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Self help for primary care

Why was the initiative launched?
What was done?
Designed support
Did it work?
Developmental phases
Tips for Success

Finding ways to use local skills to improve the management of primary care in Hackney, East London

Why was the initiative launched?

In 1998, GPs in Hackney recognised their need for support on organisational issues like health and safety regulations and the development of staff appraisal systems. Later that year it became clear that a potential under-spend in the budget for the London Implementation Zone (LIZ) would offer opportunities to fund local development work.

Within days of the opportunity being known a project was proposed by the City and East London MAAG and the Practice Staff Training Unit at the Department of General Practice at Queen Mary and Westfield College (QMW). The project would offer organisational development support to practices. Existing staff would be involved. Practice managers and practice nurses who had experience of problem solving in their own practices and who also had skills to facilitate change in other practices. Short-term funding of £20,000 was allocated to the project in September 1998: the initial aim was to complete the work by March 1999.

What was done?

Caroline Lee, MAAG Co-chair and Gillian Borrie from QMW managed the project. Their first task was to recruit a team of facilitators who had both the necessary skills and who could also devote time to the project. They recruited five practice managers and one practice nurse. Several of these people had experience of working with the King's Fund Organisational Audit Programme in primary care. The team then drew up a list of development areas where they had expertise. The aim was to build on known problem areas, but the project coordinators were conscious that practices 'would not know what they did not know'. The final list included 35 discrete topics, some of which are described in the Box.

Figure 1: Practice Development Topics

Some examples:

At the end of October 1998, the project coordinators invited practices to participate and identify those topics on which they would like support. The letter was sent to general practitioners and practice managers and the project was publicised though local networks. The invitation indicated that the resources within the project were limited: practices were offered around one session (three hours) a week of facilitators' time up to a maximum of 18 weeks.

Designed support

Eight practices responded to the initial invitation, seeking support on a range of issues. The requests from practices were followed up with an initial assessment visit from one of the team of facilitators whose expertise seemed to match the practice's needs. The visit was designed to diagnose the problems, assess the number of visits required to tackle it and devise a preliminary action plan. A programme of regular visits to the practices was then negotiated between the facilitator and the practice. The subsequent 'working' visits involved the facilitator and members of the practice team, including the practice managers, GPs, practice nurses and receptionists.

Regular monthly meetings between the facilitators and the project coordinators allowed the team to manage the demands on their time, set the framework for agreements with the individual practices and discuss any difficulties which had been encountered. It made it easy for another facilitator with more appropriate experience to step in when needed. The team took care to ensure that practices were aware that the team would respect confidentiality.

Did it work?

A second group of five practices was enrolled in the project in early 1999 so that 13 practices have now been involved. The thirteen included single-handed practices with a variety of issues to address and larger practices that required help with one issue. Some practices received just a few visits whereas others have had regular input over a longer period of time. So far, the team has been able to meet the demand for its services, with no practice turned away.

Benefits to practices

Example 1: The practice recognised that several aspects of their organisation needed improving, including appointment systems, staff appraisal and questions about health and safety issues. The project has provided advice and information and is now working with the practice to adopt a range new systems and procedures.

Example 2: The practice was single-handed and finding it increasingly difficult to tackle administrative and financial tasks. The project was able to help the practice get over the immediate difficulty and with the appointment of part time bookkeeper.

Example 3: The practice was facing a move to new premises yet no one in the practice team had any relevant experience of how to manage the move. The project was able to draw on the experience of two practice mangers to plan and manage all the work involved from the physical process of moving to the installation of new IT equipment. The move went smoothly and the team were very pleased with the support offered.

Evaluation has been taken seriously and progress monitored closely. Each practice visit is documented and at the end of the facilitator's involvement a summary of the work undertaken is compiled. In addition, the project coordinators contact the practices to discuss how useful they have found the support offered.

Developmental phases

As the work has progressed, the project coordinators have recognised several phases in offering organisational development support to practices. The practices need to acknowledge that they need help. They need to be willing to discuss their problem and the options for improvement and they need to be ready to listen to new ideas. Finally they need to be willing adopt new ideas and devote the necessary resources to the task. Given the day-to-day pressures on practices, those offering developmental support need to be patient and allow the practices to go through these essential steps.

The funds available covered the sessional costs of the facilitators. Careful budget management has allowed the project to be extended up to spring 2000. The success of the project has persuaded the Hackney Primary Care Group to adopt the project as a key element of its development and fund its continuation. The lessons from the work are also continuing to influence the training for practice managers run at QMW.

Tips for Success


For more information about the experiences within practices

Caroline Lee
Practice Manager
Statham Grove Surgery
Statham Grove, London N16 1F11

Telephone 0171 923 4122 Fax 0171 241 4098

For more information about training aspects

Gillian Borrie
Practice Manager Lecturer
Department of General Practice and Primary care
Queen Mary and Westfield College
University of London, Medical Sciences
Mile End, London E1 4NS

Telephone 0171 295 7916 Fax 0171 982 6396

The following material is available:

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