Interview: Gary Hughes on Primary Care Networks, innovation and prevention in general practice

Gary Hughes is an experienced consultant in general practices and has been a practice manager for more than ten years. We ask him about everything primary care: PCNs, innovation, public health, recruitment and staff retention.

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We were lucky enough to speak to Gary Hughes on a number of topics in primary care in 2020.

He has spent more than 25 years managing businesses in this area, including 10 years as a practice manager at the Waterfield Practice in Berkshire and many years as a consultant in general practice.

With his extensive experience, we thought Gary would be the perfect person to ask for tips on staff retention and hiring, and innovating processes within general practice. He was also a fantastic person to ask about predictions for primary care networks (PCNs), QOF and failing screening programmes in primary care.

The interview with Gary Hughes on PCNs, innovation in primary care, staff retention in GP practices, and more.

Do all the practices you work with face similar problems? If so, what tend to be the top ones?


Yes, there are definitely common problems. I can think of three main ones:


1. An ever-increasing and often unmanageable workload. Rising, and ever more frequently unrealistic patient expectations contribute to this. Patient demand is seemingly never-ending.


2. An endless and burdensome bureaucracy that often seems to have no purpose.


3. Workforce issues, more specifically, the difficulties in recruiting GP's and nurses. Often this is coupled with an ageing team; retirements can be a massive problem as it can be near impossible to get replacements. We are losing people from one end but not filling the other end.



As the PCN structure becomes more and more prominent, what advice can you give to PMs and GP partners who want to get the most out of their network?


You need to get clear on the vision for your network right from the start and then set the strategy.


Don't be afraid to be bold with your vision and goals. The success needed from networks is not going to be achieved from caution or apathy.


Furthermore, PCN leads need to make sure they listen to the patient voice. This will tell you what you need to be doing and where to head. Patients may also push you to go further than you otherwise might.


Be sensible about your limitations and put in place measures to counter them. You may not have the skills, time or resources and some of these you might not be able to do without. Don't try and get by, but go and get what you need.


Do you expect to see any changes in the way practices achieve their QOF targets in the new PCN structure? Will there be any room to collaborate to meet objectives?


Not hugely, unless NHSE or CCGs impose changes. That said, we'll see multidisciplinary teams becoming more commonplace, and they'll be used by practices to support QOF. Of course, in the PCN contracts it states that medication reviews and cancer screening uptake is a priority point for PCNs to improve, so it will be interesting to see how they collaborate for this purpose.



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Moving on to the appointments delivered by primary care that are considered 'preventative' - (by that we mean things like immunisations, screening programmes, NHS Health Checks, and related QOF targets.) 


Often we see a low uptake across these appointments, why do you think it is proving to be a challenge for General Practice to get patients into them?


Many problems contribute to low uptake:


These services, as is increasingly the case, come with inadequate funding. This means that general practice can't put much, if anything, into promotion and awareness, when often there's not even enough for delivery.


General Practice often doesn't have the capacity to deliver them, either. Our appointment books are so busy and overloaded anyway. We don't have enough time to give them, or at least not to the extent that's required.


Often it comes down to patients, or parents, not recognising the importance of the services. Which I suppose takes the reasoning back to promotion and awareness.

We wrote an in-depth article about why we think current patient recall processes are to blame for low uptake across screening programmes. We also researched the 10 top tips for improving NHS Health Check uptake to help practice increase their own uptake, for free.


What do you wish CCGs and Public Health knew about how practices deliver QOF and screening programmes? Is there anything they could do to relieve the pressure?


They could improve funding and make it realistic and remove some of the unnecessary bureaucracy. There should also be more share responsibility for public education and building awareness because preventative healthcare is sometimes hard to educate patients about. Finally, there needs to be an understanding and recognition of how a stretched workforce impacts on our ability to deliver. 



A lot of the practice managers we work with have problems with staff turnover. Do you think this is a nationwide problem and do you have any tips for practice to retain staff for longer so they aren't left short?


Definitely a nationwide problem. I'm in a successful, attractive practice in the Thames Valley and it's still an issue. We can advertise for a GP or nurse and not get any applicants. Successful recruitments take the best part of a year. Other local practices have had more significant problems, and it's well-publicised how difficult it is in other areas of the country.


Retention is challenging when the issues are largely outside the control of the practice. What you can do is make sure every member of the team is as well supported as possible. Practices must recognise that they need to maintain appropriate staffing levels; cutting costs in this area will be more damaging in the long run. They need to embrace new ways of working and different professionals. Strong, effective leadership and management is also a must to ensure there is a positive, attractive culture. 


What do you think is the best way practice managers can innovate their processes? Is there somewhere they can learn from others experience or extra practice management software you suggest they use?


It feels like there's plenty of good ideas out there, and more and more seems to be available. It's always helpful to look at what others are doing and their experience, and don't be frightened to try things. 


GP partners are often risk-averse and want to have all the answers and evidence; that can stifle innovation. 


Cost is another factor that's used as an excuse for rejecting new ideas. I feel it's better to consider the long term benefits and not immediately reject initiatives because of cost. 


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Gary Hughes has spent more than 25 years successfully leading and managing businesses in primary care and the private sector. He has been a director, partner, owner and now a Practice Business Manager. Success in these roles has come through focusing on business management and leadership, and the continual improvement of individuals and organisations.


He has an MBA and a Post Graduate Certificate in Medical Education and has a wide range of skills and knowledge with which to provide support and education. He is available for consultancy, facilitation and speaking at conferences. He can be contacted on his email address or through LinkedIn.

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Article by

Ben Goodey