GP practice in crisis – a case study
Transformation from crisis to recovery and a positive future
Located in a poor socio-economic area of the East of England, this GP practice had been placed in special measures, with the previous service-provider having been removed following a CQC inspection. The CCG responsible turned to McLaren Perry to take over the contract at very short notice for a GP practice in crisis.
After undertaking a rapid, but comprehensive review of the practice, its patient demographic and systems and processes, McLaren Perry found a wide range of issues including:
- Overstaffing, largely with the wrong skills mix
- Poor performance management
- Poor practice management
- No formal systems and processes in place
- Failure to achieve KPIs
- No permanent GPs within the practice
- Patients in a high-need area receiving poor service and support
With the issues identified, McLaren Perry set a two-stage recovery strategy.
The first six months
The critical short-term focus was on creating stability and re-staffing with committed clinicians and support teams offering optimum skills. This required a pragmatic and robust approach to change the workforce model and individuals within the practice, through a combination of redundancy, performance management and natural wastage.
New staff were recruited initially on short-term contracts (coterminous with McLaren Perry’s own contract) using a combination of NHS recruitment services and agencies. Finding permanent GPs proved the most challenge task. However, McLaren Perry’s contacts and experience led to the recruitment of two GPs, with one becoming Clinical Lead. A pharmacist and Advanced Nurse Practitioner were also added to the team.
The first year
With a proactive staff in place, training was the next step in creating a high-functioning practice. McLaren Perry developed a programme to upskill the new staff and ensure optimum training and experience for future career development.
McLaren Perry also assessed organisational priorities and implemented processes and systems for health and safety, HR and governance – both clinical and non-clinical.
From a crisis situation, patients now have a thriving local GP’s practice. A CQC visit in the second year noted the improvements, elevating the practice to ‘Requires Improvement’.
Focus on staff recruitment and training has resulted in no agency staff being used by the practice. There is also greater motivation for personal development. For example, one receptionist was trained as a phlebotomist, subsequently becoming a health care assistant.
Patient feedback and interaction has been transformed. They report as being very positive about ‘their’ practice, with patients and staff collaborating to introduce slimming, ‘knit and natter’ and walking clubs.
Telephone consultations also gained considerable support, allowing patients to speak to a GP and visit the surgery on the same day if needed. The outcome is no waiting times for appointments.
What our client says
“McLaren Perry have significantly improved many areas of the practice including implementing and embedding safe governance processes. A comprehensive action plan was put in place to demonstrate quality improvement and audits have evidenced achievement.
“I have spoken to staff and they have reported feeling safe and supported at work under the current leadership and I have noted it has a positive culture. Patient experience is at the centre of developing the practice and staff appear to be focused on patient care and quality improvement.”
Clinical Quality Lead Nurse – Primary Care, Cambridgeshire & Peterborough CCG