Leading with Purpose: Transforming Primary Care through Strategic Governance

As a concept, organisational governance may seem abstract, but in practice the impact of governance is often quite tangible—touching on areas like strategy, mission and vision, employee engagement, division of responsibilities, evaluation, audit and risk control, even succession planning.  

“Organisational governance is the compass that guides GP Practices and Primary Care Networks towards a future of exemplary patient care and thriving staff morale” – Dr. Tony Naughton

Where clinical governance is reviewed by CQC, organisational governance does not receive the same focus or scrutiny in general practice. What’s more, the impact of poor governance doesn’t end at the practice level. Lack of infrastructure to efficiently make decisions can roll up into PCNs—potentially hindering efforts to prioritise, request, and access needed funding. 

To understand the state of organisational governance efforts in general practice, Qualitas has surveyed nearly 100 practices over the last two years. This blog explores what Qualitas has learned about how practices are approaching governance and offers practical tips for partners looking to improve their governance efforts. To understand this more deeply, we analysed four key themes around data, preparation, strategic planning, and role clarity. 

About the Survey 

The governance survey began in 2022 and has been completed by close to 100 practices representing a geographically diverse sample from across England. The number of partners per practice ranged from 1 – 9+ with the highest percentage reporting 3 – 4 partners (38%). Patient list size ranged from 3,000 – 12,000+ with the highest percentage reporting more than 12,000 (40%). 

Prioritising Preparation for Governance Meetings 

Regular partner meetings, often negotiated into busy clinical schedules, are where most GP practices make governance decisions—investing significant resources to prioritise this time.  Based on sessional time costs and average number of partners, we estimate that practices invest tens of thousands of pounds each year in GP time committed to governance meetings. And yet only 1 in 5 survey participants described these meetings as effective decision-making forums. 

Nearly a quarter of respondents (23%) said they meet for more than an hour each week as a partnership team, but more than half (57%) of practice partners indicated infrequent sharing of information before regular governance meetings.   

The solution is not to stop meeting (although practices may determine in time that they could reduce the length or frequency of meetings). Instead, we counsel partners to look for strategies to improve effectiveness and efficiency of these meetings through preparation and management. 

What to do if your practice struggles to use governance meetings to effectively drive decision making:  Consider clarifying the purpose of your regular governance meetings, creating clear meeting agendas, and identifying lead roles for information dissemination. You may determine that it is helpful to designate a lead for agenda development and sharing pre-meeting materials, to support better preparation and focus. Your practice may also find it helpful to create a 12-month meeting plan, with defined areas of focus to ensure all aspects of governance, strategy, and performance are considered and to account for cyclical governance needs. 

Developing and Utilising Effective Governance Data 

Intuition and experience are both important tools for healthcare leaders. However, on their own, these can lead to bias and fail to consider emerging trends. Effective leaders often use intuition as a form of testable hypothesis, calling on data to demonstrate, monitor, or refute their gut reactions.  

Having accurate and accessible performance metrics allows practice partners to save time and better identify risks and issues promptly. However, most of our survey participants (58%) reported having limited data and reports that did not cover all areas of their work. Only 11% of respondents said that they have access to data and reports that provided a good and easy grasp of practice performance. 

What to do if you feel you’re lacking important governance data for your practice: Discuss your overall practice goals with your partners, thinking about clinical outcomes, but also financial, workforce, and other key areas. Then work together to determine what metrics would help you understand progress towards these goals. Once you know what you want to measure and why, it’s important to designate who will be gathering this data and how frequently they will feedback.  

“By steadfastly focusing on strategy and making informed business decisions, we not only enhance efficiency but also unlock the full potential of our healthcare system, ultimately fostering a culture of excellence, compassion and well-being for both patients and staff” – Dr. Tony Naughton

Intentionally Allocate Time for Annual Planning 

Having a clear road map for the year supports practices to achieve strategic improvement, growth, and sustainability goals. Still, 82% of survey respondents shared that they meet regularly, but do not have a 12-month plan.  

Annual planning offers a roadmap for large organisational initiatives, providing a helpful framework for practices looking to go beyond just focusing on clinical governance toward a growth and innovation. Nearly 40% of partners shared that they rarely look at organisation direction and governance in partner meetings.  

What to do if your practice struggles to find time for discussing direction and overall governance: Consider creating a governance structure and roles that allow performance, operational oversight, and service delivery to be managed effectively outside of partner meetings, thereby creating space for strategy and governance conversations. If finding time is the barrier, you could consider various layouts for partner meetings. For example, try focusing some meetings on retrospective review, and others on future planning. Or split the agenda of each meeting. 

Sharing Leadership Responsibilities 

For practice partners—who are often balancing several roles across practice, Primary Care Network, and more broadly—it can be challenging to fulfil the demands of practice governance. Establishing clear portfolios and roles can help distribute responsibilities effectively and prevent duplication of efforts. Across the survey, 33% of partners shared that they either lack defined responsibilities as a partnership team or allocate tasks on an ad hoc basis. 

What to do if your practice lacks clearly defined leadership roles: Consider discussing professional goals, skills, and areas of interest across the partners at your practice. Using these as an outline can help you create defined portfolios and roles to balance demands on partners and ensure comprehensive coverage of all aspects. 

We’d like to thank Dr. Tony Naughton for his contributions to this blog. Dr. Naughton is Place-Based Clinical and Care Professional Lead for the Lancashire Place Based Partnership, Senior Partner at The Thornton Practice, and Co-founder of Qualitas Pathway to Partnership Programme.