Chapter 4
Getting organised for supporting self
care as a general practice team

This chapter describes how you can get organised as a general practice team to design a strategy and implementation plan in relation to supporting self care. The outcome should be a culture whereby supporting self care is integral to all your developments and services, and the GPs and staff promote and support self care as part of their everyday work in effective ways.

Stage 1: getting commitment – developing your vision

Set up your working group or action learning set

A senior team within the practice should form the working group on promoting self care, making the case for a practice strategy and implementation plan – as in the algorithm in Figure 4.1 (adapted from the Faculty of Public Health).1 Include at least one GP, practice nurse, health care assistant, practice manager, administrative staff member, receptionist and other health professional such as a community pharmacist or a physiotherapist and one or more patient representatives.

Or take up the WiPP training programme and run it as an action learning set (see Box 4.1). You will then need someone in your practice team to lead on establishing a self care culture – planning and setting up the action learning set, getting the right people engaged, keeping others motivated, matching learning to people’s preferred styles, etc.

Decide whether you will liaise with your PCT to identify a trainer to guide you, or go it alone as a practice team, with your own facilitator as the self care or educational lead. The facilitator of the practice team should be generally experienced in, and work in, the primary care setting. They will usually be the lead for education in aGP team, or a practice manager. Facilitators should be familiar with the principles of self care and contents of the training programme about promoting and supporting self care,2 so that they can guide their team through the full programme, or extract components of it as suits the team. They should be committed to conveying the importance of good practice in the context of planning and providing primary health care.

Facilitators should advise the team on the amount of preparation and work associated with learning about self care and carrying out agreed actions. They will help to motivate team members to progress smoothly through each stage in their action and learning plans.

Practise team perspective for establishing an intergrated resource to support self care

Box 4.1:

Using the WiPP multidisciplinary training package in a general practice

Rather than a traditional working group run as part of practice core business, you could use the WiPP training programme to work out your approach as a practice to support self care, and implementing it. The WiPP website has facilitator instructions on running an action learning group and the facilitator’s
handbook.2 You can use the electronic versions of the 21 tools (see Figure 4.1), or paper versions reproduced in Part 3 of the book, and log your progress. The WiPP training programme is not prescriptive, as participating practices will be at varying levels of expertise and have different capacity in their evolution of a self care culture. The exact nature of self care support interventions and activities you opt for, will depend on your resources, the nature of your patient population, and your enthusiasm.

Consider the following options:

1 running an action learning set for a general practice team – around six key members of one practice, or representative leads on self care support from various local practices. Other interested professionals might join in – e.g. community pharmacists, community nurses, allied health professionals. You might meet two- to three-monthly, with time for development and action in between, with shared learning and development under the guidance of a facilitator, not necessarily present at all meetings. We propose a
minimum of three facilitated learning and development sessions with intervening associated work being undertaken by individuals and subgroups. Some practices may want to organise more facilitated meetings – the exact arrangements will depend on your preferences and capacity

or

2 a working group to establish an integrated self care support resource within your general practice, with minuted meetings and review of actions to evolve and implement a self care support strategy; with a chair who is a member of the practice team and champion for self care. This is likely to span a minimum of a year.

The general practice project team

Look at the section on teams (pp. 47–8) to confirm your ideas about who can contribute and in what way. Then read through the types of roles and responsibilities various members of the practice team assume in Box 4.2.

The algorithm of Figure 4.1 is similar to that for the PCT approach in Figure 3.1. The only differences between the PCT and practice approaches are in scale and the nature of the patient population. Read through the additional information in the guidance for PCTs in Chapter 3 and generalise to the approach you adopt in your practice.

Look at Tool 1 which explains how to undertake a force-field analysis and consider the positive drivers in deciding to proceed in drawing up and implementing a strategy to support self care across your practice. You can derive many of the positive factors Getting organised for supporting self care as a general practice team 45 from the evidence for self care support described in Chapter 2. On the opposing side will be the negative factors you should consider before committing to the strategy, and include in your implementation plan with solutions on how to overcome barriers to change.

Use Tool 2 to help you work through the stages of drawing up your strategy and setting priorities. Tool 3 will be useful to analyse strengths, weaknesses, opportunities and threats (SWOT) to establishing a culture of self care in your practice. Make your aspirations realistic to prevent your vision becoming a mirage.

Drawing up your action plan

Use Tool 4 to consider the political, economic, sociological and technological factors that will influence your practice’s action plan. You might prefer to undertake a gap analysis considering where you are now (with unstructured self care initiatives) and where you want to be (Tool 5). Refer back to your vision. The ‘plan, do, study, act’ (PDSA) approach of Tool 6 may help you to construct your action plan. Map out a timetable for your prioritised actions – adapting the example Gantt chart in Tool 7 to define your actions and milestones.

Resource mapping

Think about the resources you already have to support self care within your practice, those you will need, and how you might obtain them. Use the infrastructure and resource matrix of Tool 8 to map out your current resources, then plan what extra resources you will need. You are not building up self care support on your own. Harness the enthusiasm of other general practices, pharmacists and dentists who are supporting self care too. Work with social care, community and voluntary groups and share their resources.

