Why is it important?
General practice in constant transformation and should not lose focus on improving efficiency to meet a growing demand for high-quality. In the ever-evolving landscape of general practice, optimisation of GP practices is crucial. Efficient room management not only enhances patient care but also improves the overall functionality and sustainability of the practice.
Estates continues to be a challenge for the NHS, many of the significant challenges relate to aging building infrastructure, maintenance backlogs, environmental sustainability, capacity and demand, and compliance with safety, as well as financial. To address such challenges, does require a strategic approach to GP practice optimisation and a willingness to be innovative.
What a GP practice should consider
This is a significant task, one which will serve as beneficial not just in the short to medium term, but for the long term. The factors that GP practices should consider when assessing practice optimisation are:
(a) Quality of service (beyond beliefs and bias on access)
(b) Safety (include infection prevention and control (IPC)
(c) Security (data)
(d) Care models (pathways of care, (re)design of pathways)
(e) Staff impact (comfort spaces)
Why is important to achieve a mindset shift in GP practice optimisation
Many within the health and social care sector have come across the spaghetti diagram in establishing optimum layout for a room, department or even a hospital ward.
The spaghetti diagram helps to visualise the flow of workers or patients through the premises, identifying potential areas for improvement, and thus, this exercise is best completed with lived experiences of those who navigate the site, and not through completing desk top exercises, where things become a work as imagined, rather than a work as done approach.
Figure 1. Visuals of staff movement around their room
Review with a spaghetti diagram approach will not only, help to envisage what future purpose or repurpose of space can be like, but it can help to drive improvements in the current state as well. This can be particularly valuable to GP practices as supporting evidence when they are writing business cases in a bid to seek further support or funding from their commissioner on estates matters.
There is much research to support the benefits, reviewing and actioning the optimisation of space, both from an engineering, project management (Lean and Six Sigma) perspective but also design of systems and business.
With the image above, imagine replicating this for every space in practice that has people moving through it, you soon realise the complexity of the task at hand. The key is not only to consider optimising floor space, or clinical space, but how to optimise other assets the GP practice has, such as workforce and technology.
To achieve the full level of optimisation, and not just “typical usage” of space, one needs to work through the realisation system (which forms part of user centred design principles (ISO 9421:210)
Working on a methodology known as the Seven Samurai by James Martin, features a cross section, the Realisation System which has many elements, of which some tangible and some not, all will require working through when co-designing and considering how best to optimise the GP practice.
Figure 2. Visuals of the Seven Samurai methodology
(a) people & organisations
(b) facilities & equipment
(c) materials & supplies
(d) services & utilities
(e) processes & methods
(f) tools & techniques
(g) policies & procedures
(h) data & information
(i) knowledge & wisdom
How can understanding GP optimisation delivery in line with modern general practice?
Figure 3.NHSE Model for modern general practice
This model is a way of organising work in general practice that enables practices to:
- see all patient need, by providing inclusive, straightforward online and telephone access.
- understand all need through structured information gathering.
- prioritise and allocate need safely and equitably (including continuity of care)
- make best use of other primary care services and the multi-professional team.
- improve the efficiency of their processes and reduce duplication.
IT infrastructure and utilisation of clinically safe digital resources, really does feed into business continuity when we consider challenges such as CrowdStrike and HSCN dips. How best to encourage roles that support digital use, such as digital champions, digital transformation leads.
Room occupancy mapping to ensure that each room is used to maximum availability during each day of the week that the GP practice is open to support demand and capacity management, consistent with those outlines in the general practice appointment data (GPAD). Also considering how to repurpose it over the weekends and evenings too?
How services are being modelled, both practice contractual ones, and primary care network (PCN) contractual ones, with the additional roles operating from site, with varying skill mix, which supports a more diverse offering to your local population needs.
Staff access, wellbeing and minimal requirements under Health and Safety legislation, have practices converted staff rooms into working office? The impact of that from a human factors’ perspective, noise, confidentiality, pressure. Review where admin task completion can take place, modern general practice model gives practice staff better control over their workload, consistency of processes and workflows improved.
Patients’ perspective, what do they say, in national surveys, local surveys, on site observations, what analysis and percentage of split of demographics such as age, digital literacy. What other data are you considering when managing the optimisation of your GP practice?
Figure 4. How to work through key actions
Where can PCC support with GP practice optimisation:
By undertaking a space optimisation review, PCC can help you to make sure that space is being used most effectively. Our experienced team work with practices to review current usage and to consider opportunities such as, reorganisation of room schedules, flexible use of rooms, hot desking and more agile working, including hybrid working from home or another base, use of void space, collaborative working across PCNs and adaptation of space to provide digital-only consultation space. Contact enquiries@pcc-cic.org.uk to find out more.
Joanna Fox, PCC associate
