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Managing change

To launch this six-part series on the business of today's highly competitive general practice environment, Dr Sohail Butt gives advice on coping with change

To maintain healthy profits and good quality care over the next 12 months and beyond, GPs will need to decide on how to manage change.

How are you going to improve efficiency in the face of falling NHS income?

This will be the biggest problem. GPs and practice managers will need to look at:

  • staff skill mix – fewer doctors, more healthcare assistants
  • practice objectives to improve income – developing more non NHS work, new NHS provider work and joint working with other practices or non-NHS companies such as supermarkets and large corporations
  • possible mergers with neighbouring practices to reduce staff and premises costs and increase ability to provide new services
  • communication systems in the practice to engage and explain changes to staff who are anxious
  • payment and reward systems for partners and employees to keep staff motivated as workload increases
  • practice premises improvements to accommodate additional staff and new services
  • the management structure of your practice

What GPs need to do

1) Make sure partners and managers agree on plans to tackle change

It's important that the leaders of the practice are seen to unite on where they want the practice to go, and the necessary steps to get there. You may need one or two meetings or away days to achieve this, as most people will need time to get use to the new economic and NHS changes. However, it is time well invested.

Time outside the practice allows people to think laterally and move from entrenched positions. Having a group of doctors and managers committed to guiding these changes greatly increases your chances of success. You may be able to obtain pharmaceutical company support for the meetings, and the company may be able to provide you with a facilitator. Outside facilitators are particularly useful if practices have got stuck on big issues when trying to make changes before.

2) Give the practice team convincing reasons for change

To get practice employees to change the way they work and to implement any desired changes, the partners need to make a really good case for what they propose. Drive home the fact that weak practices fall by the wayside and staff will suffer. Give some scary examples. These days practices need to be competitive and cost-effective. NHS spending in years to come will probably be reduced. GPs will face competition from private providers for many services as PCTs are encouraged to create a competitive primary care marketplace to drive costs down. Staff must know all this. And they must know the consequences of failing to adapt.

3) Look for a quick win

Pick a manageable clinical area, such as a new physiotherapy service. Devise and implement a plan to improve the quality of care and access quickly. Present this to the rest of the practice healthcare team. Something achieved is a wonderful tonic. It shows people that things can be made to happen. And it sets a template for action for other clinical areas.

4) Don't tinker at the edges – change whole systems

The new NHS changes affect many different aspects of practices. For example, when looking at meeting the 48-hour access targets it may be necessary to look at the appointment system, reception training, patient education, GP rotas, and development of a nurse practitioner all at once. Failure to address all the issues may mean the planned changes fail and access payments are lost to the practice.

5) Keep everyone informed

Keep sending information to the practice healthcare team on projects and changes. Staff must feel more involved. They must be given a reason to take part in the various initiatives crucial to the success of the practice over the next 12 months.

Organise monthly meetings with an update slot for the changes. Have informal chats in the kitchen. Use e-mail effectively.

6) Keep everyone involved

It is best to involve the whole practice to look at why changes are necessary, what the changes should be and how they can be accomplished. This can be achieved by all the various strategies listed here and also by awaydays or a series of shorter meetings at the practice.

The benefits of away-days involving the whole practice team are:

  • you get more information exchanged
  • you get the staff to commit to the changes at the meeting
  • there is better co-ordination between the different teams involved (GPs, nurses, managers and reception/ administrators)
  • the changes will happen faster and better
  • planning and making change then becomes a part of normal work

Sohail Butt is a managing partner in Ashford, Middlesex

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