There is growing pressure for general practices to continue to deliver high quality care, while meeting increasing levels of demand and diverse expectations. At the same time financial resources are being reduced, requiring practices to stretch their resources to maximum capacity. One way in which practices can approach this challenge is by implementing the Productive General Practice programme.
What is Productive General Practice?
The NHS Institute for Innovation and Improvement’s Productive General Practice programme helps general practices operate more efficiently by helping them to review the way they work so that they can identify ways of improving their working processes. This releases time spent on unproductive activities that do not add value or enhance the patient experience, time that can be used to improve patient outcomes and staff wellbeing. It enables the practice to take a fresh look at the changing healthcare needs of its local community and develop services that will meet those needs in a safer and more reliable way, helping to improve patient and carer experience, staff experience and productivity.
The latest in the NHS Institute’s internationally-renowned Productive Series, Productive General Practice has been co-designed and tested by, practice managers, GPs, nurses, receptionists and patients, as well as improvement experts from industry.
Productive General Practice ‘house’
The Productive General Practice ‘house’ is a key feature of the programme. It is broken down into individual modules, with practices working through each module from the bottom of the house to the top.
There are three types of modules in the Productive General Practice house.
Enabler modules are about getting started, setting direction and collecting diagnostic data on how the practice currently runs. There is a strong interdependence between the enabler modules.
Design modules guide practices through a process of how to draw conclusions, as a team, from data and create plans for how the practice will work in the future.
Process modules are used to make changes in key process areas (eg, prescriptions and referrals). Practices can implement them in the order that best suits them.
Practices are encouraged to implement the programme from the bottom to the top. Experience has shown that trying to improve processes before gaining control of the environment and understanding what is happening in the practice often leads to unsustainable improvements and wasted effort.
How can it benefit practice managers?
The pressures on practice managers are growing, with many competing priorities. Practice managers are at the heart of the general practice; their role is pivotal to the delivery of services and the smooth running of the practice. Productive General Practice provides a comprehensive approach, resources and tools to help the practice clarify its key objectives and work through a systematic set of modules step by step.
For many practice managers there has never been an opportunity to properly review the way the practice operates, or how it manages its services. It has often been a case of just getting the job done and moving on to the next thing. This can mean that the practice’s processes can become out of sync and unproductive in relation to the needs of patients and the practice.
“We have re-jigged our appointment system so many times, but have we actually looked at what is best for patients and for us?” says Rosemary Adams, practice manager at Welbeck Road Health Centre in Bolsover. “The most important people are the patients. Are we offering them what they want – and have we ever taken the time to look?”
Taking a lead in making change happen
Productive General Practice provides practice managers with an opportunity to take a leadership role in supporting the practice to create high quality services which meet the needs of the local community. This does not mean creating change for the sake of change. “It is about working differently not harder” says Claire Gregory, practice manager at Crown Medical Centre in Taunton, so that practices are more productive and get value for money from the resources they have.
Making improvement a priority
Practice managers can use the programme to create urgency for improvement in the practice and get all the team engaged. With their vast knowledge and experience of the practice as a whole, they can play a fundamental role in helping review what it currently does, what is working well and what is not working so well. They can help identify those areas where improvements need to be made and set realistic goals that will help achieve them.
Operating more efficiently
By making improvements to the way the practice works, practice managers can make significant financial and time savings. Helping the practice work more efficiently can reduce pressure on staff and also deliver a safer and more reliable service for patients.
Some of the benefits experienced by practices testing the programme included:
Extra nursing capacity identified, worth >£11,000.
Time taken to retrieve prescriptions requests reduced by 82%, releasing 12.5 hours of staff time per week.
Turnaround time for medical reports reduced by 43%.
57% reduction in blood test resource costs.
82% reduction in nurse sickness and absence.
More accurate staff planning, avoiding £15,000 of planned staff expenditure year-on-year.
How can it benefit GPs?
Increasingly complex patients, plus additional responsibilities arising from NHS reforms, mean the greatest demand placed on GPs today is their time. Many argue that there are ‘not enough hours in the day’ to do everything that needs to be done. However, patient expectations are rising and GPs are expected to meet them regardless of their workload.
“The driving vision of The Productive Series is releasing time,” said Dr Jagdeesh Dhaliwal, GP Clinical Lead at Productive General Practice.
“Making this a reality in general practice will help us offer a great service to our patients, improve the working lives of our colleagues and help boost quality while cutting costs for our NHS.”
Some partners will be driven by improved quality and efficiency in these financially challenging times. For others, the main driver will be the opportunity to regain some of the lost work-life balance.”
Getting the right patients through the door
It is well known that not all patients that visit a GP for a consultation require it. Some requests are inappropriate, could be managed over the telephone or be seen by another member of the team.
Not only does this waste time, but also wastes appointments that could be scheduled for patients who would have benefited from them.
Productive General Practice can help GPs quantify and assess whether patients are being seen by the most appropriate healthcare professional.
There is also a wider issue that Productive General Practice can help a practice consider. Does the practice mainly work in a reactive way to all the demands being placed on it? Would it be possible to be more pro-active, and therefore be in more control of the workload? The programme provides a mechanism for the partners to consider the best way to use the most costly and valuable resource in the practice - their time - to best effect.
Reinvesting time on other opportunities
With the landscape changing in primary care and GPs having more of a say in the way services are commissioned, Productive General Practice can help GPs release vital time that can be reinvested into the opportunities and responsibilities that are arising through clinical commissioning groups (CCGs). Not only will this allow GPs to serve their local communities better, but also to develop closer working partnerships with other practices in their areas.
A business perspective
Increasingly, GPs need to think of their practice as a business as well as a provider of care. The initial module helps the partners discuss and agree on their business objectives.
Establishing a clear direction of travel can help the practice prioritise its work and galvanise team energy towards a common goal.
I don’t think any of us wants to be more productive so we can earn more money than we are earning now,” said Dr Jim Lee, a GP Partner at Nethergreen Surgery in Sheffield.
“We need to be more productive just to keep up with change and try and protect our livelihood and keep providing services for our patients in the long term. l
Productive General Practice
Sean Manning is the senior asociate at the NHS Institute for Innovation and Improvement