Our panel of leading practice managers discusses how to deal with challenging situations. Compiled by Kaye McIntosh

Steve Williams

Initially it would be best to adopt a supportive approach. You need to identify if the employing organisation has provided appropriate support. If it’s a new member of staff, review your induction procedures and ensure that you’ve had a meeting to discuss how progress is being made. You will also have the opportunity during the appraisal process to identify any concerns and how these might be rectified.

If it’s an established employee, review past appraisals and look at existing personal development plans. Consider what might have caused a deterioration in their work.

Guidance, such as the contract and QOF, changes on a regular basis and this has an impact on the workforce.

Workload pressures in general practice affect everyone, not just GPs. The financial pressures and the need for sustainability means that outcomes become more financially focussed. Remember that staff are probably aware of this too, and this can add to anxiety levels.

If you are satisfied that the organisation has fulfilled its obligations and provided enough support to the member of staff, then you need to adopt your practice disciplinary procedures.

During this process, identify clearly with the member of staff concerned the issues that need to be addressed. Ultimately, they will comply and the issues will either be solved or they won’t, in which case you may need to conclude the disciplinary process, which could lead to dismissal.

Steve Williams is co-chair of the Practice Management Network

Michelle Barksby

It depends on how well you know their character. Are they usually punctual and do they usually have a high standard of work? Is this a sudden or gradual change? 

If it’s relatively early in their employment I would advise addressing this swiftly. Meet with the staff member to establish your expectations, where they are falling short, why that might be and what can be done to rectify it. 

If this is a change to previous work ethic, it would be a good idea to meet to explore the reasons for lateness and the change in the standard of their work.

Consider whether there are outside influences that could be affecting their ability to arrive on time and their performance. Has something has changed in their life that they have not shared? Just sharing something with you might help. Their attempt to be professional by not bringing aspects of their personal life to work may be getting in the way of them effectively doing their job. However, they may have nothing to share or choose not to share, which is of course their prerogative.

It’s important to make clear the business impact. Be clear that you are happy to offer support, but you can only do so with clear communication and while this remains possible in balance with the needs of the business.

Agreeing a plan for improvement with their input will improve the likelihood of success. Ensure it includes timescales for demonstrating improvement and agree how to monitor progress.

Michelle Barksby is practice manager at Sherwood Medical Partnership, Nottinghamshire

Nick Nurden

This is a constant and frustrating challenge, especially when it’s someone you know can do better. It’s important to address this promptly. These are difficult situations that none of us enjoys dealing with, but they very rarely get better on their own. If you address it early, there will be more chance of being able to salvage the situation.

It may be worth putting the time and effort in to turn things round – set against the time and effort that would be needed to find and train a replacement.

In the first instance a supportive approach is needed. You could say: ‘We have noticed that you have been coming in late recently and your work is not of your usual high standard – is everything OK?’ Or it may be that they are bored with the current role and need a change (which you may or may not be able to offer).

You need to be clear about your expectations. Make sure they are applied consistently with the whole team, so you can’t be accused of victimising one employee.

If further training or support is needed, make sure that it’s offered and put in place. If this works you should be able to salvage the situation. If the response is negative or no improvement is seen, then you need to decide promptly which route to take.

If you need to let the person go then act as soon as possible. A formal process will take some time to resolve, with a series of warnings and a final warning. Consider having a ‘without prejudice’ discussion with the employee, which allows a more honest conversation.

The offer of a settlement agreement is a quicker and safer way to dispense with an employee, and often people are open to this. I would strongly recommend some legal support if you take this route.

Nick Nurden is business manager at The Ridge practice, West Yorkshire