Menu for Practice Management Development

MENU FOR PRACTICE MANAGEMENT DEVELOPMENT

Marion Foster Reviewed March 2012

Since the introduction of the 2003 General Medical Services (GMS) Contract, there are greater expectations and demands on the professionalism, capabilities, knowledge and skills of the Practice Manager.

If Practice Managers are to meet the new challenges of the ever-changing NHS and General Practice, they have to be more competent than ever before and have the knowledge and skills to deal with the quantity, chaos and complexity of information relevant to the Practice Manager’s eclectic role and responsibilities.

There are concerns about information overload and the fear of “not knowing what you don’t know” and anxiety of “knowing what you don’t know” and not knowing how or where to find the information or someone with the knowledge. In this profession, “Ignorance is bliss” is not a wise state to be in.

Effective Practice Managers and Leaders don’t have to keep knowing “more stuff”, but they do need to know which “stuff” matters. They also need to develop Leadership Wisdom, which is not a “mental encyclopaedia of facts”. According to Meacham (1983)[1], Wisdom is the awareness of the limits of one’s knowledge. Wisdom has the humility to recognise that the “more one knows the more one knows that one doesn’t know” and recognises that learning is not confined to specific places and times in our lives but embraces self motivated, lifelong learning.

“Knowledge, wisdom and experience are your real possessions, which fire cannot burn, nor can a thief steal." The Naladiyar

© NHS Education for Scotland 2012. You can copy or reproduce the information in this document for use within NHSScotland and for non-commercial educational purposes. Use of this document for commercial purposes is permitted only with the written permission of NES.

Frequently Asked Questions

Q. Where do we find out what we don’t know?

A. “The Menu for Learning” Learning Needs Analysis (LNA) tool

Q. How did you know what to include in the “Menu for Learning”?

A. We researched the following:

1. The General Medical Services Contract (2003/4) Annex B and C: Contractual and Statutory Requirements and the Competency Framework for practice management which sets out three levels of knowledge and skills which should be available to General Practice. The Menu for Learning is structured using the headings of this Framework

Annex B

Annex C

2. Institute of Healthcare Management (IHM) Competence Framework. This Framework is derived from three main sources: the Knowledge and Skills Framework (KSF)1, the Leadership Qualities Framework (LQF)2 and the generic standards produced by the Management Standards Centre (MSC)3.

1.Knowledge & Skills Framework: Department of Health, 2004, (retrieved 18/07/10)

2.Leadership Qualities Framework, Modernisation Agency Leadership Centre, 2002, (retrieved 18/07/10)

3. Management Standards, Department for Education and Skills, 2004, (retrieved 18/07/10)

3. NHS Scotland Quality Strategy, 2010: Clinical and Staff Governance for General Practice in Scotland. Clinical and Staff Governance are key components of the delivery of high quality care.NHS Scotland Quality Strategy, 2010

Q. There is so much! How can we manage this learning?

A. Carry out an LNA by completing the following tool with your trainer then prepare your Learning Plans. See “The Learning Contract” and example learning plans.

Q.How can this relate to my Portfolio?

A. The contents of your Portfolio should be organised under the headings of the IHM Competency Framework. You should have three examples of evidence for each Competency. (See further guidance on preparing your portfolio in the Trainee Handbook). The information gleaned from the LNA tool and the Learning Plans, will inspire and aid the organisation of your Portfolio.

Resource Headings

MENU FOR LEARNING

1.General Medical Services Contract (2003) Annex C: Competency framework for practice management

Practice Operation and Development
Risk management and assessment
Partnership Issues
Patient and Community Service
Finance
Human Resources
Premises and Equipment
IM&T
Population Care

PORTFOLIO

2.Institute of Healthcare Management (IHM) Competence Framework.

1.Communication and working with others

2.Managing Risk

3.Optimising Resources

Optimising the richness and diversity of the workforce

Optimising physical and financial resources

Optimising IT and Information resources

4.Leading Change

Organisational change

Service development

Improvements in quality

5.Developing oneself and others

6.Working with People

Leading and building teams

Assigning work to colleagues

Recruitment, selection and retention of people

Monitoring and assessment of performance

LEARNING NEEDS ANALYSIS – THE PROCESS

The LNA will help to determine the gap between existing skills, knowledge and abilities of the trainee and identify the Learning Objectives and set Goals, develop Learning Plans and Tutorial Program.
Adults learn better, when they can see a reason for a programme of study and its relevance.
The Menu for Learning is the resource identifying knowledge and skills relevant to the role of the effective Practice Manager.
Why conduct a LNA?
A LNA will help:

Identify what skills and knowledge the trainees already have

Highlight skills/knowledge/competencies that need developing and prioritise them

Identify clearly what trainees wish to achieve

Outline and define expectations and goals

Determine what can realistically be achieved given the available resources

Identify any obstacles or difficulties which may arise

Increase the sense of ownership and involvement of the trainee

Identify the content that best suits trainees needs

Determine what is the most appropriate delivery format

Determine what skill set and knowledge base is required of the tutor

Develop a budget and cost benefit analysis

Establish when is the most suitable time to deliver the tutorial and over what time frame

