Ockham Healthcare: Supporting innovation in General Practice

The Six Stages to Effective GP Recruitment

In this week’s Blog, guest blogger Nick Mattick demonstrates that GP recruitment cannot be rushed as he outlines the key stages to effective recruitment and spells out the common mistakes practices often make.

It’s a common misunderstanding in GP recruitment that spreading the net as wide as possible and throwing money around will solve the problem. But, in the current recruitment crisis where there are simply not enough GPs to go round, this is unlikely to be the case.

The reality is that your GP vacancy is only likely to appeal to certain people and to attract those people, you need a clearly defined strategy which outlines who they are and how you can target them. The lack of a strategy, or an ill-defined process may not only fail to deliver you any appropriate candidates – it could even lose you applicants who walk away in frustration.

In this blog I am outlining the six key stages to developing such a strategy. They are:

1.Define your candidate – What does the practice want and who is most likely to apply? Focus on who your candidates are likely to be dependent on the type and location of the job on offer. For instance candidates with young families are most likely to want facilities, infrastructure and flexible hours. Whereas those a little longer in the tooth, with the kids off at university, maybe downsizing and wanting to get away from the busy city.

What qualities might a successful candidate possess and how does the practice make itself more attractive to those candidates? Here, you need to consider how the practice will respond to issues such as work/life balance, portfolio roles, specialist training and, perhaps, opportunities to work with other practices to offer more exciting or innovative roles etc.

2.Candidate Attraction – This means getting your defined applicant to see your advert. Your advert is an excellent way to demonstrate what you have to offer candidates. But too often I see lazy adverts which say something bland like; “we’re a friendly team, this is our list size, our IT system and our opening times – come and work for us.” But adverts like those could be for any practice, anywhere in the country. You must find your unique selling point (your USP) and get applicants to become interested in the story you tell about yourself.

For your advert to stand out amongst all the others, you will need to advertise where your defined applicants are likely to be looking, so consider using Google AdWords, LinkedIn and Facebook; these have great tools to really focus on selling your job to the right people.

3.Candidate Handling – How do you deal with applicants once they have expressed an interest? Communication is key. Always acknowledge a CV and give a timeline for your process. Tell applicants what documents you will want from them, and ask them what they want from you.

Have ready all relevant documentation that applicants are likely to need including, as a minimum, the current Job Description and a Person Specification. But also consider CQC reports, Ofsted reports about local schools etc. Offer applicants informal visits and be prepared to help with estate agents or organising house viewings. And don’t forget to ensure your practice website is up-to-date.

4.The Interview – The interview is not just about candidates selling themselves to you; it is your chance to sell yourself to candidates. So be organized on the day and pre-plan questions; agree who will ask what questions when.

A clean, uncluttered, open and light room will put your candidate at ease. Try going informal – don’t sit behind a desk. Offer a tour of the practice and introduce them to colleagues – but most of all, however you do it, make them feel welcomed.

5.Negotiation – Once you have found your candidate you are aiming to achieve a Win: Win. You probably won’t get exactly what you are looking for and you probably aren’t exactly what the candidate is looking for either; so consider how you will “close the deal” and get both parties as close as possible to what they are looking for. Agree in advance what are “red lines” and what’s up for discussion. Many people, when recruiting, think it’s all about the money – but in most cases it isn’t. Find out what’s really most important to a candidate.

6.On-boarding – This is about getting your candidate to the start line and to hit the ground running. It’s more difficult in GP recruitment because of the long notice periods that lock GPs into jobs – usually for 3-6 months; so make sure you continue to engage with your candidate during this time.

Invite them to practice meetings or social events, offer help with finding somewhere to live, get all the paperwork and compliance done in advance and offer them an induction session before starting. Keep up the communication and start forming relationships early.

If you’re looking for an urgent start consider “buying them out” of their notice period. On Day One make sure you are ready for them to start with email and log-ins available, a list of who’s who and housekeeping issues clear such as how the phones work and how to get refreshments; and even think about, as a particularly nice touch – a welcome gift!

In essence then the key lessons for GP recruitment are:

Recruitment is not something that can be done over a sandwich at your desk – it requires a lot of effort, work and planning.

