We started holding practice 'away days' 10 years ago, feeling rather self-conscious and concerned that they might be a distraction from our real work. Yet these are now an established and vital part of our calendar. With careful thought and preparation thy can be very productive.
We are a large practice of 10 doctors and need a formal chance to meet up, but even small practices with two or three partners would benefit from being able to take a step back from their daily work. I would like to propose the following guidelines to ensure that practice away days are really worthwhile.
Deciding on the function
- Do not call them 'away days'
Although they provide a break from routine, they are not relaxation: they are work, so consider what the function of the day is to be and name it accordingly, e.g. a team building day, a prescribing day or a business planning day.
- Consider what is needed
When deciding the function of the day it is useful to consider what is needed.
We have had days to deal in detail with specific points such as prescribing. Here, the function of the day was well circumscribed and detailed. Clear action guidelines were expected and produced.
The day allowed in-depth examination of the minutiae of personal prescribing patterns, and enabled individual clinical situations to be picked over. It is impossible to deal with these issues in a normal lunchtime meeting, so you will need to resist the temptation to turn the day into a glorified practice meeting.
Other away days have been more strategic and allowed much longer term or personal matters to be addressed. There is time to develop themes and allow people to open up.
These overview days have been vital in enabling us to consider the bigger picture. We have used business planning days to look at taking on a new partner, setting up nurse triage systems, and longer term changes in information technology.
Another good use of an away day is personal, taking the time to look at the people you have and how they work as a team. This is a hopeless task in the usual 1 hour meeting.
At this type of day it can be helpful to use a questionnaire such as the FIRO-B1 or MBTI2 to help staff understand each other's personality types and preferences.
Deciding who to invite
Once the function of the day is clear, consider carefully which members of the primary care team or individuals from outside the team to invite, and the size of the group. A large group is more inclusive, but makes it harder to generate intimacy, and may need strong chairmanship to give it direction.
- Invite only those directly concerned with the issues, who can make a contribution, and who therefore need to be there.
We believe it is vital to have our practice manager present at all away days, both for her important contribution and as a reality check when we are making decisions.
There has been one away day with just the management team and no doctors. People such as nurses or dispensers can attend for part of the day to deal with matters that are relevant to them.
- Choose the venue carefully.
We have used various venues such as local hotels, partners' houses and restaurants, but always one that is away from the surgery yet close enough to allow us to return in case of catastrophe. All that is needed is space, preferably with a big enough table to sit around, privacy, and a place to eat.
The agenda is critical and there are strict guidelines here.
- It needs to be circulated beforehand, agreed and not be too large.
It is tempting to dump all the unresolved or difficult issues from practice meetings into the agenda, but this must be resisted.
- It is important to be realistic and deal properly with a few issues rather than risk being bogged down in endless problems.
Items not on the agenda should only be discussed in exceptional circumstances.
- Do not descend into detail.
Of course the devil is in the detail, but the function is strategic. This is not an excuse for being impractical and your practice manager will keep your feet on the ground, but a lot of time can be wasted on trivia. Once the major decisions have been made, put named people in charge of implementing them within a realistic but specific time.
You will need a convenor. We use our practice chairman, a post we rotate annually. Our practice manager takes the minutes and produces a report or action plan from the day.
- A key feature of the report is a review of last time's plan and comparison with what is happening in practice.
This is useful both for patting ourselves on the back and identifying what still needs to be done.
On three occasions we have used a facilitator. This has worked when there are personal issues to be discussed or a more reflective tone is needed. These are people from outside the practice who have been suggested by word of mouth, or the Patients and Practitioners Service Authority (PPSA, a local organisation specific to Devon) can be very helpful.
The PPSA or PCT can also help with funding, e.g. for locum cover. Business planning days are of recognised value and the PPSA or PCT will support these.
Locum cover is vital to allow complete attention to be given to the day. Our guidelines for locum cover include:
- No pre-booked appointments on the day and extra unbooked slots in surgeries either side of the day.
Preparatory work is important, so that partners have, say, the financial implications of taking on an extra doctor or joining an out-of-hours co-operative to hand before discussing these issues.
Do not forget that away days can feed into personal development plans. And they should be enjoyable too, with a chance for staff to see each other as people and regain some control over their work.
- FIRO-B (Fundamental Interpersonal Relations Orientation-Behavior). For further information, see the website www.careers-by-design.com
- MBTI (Myers Briggs Type Indicator). For further information, see www.careers-by-design.com