Ascertain the most suitable evaluation mechanisms

Outline what results can be expected and if/how these can be measured

APPROACH
Identify Competencies
The LNA is the process by which individual learning and development needs are established. The information gathered will assist in identifying and addressing tasks, skills and knowledge gaps required to meet the individual’s personal and professional needs, now and in the future. The data will be used to form key elements of the Learning Program and produce an overall knowledge and skills report.
The Method
The following LNA tool is designed to be conducted as discussion on a one-to-one basis between Trainer (Mentor) and Trainee (Mentee) and when appropriate the Trainee’s Practice Manager.
Consider and record your perceived level of competence and on completion return to the beginning and prioritise the learning needs. Take into consideration the training programme topics which will already dictate prioritised learning and be timetabled. You may then be able to plan and programme your tutorial topics
Learning Needs Analysis (LNA) Report
Following the completion of the LNA tool, you will have produced a Report to be used to identify the prioritised objectives.
Learning Plans
The Learning Plans will ensure the Program is developed to meet the prioritised needs identified in the LNA Report.
Evaluation & Assessment Approach
Evaluation & assessment is demonstrated by compiling evidence of learning in the Trainee’s Portfolio, Reflective Diary and the Trainer’s report.
VTS CYCLE OF LEARNING

LEARNING NEEDS ANALYSISSCORING GUIDANCE AND PRIORITISING
0 = Unconscious Incompetence

You don’t know what you don’t know and are unaware that you don’t have the knowledge or a particular competence. It is possible that your confidence may therefore exceed your abilities
You may neither understand nor know how to do something
You may deny the relevance or usefulness of the new skill and not have a desire to do anything about it.
You must become conscious of your incompetence before development of the new skill or learning can begin
The aim is for you to move into the 'conscious incompetence' stage (Score 1), with understanding of the benefit that it will bring to your professional effectiveness
Even though you have scored a topic at 2 or 3, you could also be 0 without knowing e.g. Employment legislation. When new legislation is introduced, you have to have a safety net in place to alert you and move from Score 0 to 1.

1 = Conscious Incompetence

You now know what you don’t know
You realise that there is a gap in your knowledge or skill base
Consider whether this learning is a priority this year
Where does it rank compared to other areas that you have scored 1 and 2?
Do you just need to be aware of this area and stay at Score 1 and empower another colleague to be at Score 2 and 3?
Is this a realistic priority? Is there a training opportunity; are you able to resource the information for self directed learning?
Will you have the opportunity to practice your new knowledge and develop the relevant skills?
What level of skill is required for you to effectively carry out you role.

2 = Conscious Competence

You understand or know how to perform the skill without assistance.
Able to demonstrate the skill or knowledge. Requires consciousness and concentration.
You have the opportunity to use this new knowledge and develop the relevant skills further?
Practice is the singlemost effective way to move from Score 2 to 3.

3 = Unconscious Competence

You have had so much practice with a skill that it becomes "second nature" and can be performed easily (often without concentrating too deeply).
You can be unaware that you know what you know
This level arguably gives rise to the need for long-standing unconscious competence to be checked periodically against new standards
You may or may not be able teach it to others, depending upon how and when it was learned.

Prioritise – After carrying out the scoring exercise return to the start of the list and use this column to identify your agreed priority areas for further learning or tutorials.

Practice Operation and Development

0 1 2 3 Prioritise

The General Medical Services (GMS) Contract and other contracting arrangements to include: [i][ii]

Core services etc

QOF, enhanced services etc

Annexes A,B,C[iii]

Statement of Financial Entitlement (SFE)[iv]

Understanding the NHS organisation: The internal and external organisations [v]

Awareness of Local and National Health Policy and Targets [vi]

Understanding effective communication within the NHS [vii]

Understand the principles of Care Pathways and how to facilitate process [viii]

Awareness of relevant National Legislation and how to be aware of and implement changes [ix], [x]

Strategic Management and practical application of theory [xi][xii]

Change Management and practical application of theory [xiii]

Project Management: Techniques and practical application of theory [xiv][xv]

Information and Knowledge Management: analysis; models and processes; resources; acquisition, organisation and use [xvi]

Writing Development Plans/Reports [xvii]

Organisational Culture and Practice Policies and Procedures. [xviii]

Meeting Management and Facilitation skills [xix][xx]

Ethical Practice. General Practitioners Committee (GPC), General Medical Council (GMC) Good Practice, IHM Code - Norland Principles [xxi][xxii]

Clinical and organisational audit [xxiii]

Development and Innovation in the workplace.

Time Management

Risk management and assessment

0 1 2 3 Prioritise

Clinical and Staff Governance issues and Statutory requirements [xxiv] [xxv]

Best Practice in Health, Safety and Security [xxvi][xxvii][xxviii]

Ensure compliance with statutory requirements and best practice [xxix]

Develop policies and monitor/evaluate effectiveness

Risk assessment. Risk Management process, policies and strategy [xxx]

The Organisational Culture, Practice Policies and Procedures.

