Case study summary
To help achieve a better working life, and to improve services for patients, Thanet CCG supported its practices to take part in the Time for Care programme, which is part of the support available through the General Practice Forward View, delivered by the Sustainable Improvement team, NHS England.
All practices were given the opportunity to choose from any three elements of Time for Care; Learning in Action, Productive General Practice (PGP) Quick Start and the General Practice Improvement Leaders programme. The CCG supported each practice to backfill one GP, practice manager and a member of staff who would work together to test and implement changes in their practice. Practice teams finally had the ‘head space’ and time to participate in a programme that would help them deliver change and improvement.
Collaborative learning and sharing
For the first time practices came together to share and learn, through a series of interactive ‘Learning in Action’ workshops. Sharing their insights and personal experiences, practices found they were facing similar issues and by working together more closely they could help each other; one legacy of ‘Learning in Action’ is this new way of sharing what they are doing. Alongside regular meetings, more informal networks have developed such as a WhatsApp group, where staff are sharing their improvement work, learning, documents etc.
Minster Surgery used ‘Learning in Action’ to develop a new process to reduce the volume of paperwork its GPs looked at. During a workshop the practice manager used the process mapping tool, which he had learnt from the General Practice Improvement Leaders programme he attended, to hold a session on redesigning a new process around document handling. Other practices joined the session and shared what they did in their own surgery, what worked well, pitfalls to be avoided etc. The new process was trialled in the practice and early findings demonstrated positive results (see impact). Practices that had not previously come across process mapping were keen to use the tool, with many displaying the emerging map in their practice and involving their staff in taking it further.
Re-energising and motivating practice teams
The programme increased energy and motivation across practices, helped by the quality improvement support and expertise teams had access to, that enabled them to release time and make changes. For one practice in particular, Summerhill Surgery, the programme has made a significant difference. Run by a single handed GP, the practice is located in a deprived area and there are high and complex patient demands. In the past there was reluctance to engage with any kind of improvement project however, Time for Care was an offer that appealed greatly to the GP, who along with his team fully engaged and participated in the programme. The practice has made significant improvements from creating a more efficient process for repeat prescriptions using PGP Quick Start (see impact). This cultural shift has been a significant achievement for both the practice and CCG.
A stronger relationship between practices and the CCG
The relationship between the CCG and practices has strengthened, making it more a collaborative partnership. The CCG fully integrated in the programme, participating in all the ‘Learning in Action’ workshops and making visits to the practices in between to see how they were progressing. Practices have found the CCG’s support invaluable, its backing and coordination of the whole programme has allowed them to ‘turn up to the sessions’ and focus solely on improvement work.
Below are examples of some of the impact that has already been achieved.
- Summerhill Surgery which has one GP and over 6,300 registered patients, created a more efficient process for repeat prescriptions that resulted in:
- a huge time saving of 13 hours per week within the administration and reception team*, dealing with minor prescription queries, where appropriate encouraging patients to contact their pharmacy in the first instance (i.e. trusting the system)
- less pressure on reception to interrupt other members of staff with queries
- improved working relationship with pharmacies
- saving money on prescribing budget as less waste due to only appropriate medications being ordered
- staff morale has significantly improved, for the GP it has ‘put the joy back into my work’.
- Minster Surgery has five GPs serving over 8,000 patients. The pilot of its new document handling process with one GP averaged 1.5 hours per day being freed up, extrapolating this up it has the potential to save 7.5 hours per week of a GP’s time. Over 52 weeks this could free up 390 hours per year or 2,340 GP appointments. The practice is now working to roll out the new process to all five of its GPs.
- Birchington Medical Centre has a patient list size of 9,000 patients and four GPs. Using PGP Quick Start it developed clearer roles and responsibilities for the admin team and redesigned and / or streamlined internal processes to:
- create immediate time savings for all staff
- save 85% of the deputy practice manager’s time
- clear significant backlogs of work, such as paperwork, insurance reports, admin tasks etc.
- develop a new approach by whole team – do today’s work today, go home on time, take responsibility for own work and/or forwarding appropriately.
- Ensure practices are part of the decision-making, present them with the opportunities and let them choose what they want to concentrate on.
- If possible give support for backfill, money is there within the General Practice Forward View so practices can make an investment within their teams.
- Participate with an open mind, the benefits can be huge if you just give it a go. You will also get the chance to make new contacts you can turn to for support.
Following this process allowed us time to discuss what was happening within the surgery from many angles, giving us the time to identify issues from both the clinical and admin perspective. When we had identified the issues, we agreed solutions as a group and developed the changes that needed to be made to the process which could be sustained into the future. The new process is more efficient and has the support of all staff members as a result of following this procedure.
Lisa Hardaker, Practice Manager, Summerhill Surgery
I am delighted we implemented the programme. The protected time and support to dissect processes, discuss improvements and implement changes in the practice has been invaluable. It was empowering to have the matters addressed I felt needed addressing and with outstanding results in some areas.”
Hannah Price, Practice Manager, Birchington Medical Centre
Whereas before we may have been reluctant to collaborate, practices are now more supportive of sharing and working closer together. This has made a big difference in helping us tackle the challenges we all face.”
Graeme Haggerty, Practice Manager, Minster Surgery
Our practice teams are more energised and motivated now. Time for Care has helped them get closer to achieving that better working day they strive for.”
Maria Howdon, Head of Membership Development, NHS Thanet Clinical Commissioning Group