General Practice Improvement Leader’s Programme

Turnaround of a general practice in London

Case study summary

A general practice in London was deemed inadequate by the Care Quality Commission (CQC).  As a result the provider was deregistered and an operations manager from a caretaking team put in place to turn the practice around.


The idea

Using tools, techniques and facilitation skills from the General Practice Improvement Leader’s programme, the operations manager took the lead in getting the practice up and running again, and in a position to provide a basic service for patients.  The following elements of the programme enabled this to happen.

Managing change – the manager recruited an entirely new administrative team and two permanent GPs.  Different components of the Change Model, a framework for transformation and sustainable change, helped build engagement and commitment once the team was recruited.  Central to the model is ‘Our shared purpose’, where working through the history of the practice through to the future vision was key in engaging/getting buy-in from the new practice team.

Building effective relationships – fundamental to the practice’s success was having an effective administrative team in place.  The programme’s Human Dimensions module helped identify what motivated team members, who had all come from varying backgrounds and experiences. Working together to identify a shared purpose speeded up how quickly the team was working together effectively.

Improving pathways – A focus on safe medicine required reviewing and improving pathways.  Various process mapping tools were used to define the different activities involved in existing pathways for diabetes and mental health.  This helped streamline the referral process for some conditions, or improve them so the GPs spent less time on admin.  There was also a reduction in the numbers of letters being provided for patients for unnecessary items such as housing and gym membership.  For patients needing diabetic reviews as well as medication requests, the pathway was improved to make it less labour intensive and utilise fewer staff, which freed up more time.  Furthermore, the route that incoming letters took was streamlined, the admin team became involved which reduced the workload for the GPs, allowing them more clinical time and reducing their administration needs.


Within 12 months the practice was up and running again for 6,500 patients.  A subsequent visit from CQC achieved a good rating throughout.   The practice manager said:

“The overall improvement in surgery efficiency and freeing of clinical time for the GPs was the main aims of the reviews we undertook.  With the help of the tools and ideas I had brought from the programme, these were all achieved.  Without having gained these additional skills and knowledge, it would have taken a lot longer and I doubt we would have got the “good” overall rating we achieved with CQC in the time frame we managed.”

The manager’s increased confidence meant they felt comfortable attending meetings with CQC without a GP present.  They are now sharing their learning with other practice managers in the area to make their own local improvements.

Implementation tips

  • Working together to identify your shared purpose as a team helps engage everyone and connect you to your goal through the values you share
  • Do not underestimate the value of facilitation skills in meetings – effective facilitation can make meetings more focused with better outcomes
  • Process mapping may not always give you the outcomes you expected but the exercise itself can be valuable in engaging people and giving them time to reflect