Numerous challenges presently face GP practices in their position as the principal providers of primary health care in the UK. These challenges, which include increasing workloads, reducing investment, treasury demands for increased efficiency, crises in recruitment, new procurement and tendering regulations, additional patient demands and increasing competition from the private sector have caused many partners to consider the operation of their own practice and to ask themselves whether it is equipped to respond effectively to these demands. Certain partners may reach the conclusion that their practices need only modest adaptations to their organisation, systems, procedures, processes and underlying ethos. Others, however, may decide that a far more fundamental overhaul of the practice is necessary. For those that do require a radical organisational change there are two key requisites to its successful implementation.
1. Agreeing the Need for Change
Any programme to make significant changes to a practice which does not have the agreement of the majority of partners is likely to fail. There may well be those within the partnership who are opposed to change. The reasons for this are likely to be varied but might include fear of the unknown, an inability to perceive any benefits from the proposed changes, a continuing attachment to the “Old Way”, a lack of self-confidence and a lack of confidence in the partners who are advocating change.
Where those advocating change believe that the case for it is clearly made out, it is their responsibility to work sympathetically with the “objectors” to ascertain the reason for their opposition in each individual case, work sympathetically towards alleviating concerns, provide a clear demonstration as to why there is a need for change and set out clearly the benefits to the practice, its practitioners, staff and patients. Whilst it may not be possible to change firmly fixed mindsets, the aim must be to create an environment where the partnership agrees to work together despite the fact that opinions may remain varied.
Clear lines of communication, founded on mutual professional respect, should be drawn with the intention of enabling sceptical partners to join in with the process of change rather than have it forced upon them. In a professional GP’s practice, evolution is far more likely to constitute a firm foundation-stone for change than revolution, which is almost certain to create more problems than it addresses.
2. Managing the Changes
Although the agreement and ownership of the evolution of the partnership by the partners themselves is critical to its success, the way in which the change is implemented is also crucial from the point of view of carrying along the clinical and non-clinical staff and the patients. This is particularly relevant where the evolution of the practice involves (or is perceived to involve) a change in its culture.
The reorganisation of a practice, which is likely to address matters such as the optimisation of costs, the modification of internal processes, a review of staff competencies and efficiencies, revenue development and practice leadership is likely to have a significant impact on every member of the team. It will therefore be essential to the successful implementation of change that the partners ensure that it is properly managed.
As we have already alluded to, persuading all the partners that there is a need to change may not be straightforward. The same applies to the workforce of a practice and it is equally critical that the staff team, particularly those who are most influential within that team, opt in to the proposals. Well-informed, mature and resourceful employees should be enabled by the partnership to overcome any fears that they may have, search for ways to adjust to the proposed changes and flourish under the new culture.
The key to achieving both of these imperatives is communication within the partnership itself and with the workforce from the partners down. Open, clear and frank explanations for the reason behind the proposed change, how the practice and its staff team will be affected by it, what is expected from the workforce in terms of implementation and, of course, how the partners, the practice, the staff and the patients are likely to benefit from the consequent re-organisation will be crucial to the eventual outcome.