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There is no magic wand to fix primary care


Primary care needs fixing but let’s be honest, there is no magic wand that is going to do this.

It is easy to spend all your time waiting or searching for that one perfect solution, but that can be wasted time effectively doing and achieving nothing, or at best very little. Even worse, doing or achieving nothing in the context of a changing situation can sometimes mean your position deteriorates further.

This doesn’t mean there are no options, or you need to increase your efforts to finding the ultimate fix. An alternative approach, and in some situations a more effective action, is to adopt a marginal gains approach.

What are marginal gains? While general practice looks for the ‘big wins’, what about all the little improvements that can add up to significant wins too? This is Marginal gains. It’s about making small changes that produce incremental improvements. When combined these collectively have the same level of impact as a single big improvement in one area. If you can improve twenty five areas each by a marginal 1%, then this can be the same as an overall 25% improvement. Making such small gains shouldn’t be disregarded as it is far easier to improve many areas by a small amount than improving one area by a big amount. It’s an approach that can be applied to most areas and is perfect for general practice.

Can marginal gains make a difference? It’s a principle that took British cycling to be the world’s best, so the answer is yes, and it applies to healthcare and business as much as sport. It’s small changes, which might not make much difference immediately or on their own, but combined over the long term is where significant benefits are found.

If you think of general practice as a collection of processes that work together to deliver the services, look at each process in turn. Where are the opportunities to make small improvements, such as eliminating waste, removing duplication, improving efficiency, raising quality and filling gaps? This is where the numerous marginal gains are found and add up. Be clear on what it is you’re improving; remain realistic in that you can’t do everything, and it won’t be a magic wand to solve everything. For maximum impact it’s also important to make this a continuous activity, not just done once and then forgotten, but a process that looks for ongoing continuous improvement.

Making incremental marginal gains to your practice processes should be a central focus of your improvement strategy. It may not give that single fix that answers all the problems, but it is something that every practice can achieve. It is not forlornly waiting and looking for something that can’t be found, and it’s not giving up. It’s using the time and energy to improve what you can, right now!

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