ANNE CRANDLES

Practice Management Adviser
Boroughloch Medical Practice, Edinburgh

While politicians and professional bodies discuss, pause and adjust plans for the NHS we, at the coalface, are getting on with the day job – providing quality patient care. But how do practice managers know what ‘quality’ is, how to measure this and, most importantly, maintain it?

Quality is a value-laden term that means something different to every one of us, but in a business context it is normally about striving to have few or no defects in systems and/or products. Management students write whole dissertations on quality management systems, often citing Japanese concepts such as Six Sigma and LEAN. But what about Any Town Practice on the local High Street – how does it ensure quality?

The practice could embark on a quality standards award – either one specific to general practice or a nationally recognised award, for example, Investors in People. These are all excellent schemes with huge benefits for successful participants, although they can be time-consuming and come with significant costs.

A more pragmatic but still effective approach is to ask patients what they think of the practice’s performance. I am not referring to those surveys imposed upon us from on high but inhouse questionnaires. For me, these are far more relevant and useful, drilling down to the real issues that matter to patients.

Similarly, audits could be undertaken to ensure that practice standards are being achieved and maintained, eg, turnaround times for prescriptions and reports, appointment demand and supply.

The practice manager could invite a fellow manager to assist in a joint review of practice systems. Using his/her knowledge and experience this trusted (an absolute given!) colleague would provide an objective assessment of the practice’s processes and procedures but would also fully understand the impact of any challenges or constraints the practice might be facing.

The two managers would work together to create an action plan that addresses these issues, which the incumbent practice manager would then implement. I have worked with several practices in this way, looking at a wide range of topics including a review of GP sessions to maximise availability, an overhaul of back-office procedures to improve effectiveness and efficiency and customer services refresher training to staff to ensure a friendly but professional service. Peer reviews can be arranged formally through local practice management networks or via informal arrangements between friendly managers.
 
Perhaps you have recently stopped attending your local practice management group meetings? Many managers feel that they should no longer go out to meetings when everyone in the team is being asked to work harder, smarter and probably with fewer staff.

Nonetheless, networking is still part of the practice manager’s role. These meetings provide a wealth (often literally) of information, tips and advice. This includes everything from the best way to capture those new Quality and Outcomes Framework (QOF) points and which drug companies are offering to sponsor practice nurses’ training courses to the cheapest deals on disposable instruments and copier paper.

Make no mistake: this is a sound investment of your time. It is also an excellent support mechanism – providing camaraderie and encouragement to carry on the good fight!

I realise that this might not seem the best moment to advocate giving practice managers even more work but I would argue that now is exactly the right time.

Of course you are busy, facing almost overwhelming pressures and demands on a daily basis, but given the current levels of apathy, cynicism and general disengagement what better time to show patients, politicians and the world in general that your practice is serious about the quality of the services it delivers?

“Quality of health delivery is the aim of all within the health profession and should be embraced even if it means as individuals we need to look at what we do and assess and evaluate our own contributions to the quality process. And if not up to standard be prepared to accept poor outcomes and use these to create changes in oneself by retraining for improvement in knowledge and skills which will give motivation and contribution to outcomes in quality of service delivery assessment” – V Henry, London