Someone I know, who is not a health care professional but has dedicated most of their working life to supporting improvements in health and health care, recently shared with me their observations about general practice. Rather than focussing on poor performance they studied the good to find out what it was that made them different. They studied readily available data and looked in detail at a number of practices who consistently delivered high quality services, which patients appreciated, whilst using fewer resources than most other practices.

Their key findings were that senior staff had good listening skills and demonstrated respect for others. Importantly, they had systematic ways of knowing that they were doing good things consistently.

How? The observations my friend made were:

1. They had clear objectives, known by the whole practice team
2. They had a framework of criteria to make decisions which included:
   • A duty to use every pound provided by the NHS to best effect
   • To do the best possible at the lowest cost possible
   • To be focussed on solutions not excuses
3. They believed that:
   • Patients have a right to be seen promptly, with respect, to be informed and involved in decisions
   • The practice has a right to minimise costs to the NHS
   • All staff have a right to simple processes
   • The practice has a right to expect loyalty
   • Every mistake or area where performance is not the best is an opportunity to learn and improve
   • All ideas are worthy of consideration
4. The conversation and communication in the practice is:
   • Positive
   • Supportive
   • Challenging (there is no hiding place for an individual or collective if performance is not good enough)
   • Open, honest, and seeks to engage others in decisions
5. There are regular, structured discussions about:
   • Complaints
   • Serious incidents and near misses
   • Compliments
   • Relevant national (e.g. NICE) guidance
   • Audits and follow up audits
6. They only gather data that has a clear purpose and use templates at every opportunity
7. When faced with data about mistakes or poor performance they follow a strategy to improve performance by:
   • Discussing the issues
   • Setting a realistic goal for improvement
   • Agreeing who will do what by when
   • Follow up and follow through
   • Reviewing performance.

What was also apparent was that every member of the practice was proud of where they worked.
Clinical commissioning groups have a real opportunity to spread best practice, compete on quality, and use the current reforms to drive change bottom up rather than passively wait for top down instruction. If anyone can do it I believe general practice in the UK can because all the ingredients are in place for it to happen.

Worth reflecting on?

Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.