Counting hand – three – isolated on white background

It’s a tough question and one that sparks plenty of thought: if you could change just three things in your practice, what would they be?

This question was actually posed on the Practice Index Forum this week and it generated some interesting comments. While some of the wishes – most notably one requesting less political intervention – are way out of the control of practices, some interesting comments were prompted by the original post’s three topics. Here’s a round-up of these key themes.

Payroll

It seems like many practice managers are considering outsourcing certain jobs, if they haven’t already done so, most notably payroll.

The anonymous poster of the original question said they “don’t agree that certain staff know how much everyone is paid” and that it’s a very stressful and time-consuming job for the person who runs payroll”. This view seemed to strike a chord, with numerous responses suggesting it’s a great idea. Comments ranged from “I would definitely do it… it avoids all sorts of pitfalls” through to “I would never consider bringing it back in-house”.

However, some caution was recommended by a practice manager regarding accuracy. “I tried it for a long time but recently moved it in-house,” they said. “I have a multipage document of all the errors that the outsource folk, an arm of our accountants, made that had to be fixed by myself, once I had spotted them. At least now I have no one else to blame when I make a mistake!”

Another PM added a further time-saving tip based on their experiences. “I waited six months after I started to see if it would be more efficient, and while I’m still not convinced, it is getting better. It would be better with a clocking in/out machine so I didn’t have to add or deduct hours when needed.”

External recruitment

It appears another outsourced service of interest to practice managers is some kind of recruitment agency help.

As noted on the Forum, many practices have suffered from a very high turnover of staff in the last few years, which could be down to the way jobs are described and advertised. “I think that because recruitment is so time-consuming, we have a tendency to rush through it because there is always so much to do,” one forum member said. “But this is beyond counterproductive as we don’t hold onto staff.”

In response one poster said: “I have used recruitment agencies in the past and they can save work and make it easier to finish with those that are not suitable.” Another added: “I spoke to an urban practice PM who was singing the praises of using recruitment agency staff for temporary cover etc. It’s a bit more expensive in the short-term but can be helpful to take a look at folk before they get a contract.”

To help cut down on staff churn, one PM suggested looking at incentives: “We have a holistic therapist coming in, which the partners pay for and staff have for half an hour; it was very well received. Also, keep hold of any vouchers if they come in to use as reward and recognition. I’ve also sent staff home on the odd afternoon as a reward for working so hard, which was a huge culture shock to them!”

Time for training (and in general)

Time – and the lack of it – was a huge issue for many commenting on the forum. Enhanced training was identified by many PMs as an area for improvement. Interestingly, one comment said that training would reduce the workload burden on certain members of staff, but there was no time to provide it. Again, outsourcing training on software such as Sage or EMIS was suggested as a solution. As was utilising an online training programme.

Management training for partners was mentioned more than once and it was suggested that it could be beneficial to remove GPs from any management discussions, apart from clinical matters.

One PM explained: “Partners [need to be] more business aware. I don’t blame them as in their day they weren’t trained as businesspeople and even now locums I speak to are very wary about becoming Partners, as they don’t feel any of their training covered business management.”

Staying on the theme of time, one PM said they wished there was more time for the GP team to think properly about where the practice is going, while others suggested they would like to see a reduction in pointless and unproductive meetings. Another forum member said they would like to have more time so that they could implement some of the many ideas they have. That seems a fair point!

Numerous ideas

While the three topics discussed above were the main recurring themes, numerous positive suggestions and ideas for things to change were put forward. They included:

• Start charging for DNAs
• An honest debate with the public about what can be provided with the funding
• Increase funding so staff get a fair day’s pay for a fair day’s work
• Make patients take some responsibility for their actions
• Policies and procedures should be standardised across the NHS and rolled out for all to adopt
• More patient education is required, as this is where a lot of the issues stem from

We would love to keep this conversation going, so please let us know what you would do if you could change just three things in your practice.

Let us know your top three things to change by either commenting below or sharing your ideas in the forum thread here.

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Topics trending in the forum:
Problems covering reception shifts
What would you change if you could?
Sickness absence