Service merger for a GP practice – a case study
Bringing homeless patients a space under a single roof
The CCG commissioned McLaren Perry to support the move of a primary care homeless service for 600 patients into a large General Practice. This was a multifaceted, complex project. The McLaren Perry team consisted of a Senior and Junior project manager and HR Director.
This social enterprise service for homeless patients was set up by a passionate team of people and sited in a large portacabin. However, the site landlord sold the land, requiring the CCG to move the service. An unsuccessful search for a suitable property led the CCG to request a local GP practice to take over the service at very short notice. This presented a number of challenges:
- Staff did not want to move and/or work for a different employer.
- The homeless team culture was very different to the GP practice.
- Patients did not want to move as they had their own dedicated space.
- The GP practice could not provide the number of consulting rooms, waiting area and administration offices required to run the service.
- Homeless patients would be required to mix with regular practice patients, an unfamiliar and potentially uncomfortable situation for both.
With the practice only agreeing to accept the homeless patients four weeks before the move date, McLaren Perry had to work rapidly to address the challenges.
- An open meeting was held with the homeless patients to explain the need to move the service location and register with a new GP Practice.
- The team emphasised the service retaining a separate area of the building, staffed by their familiar clinicians and administration team.
- To address the concerns of both the homeless service and practice teams, McLaren Perry organised meetings to provide information and discuss any questions or anxieties.
- The homeless team visited the main practice to meet the staff, familiarise themselves with the premises and offer comments and advice, particularly in relation to safety and security.
- The CCG funded major refurbishment to ensure the homeless team staff would have adequate space in the practice building
- The GPs from the main surgery were relocated to upper floor consulting rooms – on loan from another practice – to create consulting space for the homeless service
- McLaren Perry worked directly with the CCG to acquire funding for security cameras, emergency call buttons in consulting rooms and key clocks for the doors.
The logistics of move was carefully planned in less than four weeks. This included:
- Re-decoration to ensure as relaxed and familiar an environment as possible
- Purchase/relocation of furniture
- Installation of IT for patients records, confidential documents, medication and stock.
The relocation created very high patient satisfaction, particularly amongst the homeless service users, evidenced by anonymised questionnaires, interviews and patient representative meetings.
However, the merger had an understandably significant impact on all staff, including the adjacent GP practice that had loaned the consulting rooms. McLaren Perry sent out staff questionnaires and held open meetings to address issues and explore new ideas and solutions.
While positively supported by most staff, the change also brought to the surface longer-term issues. As a result, a number of grievance and disciplinary hearings were required, facilitated by McLaren Perry, with some staff members subsequently leaving.
Shortly after the merger, a poor CQC inspection for the GP practice based on historic system and process issues, resulted in two staff members later resigning and staff morale suffering.
Within a year of the merger, the practice had undergone a transformation:
- The collaborative approach to the grievance and disciplinary procedures ensured a stronger core team remained.
- The GP practice recruited new staff that reflected its values, with an on-going training programme to develop key skills
- New processes and systems were put in place, with MP’s assistance. The most recent CQC visit was positive, with a specific mention of the homeless patient service
- McLaren Perry is providing on-going, weekly support to maintain progress and develop a long-term, sustainable culture and working practices.
What our client says
“McLaren Perry were response and able to mobilise their service at short notice. Their Directors are experience commissioners of primary car and have the leadership and management skills to meet the CCGs requirements. They also understand governance requirements and were able to provide informative and timely reports for the appropriate committees.
“McLaren Perry were professional, effective and delivered on all projects commissioned by the CCG. They developed professional working relationships with members of the CCG, partners of our GP practices, their management team and external stakeholders.”
Lynn Dalton – Director of Primary Care, Herts Valleys CCG