Making general practice more effective

A new initiative is putting practice nurses in the driving seat when it comes to improving efficiency in primary care, writes Fran Robinson

Practice nurses are at the forefront of a new programme that is helping general practices to work more efficiently and productively in order to release time to spend with patients.

Called Productive General Practice, the initiative, launched by the NHS Institute for Innovation and Improvement, focuses on increasing internal efficiencies and streamlining processes. It is based on 'lean principles' pioneered by manufacturing industries.

Nurses who have piloted the programme have used it to fine tune appointment times, redesign their schedules and scrutinise their workload and skill mix.

The programme involves all members of the practice contributing their thoughts and ideas about how they think things could be done better.

Liz Wilson, an experienced practice nurse, has been seconded for two days a week from her practice in Birmingham to work with the Institute to provide support and guidance for nurses working through the programme.

'As practice nurses we all work really, really hard and we often think we are doing the best job that we possibly can but often we are quite isolated and don't get the chance to discuss with other people how we are doing things,' she says.

'I want practice nurses to know that their day should not be just about going to work and doing their job. I say to them, You can achieve whatever you want to achieve but you have got to be brave enough to speak up because often we undervalue what we do.'

Sharlene Hodson, a practice nurse at the Concord Medical Centre in Bristol, whose practice was one of the first to test the programme, used a nurse scheduling template to overcome a perceived uneven workload amongst her team.

She explains: 'Our nursing team were divided and some individuals felt there were differences in their work load compared with others.

'Previously, the nurse schedule didn't allow any time to set up for appointments before nurses started work at 9am. We are paid from 9am so there was little incentive to come in early and set up before the first appointment.

'When we analysed the nursing schedule closely we found that there were minutes in the schedule allocated to "nothing time" often at the end of the mornings.

'The idea for change was to reallocate this 'nothing time' appropriately to address the frustration around the absence of time to set up first thing in the morning.

'Now the nurse schedule has the first appointment of the day allocated to setting up. The "nothing time" has been reallocated to add on an extra appointment at the end of the day. So the schedule retains the same number of appointments as before but the time within these appointments is used more effectively to the benefit of the nurses.

'People are happier, with many still commenting that they still have their set up time at the beginning of each day.'

Suzanne Hallworth Manley, a nurse practitioner at Welbeck Road Health Centre in Bolsover, also looked at nurse scheduling in her practice.

This included looking at appointment times and ensuring they were the appropriate length of time.

Care of patients with multiple conditions has now been improved by streamlining services to provide one longer appointment instead of giving patients several separate appointments to review each aspect of their different conditions.

'We are working towards streamlining services to provide one longer appointment for these patients - a "one-stop-shop" approach. It will reduce costs within the practice and give the patient more freedom and ownership over the management of their conditions,' says Ms Hallworth Manley.

'I found it quite challenging to accommodate the demands of the programme into my day to day work, but was determined to do this and wanted to achieve something positive for my team and account for their time within the practice.

'At the outset a few staff were wary of change, feeling that it was being imposed on them, but I was involved in providing management and support for them.

'I myself have learnt better ways to structure my work day. The change has been fully supported and has helped us to build a picture of where we want to be in five years time.'