and goals on quality framework, enhanced services and non-NHS work. In your appraisals give your individual staff members performance objectives that tie into the practice's objectives. Simply by doing this you can improve their individual performance by about 30 per cent.

lGet the staff involved in the design and selection of the day-to-day tools of general practice such as the IT systems, telephone systems, medical equipment and use of premises. The reception, admin staff and nurses are crucial to the entry of important health data which will directly affect quality points, so have them involved in the design and selection of your IT upgrade.

lThink about financial bonus schemes and non-financial rewards (praise, merit awards, recognition in practice meetings – 'employee of the month') that reward people who perfom well or improve their performance.

lProvide staff with just-in-time training for any specific needs that come to light, such as a receptionist learning phlebotomy skills for a new enhanced service for anticogulation service to start in three months.

Look at pay structure and reward new skills and team performance

Traditionally GPs have used Whitley Council pay structure as a guide for paying staff, with staff moving up the point scale simply through duration of service.

Many GPs find they have staff on pay scales that do not relate to staff skills and tasks undertaken.

Changing how you offer pay rewards to the staff may mean you obtain the skills you need to develop your practice for the new primary care environment. Hence the practice nurse who develops prescribing skills and minor illness treatment skills may be appropriately rewarded if the practice is looking to use these skills to fill a gap in GP provision.

Most practice staff are having to work at a greater intensity, develop new skills and carry out new tasks to meet the quality framework.

Some staff are now asking whether their contribution to the quality framework effort should generate some recognition. A way forward you might consider is to change straight pay increases into part cost of living increase and part bonus payment related to quality point achievement.

This type of bonus payment may have the additional benefit of encouraging teamwork on quality framework areas.

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

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