This site is intended for health professionals only

At the heart of general practice since 1960

Motivating staff

In the second of his series on good business sense in general practice, Dr Sohail Butt stresses the prime importance of motivating staff

In the second of his series on good business sense in general practice, Dr Sohail Butt stresses the prime importance of motivating staff

In the developing primary care marketplace GPs will need to manage and motivate their staff in a more business-like way to compete for the provision of services. Otherwise they will be beaten to the draw by corporate healthcare providers – or even other GPs who are more entrepreneurial.

In 2007/8 profits from NHS work in most general practices will be at best static. More likely they will fall. Workload will increase. The going will be tough.

But things could be worse. Various surveys suggest 20-50% of public sector workers feel they could improve productivity if suitably motivated and managed. Furthermore, current average public sector worker pay is still higher than private sector pay, and the NHS pension scheme remains superior to almost all other occupational pension schemes in the UK. So GPs can hope to achieve increased productivity and efficiency savings from practice staff, either by increasing the value of staff work, by reducing your employment costs, or a combination of the two.

To ensure short- and long-term success for your practice you should know:

  • where the practice is trying to go in the next three years (strategy)
  • what you need to achieve this year(objectives)
  • how you are doing now (performance)

A balanced scorecard of objectives in at least four key areas may be helpful to ensure long-term success for the practice.

Financial performance

For example, to maintain profits within 1% of 2006/7 or to be within the top 25% of the profit league tables supplied by specialist medical accountants.

You will need to maintain financial performance to recruit and retain the best staff and invest in premises and new equipment as PCT development funding dwindles.

Clinical performance

For example, to be in top 25% for the QOF league table. High performance is a good marketing tool for influencing staff, patients and PCT, and brings the rewards that allow investment in staff and premises.

Learning and development

For example, aim to be in the top 50% for learning and development in your PCT. This may be measured by the number and range of diplomas and courses undertaken by all staff and reflect the appraisal and in-house educational system you operate. You could ask your PCT primary care tutor to rank you on this.

Good learning and development of staff is essential for people to develop the skills to do the changing work of primary care.An organisational objective may be to form a PBC consortium to allow you to bid for large PCT contracts put out to tender.

Patient satisfaction

For example, to be in the top 50% of the annual patient survey rankings and access surveys.

The Government would like to see more choice in primary care. They'd like to achieve this through an oversupply of primary care providers. They'd like to see people able to compare practice performance.

Patient satisfaction rates will be important indicators of how likely you are to retain your existing patients and attract more patients in the future – when this oversupply of primary care providers kicks in.

Keep your staff better informed about the practice annual objectives. Make sure their individual objectives, as appraised annually, dovetail with these practice objectivesInforming and reminding staff of your annual objectives in practice meetings and through email updates is a powerful tool for changing behaviour. And remember – people usually need to be reminded of a change two or three times before they do start changing their behaviour.

Chat to staff and have informal meetings to remind them of practice objectives. By giving individual staff members performance objectives which tie into the practices' objectives, you can improve their performance significantly – some research shows by up to 30%. I have adapted a performance review form which has allowed us to efficiently do this task in an employee-centred way during the annual appraisal.

When carrying out an appraisal of a staff member you should compare their performance with the performance you would expect from an excellent staff member. This gives you an idea of the potential for improvement for that individual. You can look at any possible reasons for deficiency in performance. It may be due to a person's motives (values, likes, preferences, needs), capabilities (mental or physical) or knowledge (education and skills). Alternatively, it may be the practice has not provided the staff member with enough information on practice strategies, objectives and current performance expected.

Recognise staff achievement with non-financial rewards. Praise, merit awards, recognition in practice meetings, employee-of-the-month schemes and so on all boost morale. But beware of platitudes. And remember that a generous pay structure, good working conditions and a happy practice are the real motivators. Devise a pay structure that rewards new skills and team performance.

Traditionally GPs have used traditional pay structures to decide pay for staff, with staff moving up the point scale simply through duration of service

.Many GPs find they have staff on pay scales which do not reward staff who take on additional 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 replace a salaried GP.

Many GPs have adapted part of the Agenda for Change framework to reward skills developed and used by staff. Most staff are having to work harder and develop new skills. Some now ask whether their contribution to practice achievement should generate financial recognition. Consider changing the way you give them a pay rise so that part of the rise consists of a cost-of-living increase and part a bonus payment related to practice achievement. This type of bonus can encourage teamwork on the quality framework and enhanced services areas.

Remember it may be productive to make any bonus payment dependent on having a satisfactory appraisal in the previous year. Bonus schemes that reward the team based on team performance are obviously better at producing teamwork. Similarly rewards based on some ownership of the practice may be a good way of motivating and retaining quality staff if practices move from partnership to limited company status in the future.

Provide staff with cost-effective just-in-time training for specific practice needs identified. For example, if your practice has a need for more spirometry sessions to meet QOF targets, teach a healthcare assistant how to carry out spirometry to start providing assessments for COPD patients this month. Learn the skill and start using it straight away. You may be able to find practice-based training provided at no cost by pharmaceutical company training departments.

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say