PROJECT TEN: Group GP Practice Facilitation
(Notes from David Smallacombe's pre work brief)
Your Context
Your letter describes changes of a crucial nature taking place in the practice over a relatively short period of time. Any organisation undergoing changes like the ones you describe would be well advised to find a way of exploring the past in order to help manage the future.
The past for you also includes 20 years of local service to local people and, whilst you do not specifically mention it, the practice appears to have been stable for most of the time prior to 1995. This fits with your description on the telephone (and on paper) of a go-ahead, dynamic, leading edge local primary care service of which you are all quite rightly proud.
You also talk of fatigue, disillusionment and paralysis. Dual descriptions (the practice is good yet we are unable to act effectively) like these often occur within organisations and, whilst they are manageable on an individual basis, (different people have different ways of seeing things) when such widely different experiences become part of the lived way an organisation operates it is understandable that its stake holders (you in this case) conclude that some assistance to (your words) “maintain the enthusiasm and sanity of all the partners” is required.
You mention the wider staff group and comment that at some stage you would want to extend the intervention throughout the primary care team. I’m sure you will be aware that by commissioning any form of input you will provide the wider audience with a message about how you plan to manage the future. In my view it is often appropriate (at first) to separate major stake holders (or the management team which is sometimes the same people) from the rest of the group as they have different entitlements, obligations and responsibilities from other people within the practice. You need to plan to enhance your decision making capabilities, create amicable dispute resolution processes, work on your strategic planning capacity and develop a harmonious work environment “starting at the top”. This will certainly re-kindle enthusiasm and engender support throughout the practice if and when they get to hear about it.
Working Together
In order for us to work together I need more information and you need to develop some trust in me. Neither of these tasks need take long to accomplish but I firmly believe that to be effective I would need to spend time with each of you on an individual basis to take stock of where you are singly and as a unit (usually up to an hour). This done I would present to you a suggested programme of work based on group and/or individual sessions.
Whilst any programme will be predicated on the intelligence gained through the individual meetings experience tells me that some form of team event (say a day) to explore your various entitlements, obligations and responsibilities to each other and to the practice as a whole might be a useful place to start the work. We could cover inter-partner relationships and dispute resolution under the broad banner of creating harmonious working environments on the first day. Your question on how much to tell incoming partners would be tackled during this first session.
A second (or 3rd depending on the above) day might look at decision making and strategic planning in the context of the agreed protocols from the first day and the intervening one to one sessions. In addition we might look at how you wanted to “roll out” the work across the primary care team. You could explore the possibilities and make decisions about the purpose and value of widening the work, who should be involved and the timing of any additional interventions.