Identify your priorities and target groups

You need to understand your population, know its needs and wants; understand self care and its norms, benchmarks and evidence; understand how to make change. Doing a SWOT analysis and/or audits of your current performance or application of self care (Tool 9) describes your baseline position. This should identify or reaffirm your priorities – the type of self care support and patient groups you will focus on.

Devising an education and training plan for your practice in relation to self care

A culture of promoting effective self care support as a common activity by everyone in the team will only happen if they have the right knowledge and skills, a positive attitude to self care and opportunities to enable it. Your working group or learner set should update your practice training plan to include self care before finalising your strategy and action plan.

1 Just as for any other clinical or practical field, staff in your practice team need to be:

– competent or qualified to do the job (promote self care) when appointed

or

– correctly trained to an assessed competence before working without supervision.

2 Every staff member should have a personal development plan supported by the practice manager (or other line manager); every GP a personal development plan they review and agree at their annual appraisal.

3 Identify and agree the individual staff member’s education and training needs (Tool 10) according to:

– the requirements of the service for promoting and supporting self care

– identified individual deficiencies in knowledge, skills or attitudes in relation to supporting self care.

4 Education and training in relation to self care support should be provided in-house (e.g. by a practice lead or PCT trainer) or elsewhere, and the time allowed to do this. If you are encouraging individual staff to take on responsibilities outside their traditional role in supporting patients’ self care you must ensure that the tasks are:

within their personal skills and competence
carried out after an enhancement of their knowledge or skills
not compromising their existing duties
best carried out by them and not by others with different roles or skills
organised so that they are able to be personally accountable for their actions.

Building your team

Your practice team will implement your self care support strategy. So try out Tool 11 to checkhow well your team is functioning, and/or undertake a significant event audit as in Tool 12.

Good communication is essential for good teamwork.3–5 You need:

regular staff meetings which everyone endeavours to attend
a failsafe system for passing on important messages
ways to share news so that everyone is promptly notified of changes
a culture where team members can speak openly without fear of being judged or reprimanded
opportunities for quieter members of the team to contribute
to give and receive feedback on how roles in the team are working out
to praise others for their achievements
opportunities for team members to point out problems and suggest improvements
everyone to be part of, and own, the decision making.

Teams which encourage participation are more likely to achieve a patient-centred service, to work together as a team and be more efficient.3,4 Look at the range of roles and responsibilities of a typical team in Box 4.2. If you are unaware of Belbin’s description of team roles, you can read about that elsewhere.6

Box 4.2:

Forming a coherent primary care team for your self care support
initiative: who does what

The practice manager

Understands the characteristics of effective teams and how to encourage their development
Obtains facts and figures about team members’ learning needs in relation to self care
Involves all team members and communicates regularly with them
Encourages attached staff and independent contractors to join in the practice action plan, promoting and supporting self care
Arranges regular learning and review meetings with all staff and encourages everyone to be involved
Identifies necessary resources for supporting self care
Oversees audit and monitoring of the self care support initiative

The GP

Leads on writing the strategy and implementation plan for the practice team to promote self care
Encourages multiprofessional working and values individual members’ contributions
Joins in multiprofessional learning and training with the team in relation to consultation techniques for supporting self care
Provides adequate resources for staff to have sufficient opportunities for learning development

The practice nurse

Is flexible about fitting in with new requirements for different ways of working in relation to supporting self care
Contributes to teaching patients and colleagues about self care
Actively seeks out, and participates in, learning and training in relation to self care support
Supervises the health care assistant who promotes self care to patients

The receptionist and health care assistant

Attends project and staff meetings
Joins in multiprofessional learning and training with other team members
Becomes familiar with self care literature and distributes this to patients
Helps the practice manager obtain data for the evaluation of the self care support initiative
Passes on information to colleagues who are unable to attend a meeting

The patient and/or carer representative

Attends self care planning meetings
Contributes her/his own ideas and views and passes on suggestions and comments from other patients and/or patients’ group
Participates in writing and testing of patient information systems
Advises on patient/consumer perspectives

Others, e.g. health visitor, midwife, community pharmacist, physiotherapist, community psychiatric nurse, specialist nurse

Joins the practice team to contribute to the self care support initiative as an expert in his/her own specialty
Agrees his/her own role and responsibility within the initiative

Understand what motivates your team in order to achieve the best results from them. It is said that performance = ability x motivation.7

Take team development seriously, following tried and tested approaches.8 Base it on the core business of the practice such as ensuring clinical governance, so that you tie your self care support initiative into other developments within the practice.9 If most team members have similar learning needs such as in relation to self care aware consultation skills, then consider holding a workshop on the topic in the practice or at an away day, to encourage team building too.10 Include patient representatives in your development team too – they can accelerate change and help with finding solutions to overcome barriers to progress in implementing the self care support strategy – see Chapters 5 and 7 for more on working with patients.11

part 2

Chapter 4 Getting organised for supporting self care as a general practice team