Time for change

Workload pressures in general practice are particularly pressing at the moment and the trend shows little sign of changing. The King’s Fund, for example, has highlighted that causes for the sector going through this turbulent period include patient dissatisfaction with appointment availability and volume and quantity of GP consultations increasing.

These causes sit alongside other widely identified issues, such as an ageing population and a GP recruitment crisis. The think tank also predicts that secondary care patients will soon become ever more reliant on primary care services due to the ‘relaxation of the 18-week referral-to-treatment waiting times standard for elective treatment, meaning in the interim, those requiring care will routinely turn to their practice for support.

Shaping priorities

Given that practices are struggling with patient demand and the fact that the nature of clinical work is evidently changing, it stands to reason that practice managers will be tasked with doing more. Making decisions over who to claim from, dealing with patient complaints, directing HR matters, in some cases managing demands from NHS Property Services, not to mention overseeing staff training, preparing for CQC visits and keeping on top of QOF duties, are but a sample of a practice managers responsibilities.

To handle such a hefty in-tray, effective time management strategies are required. As a starting point, scheduling a discussion with GP Partners, whether on a regular or infrequent basis will begin to shape priorities and provide a more meaningful perspective on which matters take precedent. Such a discussion also helps to understand the future direction of the practice and can help resolve other outstanding issues. Has a staff member been absent on a long-term basis and finding locum cover been difficult? Does the Partner have any alternative suggestions for improving recruitment? Direct discussions can spark a breakthrough and might just be the driving force behind service improvements and better planning.

Looking at the possibilities of spreading your workload by way of delegating others to complete certain tasks has its benefits, too. Can a receptionist or care navigator manage minor patient complaints, for example? Are there data entry tasks that can be given to an administrative assistant? How else can other non-clinical staff be upskilled or taught to learn about web-based systems?

Knowing that fixed items have to be dealt with at the end of the month, e.g. payroll, doesn’t always mean that they are hassle-free or managed without stress, but giving them extra time or concentrating on them without other distractions can be transformative. Instead of being tempted to respond to every email in your inbox in real-time, think about reviewing them during an hour at the end of the day, and only then. Additionally, while it’s nice for practice staff to value your open door policy, if the same people are becoming overly reliant on you or visiting your office regularly, productivity will suffer. Of course, where genuine support is needed it should be provided, but giving clear direction or setting out what you expect of others are both strategies that can make a huge difference to the whole practice team and save time.

Pre-empting change

For larger scale projects where working to tight deadlines is necessary, such as the introduction of, or changes to, extended services, being able to work smarter will pay dividends. Perhaps its easier said than done, but instead of attempting to learn about how to implement new services without the experience of having done so before, speaking with a PM who has recently completed a similar project is one way of gaining confidence. Asking them various questions that spring to mind will save time in the long-term, not least by knowing how best to liaise with NHS England to identify how to claim extended service payments in good time.

In a similar vein, pre-empting potential or likely changes in your local area will improve long-term playing and reduce the pressure of having to react quickly when such change occurs. Has a nearby practice closed or likely to close? How prepared would your practice be if it had to then double the size of its patient list? Extra patients will lead to extra funding being provided but evaluating if funding will stretch to employ an extra member of clinical staff is much better to know beforehand, rather than existing staff having to share the additional load. Again, framing expectations can help in this instance. If your staff is aware of changes long before they are set in motion, they’re more likely to be responsive and motivated rather than disgruntled. 

What’s best for patients?

Finding new ways to work is also important. For example, trialling telephone triage could be one method to combat a patient access problem. Seeking patient views and having a better understanding of the services they need can ensure reasonable and worthwhile adjustments are made. If your practice is made up of an ageing or elderly population, introducing a state of the art online booking system will probably lead to teething problems and disruption to appointments, even a tide of complaints. Only by determining what patients are most in need of can practice managers determine how to make best use of their resources.

At all costs, if work becomes a major source of stress and it feels as if one day to the next is no different from previous weeks, talk to PM colleagues and your GP partners. They will have strategies to help and in the partners case they may even be able to reduce your workload. It almost goes without saying, but slaving away at a desk for 12 or 13 hours a day is far from an efficient use of time.

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