  • Don’t expect to place an ad in the BMJ and have candidates queuing at the door; you have to work for them.
  • It will take some compromise.
  • Don’t be locked into a mindset of replacing like for like recruitment is an opportunity to change, to freshen things up.
  • Recruitment is all about up-front planning, a clear process, adapting and communicating.
  • Above all – you need to sell, sell, sell!

Nick Mattick is an expert in Clinical Recruitment & Recruitment Strategy. Nick has worked for NHS and private healthcare service providers and recruitment agencies. You can contact Nick:

Call 029 2051 2517 or email Nicolas.mattick@me.com

 www.OliverRose.net

 Recruitment strategy, planning, help, support, advice & experience in all things Clinical Recruitment. We’re not an agency – we help you to avoid having to use one.

Transforming general practice: The CCG Dilemma

CCGs face a choice. They want to support GP practices to make the changes necessary to get out of their current malaise and to play a more active role in change across the wider system. To do this there are two approaches CCGs can take. Their dilemma is which one to choose.

The first approach is the easiest choice to make. CCGs focus on changes that will impact on all practices. So for example this might be creating incentive systems for practices to get involved in things like managing the complex frail elderly. It may even look like offering services for practices working together, for example to offer extended access. The £3 per head for general practice is divided up evenly for all the practices, and everyone gets their fair share. The proposals are acceptable to the practices, the LMC is happy, and they are deemed equitable by all.

The problem is no actual transformation happens. Practices continue to struggle, emergency admissions continue to rise, and the distance between general practice and the rest of the system does not really change.

The second approach is more challenging to implement. CCGs focus on supporting the small number of practices most likely to drive transformation. They do not make funding and development opportunities available to all. Instead they identify the most dynamic and progressive practices, the ones with a track record of making changes, who are actively seeking to grow, and who have leaders who can make things happen. The CCGs invest in these practices. They ask them what support and resources they need, and they provide it. They work with them to develop solutions that work for general practice as well as the whole system.

It is not an approach that will be popular. The majority of practices will be against it because they will see an uneven share of resources flowing to the “favoured few”. CCG board members whose practices are not part of the selected group will be against it, and they will become representatives of practices who not only are struggling but are now not receiving any further investment. LMCs will be against it because they have a responsibility to represent the wishes of all practices.

But popularity of an approach is not a great indicator of its chances of success. The question for CCGs is do they want the changes in general practice to happen at the pace of the quickest, or the pace of the slowest? The problems in general practice require radical change; changes many practices are not prepared to take. Working with those most likely to make these changes is a far more sensible strategy than it might first appear.

Practices who can make change happen can work with CCGs to overcome the initial resistance. The natural GP leaders are by definition already in these practices. With support they can bring the rest of the practices along. It can still be an inclusive strategy – it just has a different starting point.

The stark reality is the transformation of 7800 GP practices will not happen at the same pace. We are already seeing a small number of practices embracing the need for change and making the most of the opportunities that exist to make themselves fit for the future. But many practices are stuck, unable to find a way forward or to overcome the internal resistance to making the necessary changes. I would argue that hanging on the coattails of those who are moving forward, and focussing support, time and energy into them, is the only approach that will actually deliver results.

10 Surprising Lessons from over 50 Podcast Guests

I had just finished an hour long interview (by Skype) for the podcast. The conversation had gone well, and I was excited by the quality of the content. As usual, I started to upload the recording for editing. Only nothing was happening. Panic started to well in the pit of my stomach, as I pressed buttons and searched for the audio file. But the file wasn’t there. The conversation hadn’t recorded.

I am not a technical person. I don’t have a background in radio or recording. I started the podcast as a platform for great practice, new ways of working and innovation in general practice to be shared. Learning how to use the kit has probably been my steepest curve, but I have learned other things (about GPs, about general practice, about podcasts as a platform for sharing) from the many guests I have had the privilege of interviewing. Here are the 10 most surprising:

