How I turned round a struggling practice
Singlehander Dr Karen Brown brought a struggling practice up to scratch in less than a year, earning her accolades from colleagues and the top prize of ‘GP of the Year’ at the prestigious General Practice Awards. Here’s how she did it.
Profile: Dr Karen Brown
What’s your role? Singlehanded GP principal at the Jacksdale Medical Centre, Nottinghamshire
How long have you been a GP? Since 2007
How would you describe your practice? It’s a smallish, nearly 4,000-patient practice in a semi-rural, former mining area; a typical village GP surgery where you can do ‘proper’ general practice, with patients who value continuity of care
What gets you up in the morning?
My children! But I do find it really motivating to go to work at a practice where we know we’re providing a great service and our patients appreciate us
What problems were the practice facing?
In 2015, before I took over, the practice had received a ‘red’ score in the CCG’s Infection Prevention and Control audit and the CQC rated it as ‘requiring improvement’, in particular on the safe and well led areas. The practice was also running with high referrals and A&E attendance in CCG audits. I’d worked there as a salaried GP several years ago, so I knew I liked the staff and the patients, and the ‘feel’ of the place – and I just felt it was shame that, for whatever reason, the patients weren’t getting the service they deserved.
What did you do?
I took over running the practice in early July 2016 and the first decision was to undertake a full refurbishment of the practice to bring it in line with regulations and also introduce rooms to run family planning and minor surgery clinics. Working closely with the practice team, I also set up new procedures to strengthen our infection prevention and control management.
We introduced telephone consultations to help improve access and prioritise GP appointments, and this year employed an advanced nurse practitioner who offers patient consultations for minor illnesses.
We also signed up the practice to a minor injuries LES which has enabled us to offer more clinical slots.
What were the challenges?
Committing to financing the refurbishment was obviously a risk, but to be honest I didn’t think too hard about that – I knew we could make it work with such a great team. Accessing help from the CCG and NHS England to commit some reimbursement was a challenge, but we managed to secure some funding, in particular from the vulnerable practice scheme, and in the end I’ve covered nearly half the costs.
The refurbishment itself was disruptive, but we had most of the work done during evenings and weekends and although it meant moving staff around at times, the team really pulled together and engaged patients in the process and by explaining what the benefits would be, we were able to get them on board.
What improvements did you see?
The CCG was really impressed with the refurbishment, which they said was ‘outstanding’, and a recent Infection and Prevention Control audit gave the practice a ‘green’ rating showing it is now fully compliant with legislation and guidelines.
The CCG’s latest practice profile audit showed our GP referrals to hospital have decreased 40% since June 2016 and are now at their lowest for two years. In addition, we have seen a 14% drop in non-elective admissions to hospitals, while inappropriate A&E attendance fell nearly 10% and we now have the lowest rate for practices within our locality.
In line with the effort to improve our quality ratings and offer better access we have seen the practice patient list grow from 3,796 to 3,878 – and the proportion of patients who would recommend us has gone up from around 40% to 100% at the latest survey, which we are really proud of.
Despite the initial cost outlay we’ve managed to return a decent profit every quarter which is quite impressive.
What colleagues say
Nikki Hughes, Infection Prevention and Control Matron at Mansfield and Ashfield CCG: ‘The practice has improved dramatically in all areas, including patient care. Dr Brown deserved recognition for her achievements. It has been a privilege to support and witness the many improvements that have been made, not only for patients but for staff too.
‘Staff are happy and enjoy coming to work, it is clear to see that there is a real sense of community spirit within the practice team and this only benefits patients further.’
Practice Manager Melody Lindley: ‘Dr Brown has really brought the best out in the team; she has invested a lot of time and thought into each member of staff, she knows what makes each of us tick and how to involve us in decisions as well as helping us to get the training we want to progress and feel valued.
‘She is really vibrant and lovely to work with too, it helps to have that day-to-day interaction to feel part of the team and motivated.’
Surgeon and media doctor Peter McDonald (right) presents the award to Dr Brown, with James Dunby from award sponsor Medical Professional Risk Solutions