Diagnosing the Clinician: Business Capability Development and GP Practices

The focus of this exploratory paper is examining the development of business capabilities within General Practitioner (GP) practices by considering the feasibility of using an underexploited data source and methodology. The topic of business capability development within GP partnerships is an area that has been neglected in the literature and is timely given the structural and process changes impacting on the NHS. The partnership–based model of GP practices throws up challenges of small firm management similar to other professional partnerships models such as in accountancy and legal services. However, as part of the NHS undergoing significant change, GP practices also encounter unique challenges in small firm management; most notably, how to chart a strategy of partnership development and growth within an evolving institutional context that is introducing quasi market regional actors against a back drop of top down performance management. As the primary gatekeeper of medical services, GP practices are at the forefront of coping with these changes both at a medical and a business level. But recent evidence suggests that business capabilities within GP practices are underdeveloped; As NHS England indicates, practice numbers have fallen by 9.2% between 2005-2015, with the rate of closure increasing from 2012. This fall has coincided with a move towards larger practices (5+ partners) and away from the single partnership model. These larger practices are employing an increasing number of staff – specialist and general (GPs, nurses, administrators and non-clinical staff, such as receptionists). However, from a recent survey of 2830 GP practices, only 5% viewed themselves as financially robust while more than 10% of practices surveyed expected to close.
A GP partnership is responsible for running their business. Partners act entrepreneurially in exploiting their existing resources while being alert to future profit opportunities (O’Reilly and Tushman, 2008; Lubatkin et al., 2006). This means balancing efficiency, cost control and resources such as facilities, staff and technology with potentially disruptive change through innovation and leadership. The operational tasks of running the practice include appointing, training and appraising staff, meeting regulatory requirements, organising payroll and cash flow, marketing (website and practice literature), premises maintenance, security and IT management. Strategically, partners plan the practice’s future growth and income generation, such as the development of specialist services, new contract bids and increasingly network building. Structural and organisational changes in NHS commissioning and delivery continue to impact on practices, through the securing of Quality and Outcomes Framework (QOF) points, meeting Care Quality Commission (CQC) ratings and the more strategic formation of practice federations and networks at local and regional levels. Broader still are societal pressures of an aging population increasing demand for primary care against a backdrop of economic austerity and costly technical change. This suggests that practices, as small businesses, operate in a complex environment that is increasing in dynamism.
The focus in this paper is on how these changes impacts on business capability development within GP practices in terms of skills and strategic development. To do so, this paper aims to explore the feasibility of adopting a novel approach to charting capability development. Feasibility here, is to be assessed through a literature review of prior work in the use and analysis of job adverts, together with a review of capability measures in the Resource Based View tradition. This is to lead to the construction of a conceptual framework for examining business capability development within GP partnership practices through the analysis of the content of adverts put out by GP practices when seeking new partners. It is the intention of this present paper to explore through a comprehensive literature review, the feasibility of using job adverts and content analysis as a means of analysing changing skill requirements in a dynamic context, namely by focusing on GP Partnerships.