  1. Very few GPs use Skype. With all the chat about Skype GP consultations this wasn’t a problem I predicted, but I would say over half of the GPs I have spoken to had to set up an account (or ask their teenage children to set up an account for them).
  2.  Academics are rarely given a platform to discuss the implications of their research. When academics produce research they become very clear about what it does and doesn’t prove or say. However, here in the real world we are interested about the application of their research to our daily lives. Some academics have loved the opportunity to explore this, but most feel well outside of their comfort zone!
  3.  The non-GP general practice workforce doesn’t feel heard. When we talk about general practice most of us immediately think GPs. But there is a whole other “hidden” workforce out there of nurses and other clinical staff, as well as the practice managers and administration teams. These groups do not feel well represented, and the podcasts involving these groups have had tremendous support from their peers.
  4. Physician associates can add real value. A year ago when I discussed new clinical roles in general practice with GPs many were quite open to the idea, except for physician associates; the mere mention of whom usually provoked a withering look. However, our occasional podcast series exploring their impact has shown they can add tremendous value to practices.
  5. Locums are not all bad. An even less popular group than physician associates are GP locums. Last year we explored why GPs become locums, and the concept of GP locum chambers, and learned in a world where there are not enough GPs we need to find ways to make the most of this critical resource.
  6. It is not just GP practices that are independent, it is also those providing support to GP practices. We all know there are c7800 GP practices who contract independently with the NHS. Less well known is that what this in turn leads to is a sporadic and independent group of individuals and small companies that provide support to general practice. You won’t find many commissions for the big four consultancy firms from individual practices!
  7. The changes with the biggest impact are not necessarily the most complex. The change that I have seen with the biggest impact is “workflow optimisation” or, alternatively, “keeping the post away from the GPs”. It can save up to an hour of GP time per day.
  8. Great editing can perform miracles. Not everyone who comes onto the podcast is a fluent orator. But listening to the podcast you wouldn’t necessarily know it. On the other hand I have finished recording interviews and wondered whether there will be any tape left that we can actually use, once the stumbling and disjointed sentences have been removed. But out of the editing suite come these coherent, intelligible productions that make both me and the guest sound great.
  9. Being on the podcast creates opportunities for guests. I am not sure I anticipated how positive an experience being on the podcast could be for those being interviewed. For example, I recently received a note from previous guest Mia Skelly who said, “People’s general feedback has been very complimentary and it’s given me some wonderful opportunities to continue to promote general practice nursing”.
  10. The Ben Gowland podcast is not the best name for a general practice podcast. When I came up with the title I thought it sounded good(!), and I have been surprised to learn that 1) the title in no way explains what the podcast is about, and 2) people not knowing what it is about can make it harder to access. As a result, we are going to go for the slightly clearer but less narcissistic title “The General Practice Podcast” from April.

Maybe only some or even none of these things surprise you. But they all surprised me, and I am looking forward to continue being surprised by the second year of the show. Thank you for all your support over the last year, and if there any changes (other than the title!) you think we should be making, please do get in touch.

Why making change in general practice is difficult

I wanted to leave my job as a CCG Chief Executive for a long time. But it took many months until I finally handed in my notice. I was nostalgic about the past, and clung to memories of a time when I had loved the job. My attachment made leaving difficult. Despite the relentless, day to day pressure there was always this nagging concern; if I left I would no longer be needed in the same way. And I was not 100% clear what my new future would look like. In many ways a bleak certainty was easier to cope with than the uncertainty of the unknown.

I don’t think I am alone. Letting go (of control, of certainty, of routine) is difficult for all of us. Unfortunately, nearly all of the things that can make a difference for general practice seem to involve GPs “letting go” in some guise or other. So, for example:

  • Practice mergers. These involve GPs “letting go” of the control of their (smaller) practice for a lower amount of control in a bigger practice.
  • Introducing new roles. Bringing in clinical pharmacists, paramedics, physician associates and the like involves GPs “letting go” of some of their workload so others can take this on.
  • Workflow redirection. If you have not come across this yet you should (listen to this), but effectively it involves GPs “letting go” of their post, and trusting much of it to be handled by others.
  • New models of care. Okay, not yet a common solution but a designated national direction of travel, and it involves GP partners “letting go” of their independence and becoming salaried employees or, at best, board members in an NHS organisation.

This is why making change in general practice is difficult. It is why practices don’t merge, don’t introduce new roles, don’t make changes to how they operate, and don’t jump into bed with the local hospital just because they are under pressure. The changes may be logically sensible to an outsider, but if they are not underpinned by a strong desire to take whatever action is needed they won’t be implemented.

