Case study summary
Hawkesley Medical Practice has three whole time equivalent GPs covering a list size of approximately 4600. When Hawkesley Medical Practice heard about the support NHS England’s Sustainable Improvement team provide to general practice as part of the national General Practice Development Programme, it saw it as a much needed support to help develop its reception team. After years of working the same way, stuck in numerous and inconsistent processes, they hoped the programmes would help the team to work together more effectively and productively.
The team was led by a practice manager, who attended the General Practice Improvement Leaders programme, which guides participants through a number of quality improvement tools and techniques, which helps to build skills and confidence to support others with making changes. The development of her skills in leading and facilitating change coincided with the practice receiving an on-site Productive General Practice (PGP) Quick Start support package, which helps the practice team release time for care and build improvement capability. Synergy between the two programmes has reenergised and transformed the practice in the following ways.
- Developing the team – in the past reception staff worked in silos and had little understanding of each other’s roles. This placed extra demand on the practice manager’s time who they constantly turned to for answers to questions. The PGP Quick Start module, Clear Job Standards, helped all staff get a better understanding of the tasks the reception team did on a daily, weekly, monthly and ad hoc basis. The work identified various training needs that had never been identified before and gave staff opportunities to develop and fill their knowledge gaps. The team is now more proactive, asks fewer questions and requires less supervision from the practice manager.
- Increasing productivity – using a simple visual management technique, the T-card Board, a system that uses a card for each job that needs completing, has seen the biggest cultural shift in the team and increased productivity. A T-card Board was placed in reception displaying cards of every job that required doing. One side is red indicating the job is outstanding; the reverse is green showing the job has been completed. Seeing this information in real-time motivated the reception team to work together to get jobs completed, staff became more proactive and were more flexible in working at different stations, something that did not happen before. Seeing the board turn from red to green gave the team a huge sense of achievement and teamwork. For the first time in years the reception team is on top of its workload on a regular basis and working to full capacity. This has increased productivity and freed up time, making holiday and leave cover easier to manage.
- Improving processes – numerous inconsistent processes existed in issuing repeat prescriptions, which varied between staff and in some cases were lengthy and unnecessarily time consuming. Using the process mapping tool the reception team, along with clinicians, mapped out the current process for repeat prescriptions which visibly showed the numerous steps involved and the high level of discrepancies that existed. Seeing how much time was being wasted and effort duplicated, the whole practice team supported a reception team leader to draw up a new process. This was approved by all and is now embedded in the practice and used as a training tool for new staff.
- There were 6 reception/ admin staff who between them covered 3.5WTEs (134.25 hours) per week. The changes described have freed up five to six hours per week through quicker handovers and quicker status checking of jobs. A further two hours per week have been freed through better management of repeat prescriptions. In total, this amounts to the release of 5-6% of admin time.
- This time has been reinvested to reduce administration backlogs, thereby avoiding the cost of increased hours. One team member was previously unable to complete the daily task of summarising medical records due to too much time being taken up by reception duties. Increased productivity has freed up time and allowed support staff to complete the work within their existing contracted hours.
- Morale and job satisfaction has improved significantly. For the first time the reception team has been given opportunities to develop and have been empowered to make improvements to the way they work. This has made staff feel more valued and appreciated, especially now that the whole practice team, including clinicians, can see the volume of work they do.