By Alan Moore

Management theorists have for many years promoted the idea that all businesses need to be aware of the world in which they operate; they call this environmental monitoring. The days when Henry Ford could say that a buyer could have one of his cars in any colour so long as it was black are gone. If he was still adopting this approach then Ford would have gone the same way as Triumph and Rover.

Knowing what’s happening in your business sector is a major part of managing, and this is particularly the case in the fast-paced world of healthcare. Keeping up to date is almost a full-time job for practice managers. You may well ask, why should we do it? The short answer is to reduce risk, shape services and preserve profitability.

Taking a structured approach to your environment should mean that you can keep up with changes.  The world is divided into Political, Economic, Social, Technological, Environmental and Legal issues (PESTEL).

Political awareness enables an astute manager to spot where political interference may change what the practice is expected to do. Just look at the changes that were signalled back in 2002 and which gave rise to the ‘new’ GP contract in 2004. We have QOF and ten-minute appointments directly as a result of political pressure and for those of us who were in practice at that time it certainly didn’t seem like it was a voluntary process!

Economic issues also affect how we operate. Awareness of the parlous state of UK finances from 2007 onwards should have alerted PMs to the squeeze on the amount of available money, encouraging them to look at ways of reducing costs.

Social changes are difficult to predict but there are still clues. The increasingly aged population, the seemingly inexorable rise in population, the reliance on social media and the effect of instant communication have had a major impact on practices. Who hasn’t noticed that demand for home visits has increased, or that so much time is spent servicing the needs of patients in nursing homes? Who hasn’t also noticed that patients ‘google’ their symptoms before coming into an appointment, thinking they have all the major diseases?

Technology also changes workload so that whereas before we might have spent time responding to Subject Access Requests, we now have to ensure this is available online for free – but that in itself changes what we do as records may be challenged once the patient can review them more easily. Web-based clinical systems make it easier for a practice to set up anywhere there is web access, but when it doesn’t work well it is infuriating!

Environmental changes have had an impact on us too – our buildings may be below floodplain levels now that the weather is becoming more unpredictable, or on the positive side there may be grants and support available to help us reduce our carbon footprint.

The legal environment probably has the biggest impact on how practices work. Look at the original setup for QOF which involved a whole raft of management ‘outcomes’.  These were dropped in the final document but who can now say that they haven’t reappeared as KLOEs and are the legal framework for the operation of the CQC? Health & Safety legislation is equally important – for example, the new shiny surgery building with showers for the staff has to be inspected and tested for legionella.

The legal environment brings us back to “risk” and in a society where people are quick to consider recourse to the courts if things go wrong, can any business fail to ensure they have got everything right? There’s nothing worse than standing in the witness box being asked a question that comes out of nowhere and which you can’t find an answer for. It’s potentially embarrassing, frustrating and financially penalising in equal measure.

So where does this all lead? It leads to the realisation that just having something in place today doesn’t mean it will be fit for purpose tomorrow. It leads to actively making time to learn – whether it’s attending the local PMs’ forum, going to various seminars and exhibitions, or making sure the partners appreciate that you too have CPD needs, not just clinicians. Mostly it leads to knowing that if you get something right the first time, this will free up time later on to attend to other important matters.