“Had we not made the changes we did the practice would have struggled to survive in the long-term” – Bottreaux Surgery, South West

Case study summary

Bottreaux Surgery in Cornwall has two sites and 2.8 whole time equivalent GPs, serving a patient population of nearly 5,000.  A GP and business manager meeting to discuss succession planning brought to light pressing issues around  workload and burnout. The manager, who had participated in the General Practice Improvement Leaders programme, used learning from the programme to help the GPs address the issues head-on. The programme is part of the support available through the General Practice Forward View.

The idea

Use quality improvement tools and approaches from the programme to create a more sustainable way of working that makes GPs happier and want to come to work.

GPs voicing their concerns

A meeting between partners and the practice’s business manager, raised some unexpected concerns by one GP who expressed he was struggling to work eight sessions a week, and spend time with his young family. He was worried that current working levels were unsustainable. Recognising the long-term sustainability of the practice was at risk, the group decided to do something about it and started by first pinning down what they felt the issues were.

  • The work-life balance for GPs was wrong; the younger GP in particular was feeling burnout and wanted to spend more time with his young family.
  • Due to cost there was reluctance to book locums unless necessary, putting greater pressure on GPs when covering annual leave and absences.

Taking a creative approach to sustainability

The practice used creative thinking tools from the ‘Thinking Differently’ toolkit to begin considering how they could improve their position. Firstly, using the ‘Reframing by word play’ tool, the manager worked with the GPs to draw up a statement that best described what they needed to do to achieve personal sustainability. Their statement was; To be happy and not poorly at work, to have fun at work, and to play more.

Having created their own statement, the GPs felt compelled to change the way they worked.

Breaking the rules

The manager encouraged the GPs to list all the unwritten rules they currently work to and counter each with one way they could break them (see examples below).

     Unwritten rules      Break the rules
  • Start at 8:30am and finish at 6:00pm.
  • Always accessible/never get away.
  • Appointments keep getting added.
  • Work eight sessions a week.
  • Change the time they worked.
  • Say no.
  • Work less than eight sessions a week.
  • Employ a salaried GP or work six sessions a week.

The “Breaking the rules” tool opened up ideas and ways they could make the practice more sustainable.

Striking a better work-life balance

Following a review of the weekly GP rotas and learning from other practices as to how they managed sustainability, the manager found too many tasks squeezed into the GPs’ working day. Each GP had morning and afternoon sessions four days a week with 10 minutes either side for staff queries. Queries were often put to them when they arrived first thing in the morning and feedback from staff showed that many went unanswered. To help the GPs have a more manageable working week, the manager created a new rota which the GPs tested and subsequently agreed to implement.

Week one Week two Week three
Six sessions (three days) Six sessions (three days) Eight sessions (four days) including one evening surgery and on-call

The new rota system has two GPs working six sessions per week and one working eight sessions. No GP works more than two days in a row and the GP working the four day week has the following Monday off. To cover annual leave GPs may occasionally be required to work two eight-session weeks back to back, but this is not the norm and would only be done to reduce the need to book a locum which can be difficult.

Queries are shared amongst all GPs and now moved to later in the day when they have a break after patients; 30 minutes are put aside instead of the usual 10 minutes allocated before. This allows GPs to spend 20 minutes on questions and a further 10 for contingency.


  • The work-life balance for GPs has been hugely transformed, they no longer feel stress and burnout. They are now able to manage their daily workload better, helping them get home by 6.30pm whereas previously it was 10.00pm.
  • Workload is shared equally amongst all GPs.
  • The practice is more attractive to new GPs e.g. a new salaried GP looking to join the partnership tested the new rota system and found it worked with commitments to her young family, and so continued on to partnership.
  • Staff are happier their daily queries are being answered in a managed, timely way.
  • The long-term sustainability of the practice means patients will continue to have access to their local surgery in the foreseeable future.
”I feel like I have been given a gift.”
Sam Radford, GP Partner, Bottreaux Surgery


“Had we not made the changes we did the practice would have struggled to survive in the long-term”
Matthew Gibbons, Business Manager, Bottreaux Surgery

If you would like to find out more about participating in the General Practice Improvement Leaders programme, along with details on how to apply, visit our web page.