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The key to good leadership in the practice

In his fourth article on the business of general practice, Dr Sohail Butt stresses the importance of successful leadership and offers advice on how to achieve it

In his fourth article on the business of general practice, Dr Sohail Butt stresses the importance of successful leadership and offers advice on how to achieve it


Many a practice has grown and grown – then drifted into inertia. Time was, this was not a problem. But general practice is now so competitive that to stagnate is to die.

Until recently leadership and management was something the partners could delegate to the practice manager while they got on with the clinical care of patients. In most cases this is no longer an option. Management alone can perhaps be left to the manager. But leadership, which is about setting out the direction of travel, inspiring people to follow you and ensuring action is taken whenever necessary, is now needed at all levels in a practice to beat the emerging competition.

At the grass roots, where most patient contact occurs, staff must look at improving the service provided. At the team leader level, colleagues must look at developing new services each year to boost practice appeal and generate new income.

And at the top of the practice, the partners and practice manager should have a couple of big initiatives such as premises development, mergers or collaborative working to take the practice forward.

Most practices will have groups of GPs, nurses, administration and management staff working loosely as teams. To increase the performance of these teams, the GP partners need to ascertain whether they are maximising their potential. GP partners need to ensure the following are in place and adhered to.

All staff in leadership positions should have had leadership training

Most people have to work reasonably hard to develop leadership skills. So it's worth training those members of the practice who have leadership responsibilities as far as possible. There are some excellent day workshops run by training companies, which may be available at no cost through pharmaceutical company sponsorship.

Learning together helps to forge a leadership team. A day a year for the next three years is probably a good investment for most practices.

Have a nominated team leader with clear responsibilities for each team

The team leader will usually be a GP, nurse or manager. It will be their responsibility to facilitate team meetings. They may take on roles previously carried out by the practice manager such as organising rotas, daily work schedules and appraising team members.

Each team should meet at least once a week

Meet every week, if only for 15 minutes. This helps build a team identity and reminds everyone what the team objectives are. For example, the main objective of the reception team might be to facilitate patient care enquiries within a specified time frame and ensure key health data is entered into the clinical system in accordance with new contract targets (BP, height, weight, smoking, data from hospital letters and so on). Make sure everyone understands this.

Each team must be prepared to innovate

To adapt to change and beat the emerging competition, teams will need to adopt new ways of working. The practice nurse team could be encouraged to look at the skill mix and new ways of delivering care, for example. This may involve them training additional healthcare assistants and delegating some chronic disease care to them.

Each team member should have the skills to allow for cross-cover for absences

When you propose a new task (such as a new enhanced service) ensure that at least two team members are trained to do it. This promotes teamwork and flexibility and means that if a staff member is absent or leaves the practice someone is on hand to do the job.

Leaders must be trainers rather than managers

The traditional practice manager's role – telling you what to do – is not conducive to personal development and learning new skills. Each team leader should coach staff through new roles and learning new skills. The most effective way to train a member of staff is in the practice, not in the lecture theatre, just before they embark on a new task. Staff who widen their skills are usually happier and more fulfilled and stay longer.

Promote teamwork and flexibility as essential to working at your practice

Teamworking skills and flexibility should be essential qualities in the job specification of all practice staff. If they don't have these qualities, don't employ them. Existing staff may require training and support to learn these skills. Additional training on communication, conflict resolution, decision-making and problem-solving may be required for team leaders.

Team leaders should regularly give feedback to staff on practice performance

GP partners and team leaders should give regular information updates on practice performance and how it measures against planned targets. This information should feed into the staff appraisal process when setting individual staff goals.

Leaders should lead by example

It's better to walk the walk than talk the talk. Partners and practice managers should show flexibility about their roles, willingness to go the extra mile for patients and colleagues, a commitment to team working, and be seen to be working harder and longer than anyone else. In short, you should demonstrate the behaviour you expect of your staff, and then they will follow you.

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