Case study summary
York House Medical Practice in the West Midlands is made up of six whole time equivalent GPs, covering a population of approximately 12,000 patients. The practice was experiencing issues with staff cover and rotas, making it difficult to meet the demands on its services and causing increased levels of stress amongst staff. Looking to address the issues the practice took up the Productive General Practice (PGP) Quick Start programme from NHS England’s Sustainable Improvement team. The programme is part of the support available through the General Practice Forward View.
Undertake the Team Planning module of the PGP Quick Start programme to help staff manage the demand on the practice efficiently throughout the year, with appropriate staffing levels in place.
Identifying the issues
The practice team carried out a staff availability analysis where it used data from the previous year that identified staff holidays, sickness, meetings, training and actual staff availability. This information gave a clear account of the impact on staff availability throughout the year and identified peaks, troughs and exceptionally busy periods.
The outcome of the data collection process was reviewed by the management team and GPs, to identify trends, issues and areas for improvement. All staff were encouraged to be involved in the work by sharing their frustrations and ideas for improvement on a staff comments board.
The following findings came out of the staff feedback and data analysis.
- There were high levels of sickness/absence across all staff groups.
- Sickness reporting was ad hoc, resulting in sickness management not being effectively monitored.
- Staff holiday policies and protocols required updating to ensure an effective response to demand on the service.
- Improved communication was needed to ensure all staff receive the same communication, especially part time staff.
- New processes were necessary to ensure sufficient cover was in place by adequately trained staff.
The above findings were shared across the practice and communicated to all staff.
Armed with greater insights into the problem, the team set about making a number of changes.
- Implementing more effective sickness/absence management policies. This ensures staff are fully aware of what is expected of them with regard to reporting to management, and the need to attend a return to work interview.
- Create revised holiday protocols so no more than two people from each staff group can be on leave at any one time.
- GPs to cover their colleagues’ absence where possible, helping to significantly reduce the cost of locums especially during busy holiday periods.
- A staff skills matrix analysis to be completed for the back office/reception/ prescriptions teams, with a view to increase multi-skilling. This would allow for greater staff cover to ensure there was sufficient capacity to deal with the demand on the practice’s services.
In order to sustain the above changes it was agreed that ongoing quarterly audits would be carried out by senior staff.
- By talking to staff about the issues and sharing data that demonstrated the impact staff absence was having on the practice team, it has brought about a change in culture that has led to approximately seven hours of GP time per week released through reduced sickness levels in the clinical teams. Over a year this has the potential to release 364 GP hours.
- Approximately 11 hours per week has been released in the admin team*, over a year this has the potential to release 572 hours.
- Through better team planning and the time released, the practice is better able to meet patient needs e.g. quicker booking of appointments and access to information, continuity of care. The changes have also led to less patient complaints about appointments being cancelled.
- Levels of stress amongst staff have reduced as workload is now managed more efficiently.
* Time released based on 11 whole time equivalent members of staff.
- Effective communication and the involvement from all staff groups will have a profound effect on practice wide improvements – make sure you involve all teams in this work.
- Quality data gathering is essential in such an emotive area as team planning. Give yourself time to collect and analyse the data properly.
Undertaking the Team Planning module of PGP Quick Start has transformed the way we work and support each other as a team. Having found better ways of working there is now less pressure on the team as a whole, we’re working more efficiently and better meeting the demands on our services.
Chloe Hodgkinson, Practice Administrator, York House Medical Practice