Building and sustaining a Safety Culture promoting Quality Improvement [xxxi]

Risk Safety and Quality Improvement Methodologies e.g:

Audit [xxxii]

Significant Event Reporting[xxxiii]

PlanDoStudyAct Cycles

Problem Solving Techniques e.g. – 5 Why’s

Models for improvement

LEAN etc

Service Redesign

Rapid case note review

Problem based Learning

Root Cause Analysis[xxxiv]

Occupational Health Processes. Statutory requirements. [xxxv]

Managing Poor Performance

Appraisal/mentoring/coaching/training process

Disaster Planning. Business recovery and continuity planning, Insurance.[xxxvi]

Infection control [xxxvii][xxxviii]

Confidentiality and disclosure - policy and legal requirements [xxxix][xl]

Misuse of Drugs Act 1971. Medicines Act 1971 Understand the management of controlled drugs, emergency drugs and other treatments. (Shipman recommendation) [xli][xlii]

Partnership Issues

0 1 2 3 Prioritise

The General Medical Services (GMS) Contract and other contracting arrangements [xliii]

Statutory requirements and partnership options

Partnership agreements - Governance in Partnerships – Partnership disputes [xliv]

Partnership Changes and Recruitment[xlv]

Partnership Finance and Taxation

Continuing Professional Development (CPD) requirements, GP Appraisal, Revalidation [xlvi][xlvii]

Duty of Care – Good Practice - GMC [xlviii]

GMC and Defence Union Resources [xlix]

GP Time management – Rotas, Capacity and Demand etc.

Locums – supplementary performers list- GMC [l][li]

Partnership meetings

Patient and Community Service

0 1 2 3 Prioritise

Reception Services and Practice Administration. Promoting the rights of Patients [lii][liii]

Patient Involvement [liv][lv]

Patient Information, Practice Leaflet, Website, Waiting Room, Freedom of Information Act etc.

Services and Health promotion

Managing patients and outside agency complaints, conflict resolution [lvi]

Patient Protection including those with Capacity and Child Protection. [lvii][lviii][lix][lx]

Advance Directives – Adults with Incapacity Act – Power of Attorney etc [lxi][lxii][lxiii][lxiv]

Value of professional working relationships with peers and colleagues from other practices other external organisation.

Finance

0 1 2 3 Prioritise

The role of the bank, lawyer and accountant

The General Medical Services (GMS) Contract and other contracting arrangements[lxv]

Statement of Financial Entitlement (SFE) [lxvi]

GMS/PMS Funding streams

Private Fees [lxvii]

Partnership Agreement

Practice Accounts

Establish processes and ensure financial/security control. Petty cash - Develop and operate systems to monitor and record transactions

Payroll and pensions

Monthly Invoices, Receipts and Accounting

Claims, Targets and Quarterly payments

(Practitioner Services Division (PSD)) /

Annual accounts

Financial Planning, Managing annual budgets. expenditure, deficiency registers and financial risk

Drawings and Personal taxation

Practice Development Planning. Workforce Planning and budgeting

Business Case Development. Resource Negotiation. Plan, implement, monitor and review acquisitions. Allocation and management of financial resources

Understanding and Monitoring all relevant insurance and ensure cover is in place – building, practice, legal, locum, tax etc.

Human Resources

0 1 2 3 Prioritise

Workforce Planning: Workload analysis, workload planning, evaluating effectiveness, skill mix review Personal Development Plans. Commission/facilitate training

Team working and skill development

Leadership v Management. Styles. Emotional Intelligence. Organisational culture. [lxviii][lxix][lxx]

Recruitment and selection, Induction and training

Performance review, mentoring and appraisal. Giving effective feedback

Developing oneself and contribute to the development of others: Mentoring, coaching and counselling. Pastoral care. [lxxi]

Promotion of health and wellbeing and prevention of adverse effects on health and wellbeing[lxxii]

Recognising others learning needs

Conflict and dispute resolution, assertiveness

Employment practice e.g.[lxxiii][lxxiv]

Contracts and Written Statements

Bullying and Harassment

Discipline and Grievance [lxxv][lxxvi]

Absence, Stress, Alcohol, Drugs, Incapability management [lxxvii][lxxviii]

Premises and Equipment

0 1 2 3 Prioritise

Managing budget and financial planning, deficiency registers.

Business case development. Resource negotiation. Plan, implement, monitor and review the acquisition, allocation and management of financial resources s

Monitor and evaluate all insurance and ensure cover is in place – building, practice, legal, locum, tax etc.

Supplies

Equipment and Facilities management and maintenance

Security

Project Management (equipment/premises) Utilise project management techniques to ensure smooth running and completion of project [lxxix]

Value of professional working relationships with peers and colleagues from other practices and other external organisation.

Finance – SFE - improvement grants – premises development opportunities – Private Investment [lxxx][lxxxi]