New contract – don't forget the job satisfaction
Most of the contract debate has been about pay, but other factors will also be crucial in improving GPs' working lives, writes Dr Melanie Wynne-Jones
There has been so much emphasis
on money that many GPs have not yet had time to think through how the new contract will affect other aspects of the job.
But switching from personalised care to protocol-driven, cost-limited service delivery and competition with other providers, will have major implications for practices' day-to-day work and interpersonal relationships.
Some partners may still be mourning 'the loss of general practice as we know it' and lack enthusiasm for change.
They may be contemplating retirement, going part-time or changing career. This could destabilise the practice at a critical time.
Others may be impatient to maximise profits or move to new premises, and become frustrated or consider leaving if they feel unsupported in their ambitions.
Partners who have learned to accommodate each others' quirks and preferences may find they no longer wish to do so.
It may ultimately be better for all concerned
if this results in a relatively clean break, and this should be borne in mind when drawing up the partnership agreement.
However, many partnerships where GPs have previously worked harmoniously will hope to continue reconciling their different values and beliefs.
These will include beliefs/values about:
lContinuity of care and skill-mix
lConsulting rates and styles
lTensions between cash-generating and resource-consuming care
lRelative workloads and remuneration – are all patients equal, and how does seeing patients equate to time spent managing the business?
lWhich services the practice should provide – or abandon – and the effect on partners and patients
lInvesting in the practice versus maximising profits
lIndividuals' perception of work-life balance, their stage in life and how much time and effort they want to put into the practice's future success
lWhether and how partners should fund new premises
lCost-control – staff and other resources
lNew alliances between individual partners with similar goals
l'The GP's role' – what makes the job worthwhile? – potential for depression or burnout
lAttitudes to partners who are under stress, sick or not pulling their weight
There are so many strands to the new contract that practices may feel there is no spare time for meetings but it is vital to address these issues early, explicitly, and regularly.
Consultation, communication and anticipating/confronting problems are essential in any organisation, and most practices will be using some of these tools already.
lregular scheduled meetings with all partners present, plus time for informal discussion – for example coffee breaks taken together
lProtected time or awaydays (partners or whole practice)
lEfficient communication pathways
lA practice development plan
lAgreed targets and priorities
lMonthly or quarterly finance and performance review meetings, including up-to-date and contextualised statistics (involving the accountant where necessary)
lAssessment of individuals' strengths and weaknesses, aspirations and fears – Belbin team-role analysis1 or 360-degree appraisal2 may be useful
lAssessment of internal/external threats and opportunities
lPersonal development plans
lReview of partners' management roles – 'executive partner' or democratic 'board of directors' with specified roles?
lReview of practice manager's role/job description and practice's line management structure
lRegular review of workloads and profit shares
lCo-mentoring/opportunities to debrief, for example heartsink patients, significant event analysis
lPractice agreement which provides for all the above as well as provision for mediation
The range of solutions will depend on
the nature of the problem, but useful strategies, skills or resources – which may be found in-house or will need to be brought in – include:
llocal medical committee
lsick doctors' resources3,4,5
llegal advice – for example, medical defence, employment law
lchanges in practice services/structure, including use of locums, to accommodate flexible working or changes in role.
Melanie Wynne-Jones is a GP in Marple, Cheshire
2 Jennifer King, 360° appraisal. BMJ Career Focus, Jun 2002; 324: S195
3 National Counselling Service for Sick Doctors 0870 241 0535
4 Sick Doctors' Trust (support for alcohol and drug addiction) 01252 345 163
5 Doctors' Support Network (support for mental illness)