Shanti Medical Centre: Turning a struggling practice around

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What an interesting and challenging journey it has been! It started with a phone call, a practice in trouble. Rated inadequate by CQC, staff unhappy, lack of clinical staff and not meeting quality standards. Bolton GP Federation needed a clinical lead to support the turn around.
Luckily, I had support – the GP Federation willing to support me and provide me with autonomy, a manager with great dedication to the cause and a group of clinical and non-clinical staff willing to accept the new team and work to a common goal. The patients needed stability, support and provision of quality healthcare.

Having the excellent team on board meant the first challenge was overcome. We asked more of them than they were used to and they all willingly accepted and worked with us. Recruitment was difficult in an uncertain landscape, and I’m thankful to all the clinicians who were willing to accept the challenge with some blind faith to join the team. Some came on board on a salaried basis and others on a sessional basis, but they all worked together with no barriers. Then we had to redefine the processes and implementation of change was successful due to the amazing willingness from everyone to adapt to the new way of working. An example of this is when the prescription requests were done on paper and this limited the ability to work remotely. A change of system was implemented and overnight the process was streamlined to everyone’s satisfaction.

Safeguarding systems were lacking and tireless work from the team ensured all the staff had appropriate training and processes were established to ensure systems were in place to protect the vulnerable within our practice community. The wider team also were linked in leading to some very positive Multi-disciplinary team approaches to support patients. There has been some very positive feedback from the wider safeguarding team about our approach.

An excellent incident-led approach to safety was implemented leading to changes in prescribing practices, monitoring, and follow up of abnormal findings. The processes were also developed to ensure these events didn’t occur on a repeated basis.

Quality and performance was an another area that needed development. Working through the patients we identified ways to optimise their care and in return it improved our overall performance in QOF and Bolton Quality contract. We as a practice were also outliers in the prescribing arena. There was significant waste of NHS resources but with a lot of joint working with the clinicians and the patients we were able to become one of the most efficient practices in utilising our prescribing budget. We were also noted to be outliers when prescribing antibiotics appropriately and also high users of what are deemed high risk antibiotics. Following a lot of staff and patient education by the whole team, we have performed very well in this area.

Access and equity have always been a challenge especially ensuring our population from deprived backgrounds with significant ethnic diversity get adequate care that meets their needs. We used various methods including longer appointments, varied access points and proactive approach to long term care to ensure we address and meet needs.

The team approach has led to excellent feedback from patients, significant improvements in our quality markers and overall improvement in staff morale and satisfaction.

The last 18 months has been personally challenging as well as rewarding. I am hoping that the stability and satisfaction we have created within the practice staff as well as the patients will lead to a successful practice moving forward that will continue to support and care for this community who’s needs are so varied.

I would like to opportunity to thanks all the patients who have endured the changes and have supported and have given us constructive feedback. I would also like say a huge to thanks all the clinicians and the administrative team who have worked extremely hard in some difficult situations to achieve our success.
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Dr Niruban Ratnarajah

Clinical Lead, Shanti Medical Centre
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