Developing Your Practice

What constitutes good management?


Keeping things going without major incident or developing your practice to meet future challenges. For many practice managers, their job is a mixture of both. They are required to take a very hands- on day to day role in ensuring that things run smoothly and also take on responsibility for developing the practice business for the future.

The thought of practice development planning is sometimes a luxury that takes second place to immediate management activities but is really a vital part of preparing for the future that practices face. For many managers external change puts a huge amount of pressure on the day to day work – but this is often when it is most crucial to devote time to planning.

Practice Planning

Practices may need to consider two different types of plan:

  • Practice development plan  - involves the whole team in establishing the future direction and goals
  • Business plan – which is often carried out by the management team to establish viability or feasibility of different courses of action

However – Do not waste time thinking about semantics – get on with the planning activities.

The Planning Process

Understanding your business and effective planning for the future is often seen as a continuous process or cycle involving the following stages:

  1. Create your mission and philosophy
  2. Analyse your current situation
  3. Understand the future changes
  4. Generate and prioritise your goals
  5. Create your long term plan
  6. Create your short terms plans / Write and analyse your business plans and cases
  7. Monitor and evaluate your plans and actions
  8. Reflect on your plans and review the process

One of the most important aspects of this is in understanding your current situation and what will be changing the in the future.

What Does the Future Hold?

Predicting the future is almost impossible to do, especially in the NHS as a politically driven organisation. However, this should not stop managers from thinking realistically about the changes that are planning in the foreseeable future that may only be 2 or 3 years at present. There are a number of useful analysis tools to help with the process.

It is worthwhile carrying out an internal analysis of what you know will be changing or needs to change internally and then consider what impact external factors will have. For this external analysis, tools such as STEP and Pest analysis can be very useful. Take your headings from the following list:

  • Social
  • Political
  • Economic
  • Technological
  • Environmental
  • Legal
  • Demographic
  • Cultural
  • Ethical

Another very useful model is Porter’s Five Forces

5 forces
This is a very useful addition to the ways in which we consider external and internal changes in the future.

  1. Force number 1 is the entry of new competitors. How easy is it for other people to enter your immediate competitive space? In the primary care market potential competitors may already be involved in health care delivery so may already have systems and regulatory compliance in place. Identify the people who could enter the market easily. 
  2. Force number 2 is the threat of substitutes. Could your service easily be substituted by something very similar or something new? Could primary care be delivered in new ways – is there an innovative approach that your users would like that a competitor could deliver?
  3. Thirdly, what is the power of your buyers or your customers – this could mean both the commissioners of your service and the service users or patients. How easily could the commissioners or patients change their supplier?
  4. Fourthly, on the other hand, do your suppliers have any power over the future of your business or services? How much of a risk do things like price increases cause to the delivery of primary care services
  5. Last, but not least, what is the rivalry among your existing players? Are you in a very fiercely competitive industry, or is it more like friendly competition? This poses a big question for the future in general practice. Should you worry more about existing competition or new competitors?

Many practices are now considering this final issue – is there merit in protecting each other through stronger federations and bigger organisations.

Planning for the future becomes even more vital to the future stability of a practice when there is a lot of internal and external change. Keep in mind this quote from Charles Darwin:

“It is not the strongest of the species that survive, not the most intelligent, but the one most responsive to change.”

 The Thornfields@fpm course on Practice Development and Business Planning will provide managers with a range of tools to use to get started on this essential process.


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