Moving to a Multiskilled Practice.

You’ve all heard the announcement in the supermarket, ‘Will all multiskilled staff go to the checkouts’.

What does that mean and what relevance does that have to running a practice?  What the supermarkets are good at is training people to a consistent standard and giving them a sufficiently wide range of skills to do a range of jobs at the same level of competence or skill.  This enables retailers to deal with peaks in demand, to keep the queues down and to cope with holidays and sickness without affecting their service to the public.

In many practices, people have been hired to do specific jobs and can be reluctant to stray outside the limitation of those jobs.  This can cause problems when the practice has to deal to with fluctuating demands or with absences.

Clearly, it makes sense to have a flexible group to staff which can turn their hand to a numbers of tasks to meet the changing demands of patients, government and the CCG.  One of the features of organisations dealing successfully with change is the emergence of a more flexible and empowered workforce.

Where to start.
Your team will need to understand the importance of providing consistent service in terms of satisfying patient expectations and the impact of good performance on practice income.  Some practices incentivise good QOF scores from the additional revenue created.

The Jobs Matrix
Our starting point has to be a simple jobs matrix – you can produce this in word or excel.

However rather than struggling over it yourself get the team to do it using mind mapping and a pile of post it notes. Get everyone to write down the jobs they do, not the whole job, but the specific tasks they do.  Stick these on the wall and then group them, making sure people put their initials on the post it notes so you know who does what!
Prior to the meeting, you can get people to write their own job description listing all the tasks they do, so they have their thoughts in order.
From their notes and your mind map, you can create a grid showing all the jobs down the left hand side, and all the people along the top axis. Tick all the tasks people do and immediately you will have a picture of all the gaps and the overlaps


Pic Jobs Matrix

Job Matrix for multipractice

From this may emerge a job description for receptionists or administration that is wider than currently covered by job descriptions.  Most job descriptions are out of date 6 months after they are written, so it’s a golden opportunity to get them all up to date.  I would advise strongly that you work with your team to evolve these so that they own them.  If you simply impose them, you risk resistance.  Yes, you might have to look at rewards for increased flexibility, but balanced against the impact and cost of poor service or the inability to provide holiday of sickness cover the benefits should outweigh the costs.


Job descriptions usually contain what the job contains, but are less likely to state how the job should be done and to what standard.   Take the opportunity to establish levels of competence for each role.  This will allow you to assess whether your staff have the skills they need for that role, and to the appropriate level.

The Competence Matrix

If you establish the competence needed for each job role it become a simple matter to create another grid with the names of the team and an assessment based on appraisals of the level of skill and competence that person has against each of the tasks the job description contains.  You could use a simple grading system like the one below.   Clearly where people need development to deliver the required level of competence, this shows the need fro some training and almost writes the practice training plan for you.


Pic Competence Matrix




Developing your team to a consistent level of performance makes obvious sense.  Here is a method for understanding where each member of your team is right now, where you want them to be and putting in place a plan to get them there.   If you have used the skills matrix this next step should be fairly straightforward.

The Performance Matrix.

Pic Performance Matrix

This shows performance along one axis and the amount of time you might spend managing people on the other.

For instance, you might have a high performer who you trust completely to just get on a do things – and you spend very little time managing them. Wonderful you say! But are their dangers, how long will you keep this person, are you taking them for granted, will they get bored, do they get overloaded because they are willing and competent?

At the other end of the scale, you may have someone who is performing poorly and requires constant supervision. If they are new, this may inevitable – if they are established you are going to need to do something about it.

To use the grid, plot where you think each member of the team sits, refer to their skills, refer to their appraisal and put a cross on the grid according ling   Then consider where you need them to be – ideally you would probably like to have them perform better and need less supervision.  Put a second cross.

Direction of travel

This will now show who needs to improve and by how much. This will enable you to sit down a write a coaching plan to move them in the  direction of where you need then to be. It will allow you to agree short and medium term objectives with them.

The coaching plan
We have all seen the results of coaching on our screens over the last year with ‘Dancing on Ice’ and ‘Strictly Come Dancing’ where celebrities have learnt new skills. The power of coaching is that it is driven by the learner and the learner takes responsibility for their progress. Retention levels are much higher and progress can be rapid.   Coaching does not require specialised skills simply a different approach based on questioning, rather than telling, letting the learner come up with the answers themselves and self-reviewing their own performance.
To use a coaching approach to setting short and medium term performance or learning objectives you will need to write a script for the interviews with each team member to take them through agreeing the needs, and the actions they will take.

A good structure for the interview is the GROW model


G – Goals and Objectives

  • What do you think we need you to deliver in your role?


R – reality –  where we are now, evidence

  • How do you feel you are doing right now
  • What areas do you think you might need to improve?


O – options – The way forward to improve/implications

  • How could we help you improve your skills?
  • What might you need to do?


W – wash up – Summary of action agreed

  • Can we just summarise what we agreed to do and when?

The benefits
External change forces internal change and the driving forces mean that flexibility in an organisation will give it the resilience to deal with higher expectations from its stakeholders and competition from newcomers such has private providers and polyclinics.

This year’s mission?  Get multiskilled!

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