The big mistake made by those trying to lead change in general practice is starting with the solution, with a description of the change that is to be implemented. Taking the desire to actually make the change for granted, on the basis of the parlous state of general practice, is a fast track to failure.

Professor John Kotter, regarded by many as the leading contemporary expert on change, believes[1] assuming people know they are in trouble and need to change, and focussing instead on strategy and solutions, is what kills most change efforts. He differentiates between a “false” sense of urgency whereby people feel anxious, angry and frustrated, and a “true” sense of urgency whereby people have a powerful desire to move, successfully, now. The former does not lead to taking action, but the latter does. GPs feeling under pressure and angry is not the same as GPs wanting to make a change.

Ultimately I made my decision to leave based on a strong desire to create a new future for myself. After many months of anxiety, frustration, and (frankly) inaction, I reached a point of determination to make a change, however hard it would be. It was only then I was able to actually resign. To be successful, those leading change in general practice must first focus on establishing a sense of urgency for change, before ploughing into the details of the uncertain future they want to create for their GP colleagues.

[1] A Sense of Urgency, Kotter J.P. Harvard Business Review Press, 2008

Why the new GP contract is disappointing

There has been a cautiously positive reaction to the GP contract. But for at least one enthusiast for general practice, it doesn’t live up to its promise. Here, Ben Gowland explains his huge disappointment…

The GP Forward View was published in April last year. It promised an additional recurrent investment of £2.4bn into general practice. But for all its rhetoric, the finances have been hard to pin down. After a raft of national pots of money that have all translated into very little at local level, all hopes were pinned on additional money arriving in the core contract.

And has it? Well in 2015/16 the contract was uplifted by £220m, the equivalent of 3.2%. That was pre-GPFV. So what was the outcome of the 2016/17 contract, the first one after the publication of the GPFV? An uplift of £239m, or 3.3%. An almost identical award.

What does it mean for the promised additional £2.4bn? Well at the current rate of uplift, which does not like it will change, an additional £1.3bn will have been added by 2020/21. The global numbers sound a lot, but the reality is last year’s contract award did little to assuage the problems faced by general practice, and there is no reason to believe that similar uplifts next year and for three years afterwards will have a greater impact. The rises continue to be offset by a parallel growth in costs.

The tinkering with the elements of the contract, and moving money from one part of the contract to another, really only acts as a smokescreen for the overall failure to invest. It creates opportunities for people who don’t understand general practice to complain about specific elements (e.g. funding the cost of CQC registration), and leads to odd behaviours (e.g. locums increasing their fees by 2% because of the indemnity reimbursement).

The only significant recurrent additional funding in the GPFV, on top of the contract awards, is the funding for additional access. This is £500m, and we know it translates into £6 per head of population. But it is not funding for individual practices. The sites involved in the prime minister’s challenge fund, which receive the money recurrently from April onwards, have to bid for a large single contract. So it is only really available to large organisations. Plus, individual practices just don’t want to do it. As one GP explained to me, if a practice receives what amounts to £115 per patient for 8 – 6.30 Monday to Friday, why would they extend that to 8 to 8 7 days a week for an additional £6 per patient?

So where is the rest of the GPFV money? £2.4bn has been promised. £1.3bn will be in the core contract. £500m is for extended access. Where is the other £600m? I have not yet met anyone who can answer this. It begs the question as to whether it will ever arrive.

Worse, NHS England are predicting a £70m underspend on primary care and public health budgets this year. An underspend that will offset an overspend in the acute sector. Changes to the tariff have pushed many CCGs into financial difficulties, and it seems unlikely all will be able to meet the requirement to provide £3 a head to general practice in the next 2 years. And it is not official, but I am yet to meet someone who does not believe the promised £900m capital fund (the Estate and Technology Transformation Fund, or ETTF) has been cut.

The GPFV made specific promises about putting funding into general practice. This year’s contract award was the last chance for NHS England to demonstrate it was going to meet these promises. But the contract disappoints, and instead reinforces a growing belief these promises are never going to be met.

Page 4 of 13
12345613