(Time to read: 6 minutes)

In a recent report published by the CQC, it was excellent – and refreshing – to see the role practice managers play in primary care effectiveness being recognised. The authors of ‘Driving improvement: Case studies from 10 GP practices’ rightly recognised that leadership, communication and collaboration are among the key drivers of improvement for 10 GP practices featured in a new report published today.

The report draws on interviews with a broad group of staff from 10 practices – nine of which were originally rated as inadequate and, through dedicated effort, improved to an overall rating of good on their last inspection. The tenth practice – Litcham Health Centre in Norfolk – went from a rating of ‘requires improvement’ to ‘outstanding’ in just over a year, after joint practice managers Tony Bailey and Marta Haskiewicz invested a considerable amount of time updating policies and procedures.

Everybody matters

A common theme running through the report – and a message that the BMA, RCGP and NHS, amongst others, should probably take more notice of – is that the 10 featured practices all had a deep understanding that everyone at the practice had a role to play in progress, including clinical, nursing, administrative, managerial staff and patients. Recognising what each person could contribute to the improvement journey helped to build collective progress.

Through working with others locally, accepting the support available nationally and empowering practice managers, the practices that generously contributed to this report demonstrated an impressive commitment to not only driving high-quality care for their own patients, but also helping others to learn from their experience.

All the practices interviewed faced similar challenges and shared some common experiences, including:

• ensuring practices had strong leadership from a practice manager with the time and skills to lead the practice team
• addressing staffing and training issues such as poor recruitment or training practices
• ensuring that every member of the practice team understood their role, communicating these responsibilities and involving the whole team in the running of the practice
• realising the benefit of involving patients and the local community
• accessing external support, whether locally or nationally.

Good practice 

The 10 case studies make for interesting reading – and offer plenty of ideas and best practice examples to other practices, making it a must read. For now, however, here are ten of our favourite initiatives:

One
Litcham Health Centre in Norfolk introduced a Patient Passport system. Patients have a smartcard that links to the data held on the practice’s system. Scanned at reception when a patient arrives, the Patient Passport alerts staff if any outstanding tests are due or if additional clinical input is needed. The Patient Passports are directly linked with local hospital data and allow the extended healthcare team to access the patient’s key medical information outside of the practice.

Two
As part of the NHS Long Term Conditions Year of Care programme, Metro Interchange surgery in Gateshead began to generate letters and search lists for patients according to their month of birth to get them to come in for annual reviews. These lists are then passed to the practice secretary who flags on the system any patients who have not responded to letters. She also keeps track of the patients who are attending appointments for blood tests so the practice can monitor their attendance and DNA (did not attend) rates.

The new way of handling annual reviews for people with chronic diseases has resulted in extremely positive feedback from patients. “Patients absolutely love this new system as it is based around their birthday, so they know when to receive a letter from us to come in,” says practice nurse Denise Blair. “It’s made a huge difference to us and them. Now they’re seen for everything all at once, for example diabetes, COPD or hypertension, and they find this much better than before.”

Three
“We work with other practices in the locality to give advice and support them through the inspection process and we’ve found this to be really positive and helpful for both sides,” – Carole Crawford, Practice Manager, Metro Interchange Surgery

Four
St Mary’s Surgery in Bloxwich, Walsall, improved the way that it identifies patients who are carers – the inspection report had identified this as an area to address. At the time of the first inspection, the practice had only identified four carers; but after carrying out a full review of patient records, by the time of the second report that number had risen to 18.

Five
“One of the other things we did was to define roles so that everybody knew what their jobs were. It’s important that everybody in a small practice can multitask, but people need to be clear about their main roles,” – Stacey Wyatt, Practice Manager, St Mary’s Surgery.

Six
Falcon Medical Centre in Sutton Coldfield introduced additional services, including regular clinics run by mental health charity Mind, who referred patients to counselling or advice about benefits, and access to the practice’s trained substance misuse prescriber. As a result of the subsequent merger with four other practices to form Sutton Coldfield Group Practice (SCGP), Falcon patients were also given access to minor surgery in those practices. Staff have also organised an education session on sexual health at a local school.

Community matrons employed by the group as a whole have also worked with Falcon patients to provide more support to people at home, which helps to reduce the number of unplanned hospital admissions. The group of practices also employs semi-retired district nurses who, along with palliative care nurses, now provide services to Falcon patients as well.

Seven
Prescriptions were a key issue at Falcon. Under the previous provider, receptionists had the authority to issue repeat prescriptions without referring to the GP. According to Dr Dubb, this meant that some patients were not getting annual medication reviews. The practice carried out audits to identify the affected patients and implemented systems to ensure that these patients were monitored appropriately. The CCG’s pharmacy team supported the practice to ensure that its prescribing was in line with best practice guidelines.

Eight
At Dr Krishnan’s practice in Leigh-on-Sea, patients have also benefited from a change to the layout of the premises, which has created an extra room so the nurse and healthcare assistant can see patients at the same time.

Nine
After noticing poor rates of dementia diagnosis, Conway PMS in London paid for administration staff and clinicians to have awareness training, with the result that diagnosis rates subsequently improved. This upskilling across the whole practice team ensured that all staff were able to play a part in the improvement journey.

Ten
Also at Conway PMS, there was a focus on boosting communication. This included instigating clinical meetings using teleconferences to get around being based at two different sites.

Practice nurse, Debbie Hines felt the move to monthly clinical meetings was a real positive for engendering the team spirit required to improve on the rating. “Before, these were ad hoc, but they became permanent and we used the time to look at issues such as clinical case studies or patient complaints, and discussed ideas on how we can manage them.”

Communication outside of the practice also improved. When patients were referred or discharged from hospital, information was shared and meetings took place with other healthcare professionals where care plans were routinely reviewed and updated for patients with more complex needs.

The above 10 points are just a small snapshot of the differences practice managers are making at practices across the country. The report, which can be read in full here, is hopefully the first of many that will highlight the great work PMs are doing in primary care.

What leadership and management initiatives have you successfully introduced? Let us know by commenting below or take it to the Practice Index forum here.

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