A great practice is built on strong governance
What would your practice be like if nobody followed the rules?
Imagine there were no agreed systems, processes or policies. Nobody was clear about their responsibilities, decisions were made without accountability, and there was little monitoring or control over how things were done.
Think about the impact on efficiency, safety, quality and the people working in your practice. How much time would be wasted, how many mistakes would be made, and how much would all of this cost?
Fortunately, I’ve never come across a practice that operates like this. But I have experienced plenty where weaknesses in business governance have created unnecessary problems, increased workload and exposed the practice to risks.
Strong business governance is the way to avoid this and one of the foundations of a great practice.
What is business governance?
Put simply, business governance is how your practice is managed at the highest level. In general practice, that responsibility sits with the GP partners and senior managers.
We are all familiar with clinical governance and its importance in ensuring safe, effective patient care. Business governance is equally important but focuses on how the organisation itself is managed.
It means having the structures, systems and processes to ensure your practice operates efficiently, safely and successfully. That includes:
Clear responsibilities and accountability.
Effective decision making and leadership.
Sound financial and risk management.
Meeting legal, regulatory and contractual responsibilities.
Protecting information and building positive relationships.
These aren’t complicated ideas. They’re what you would expect in any well managed business. Yet business governance doesn’t always receive the attention it deserves in general practice.
Good governance reduces workload
One misconception is that governance creates more work. More policies, more processes, more meetings and more paperwork. I believe the opposite is true. Good business governance doesn’t create work, it reduces it.
Think about the time wasted because responsibilities aren’t clear, decisions aren’t made or the same problems keep happening. Consider the cost of mistakes, duplicated work and problems that could have been prevented.
I’ve seen practices where insurance has lapsed, former employees have retained access to bank accounts, partnership agreements have become outdated and income hasn’t been claimed. These are often weaknesses in how the business is managed, rather than failures of individual people.
Good governance helps prevent them and frees leaders to spend less time solving problems and more time improving the practice.
The seven pillars of business governance
How do you know whether your governance is strong, and where you need to improve?
I use the 7 Pillars of Business Governance, a practical framework for assessing how your practice is managed and identifying opportunities to strengthen it.
1. Organisational Structures
People should know what they’re responsible for, which decisions they can make and who they’re accountable to. Without that clarity, work gets duplicated, decisions are delayed and important tasks are missed.
Ask yourself: Is everyone clear about their responsibilities and authority?
2. Effective Leadership
Partners and managers need to provide direction, establish priorities and make sure plans lead to action. They should create a positive culture, support their people and encourage improvement. Even good systems achieve little without effective leadership.
Ask yourself: Do our leaders provide direction and make sure things happen?
3. Regulatory Compliance
Every practice has legal, regulatory and contractual responsibilities, from CQC requirements to employment law, health and safety and NHS contracts. Good governance means knowing what’s required, meeting those requirements and being able to demonstrate it.
Ask yourself: Do we know what we must comply with, and can we evidence it?
4. Financial Management
Strong financial governance means claiming the income you’re entitled to, controlling costs and making informed decisions. Partners and managers need accurate, timely information about income, expenditure, profit and cash flow, reviewed regularly.
Ask yourself: Do we have the financial information needed to make good decisions?
5. Risk Management
Every practice faces risks that could threaten its future, including financial losses, key staff leaving, property problems or system failures. Identify them, assess their impact and take action to reduce them. A regularly reviewed business risk register is a useful starting point.
Ask yourself: Do we know our greatest risks, and are we managing them?
6. Information Governance
It’s not just patient records that need protecting. Practices also hold financial information, employment records, contracts and payroll details. Good governance keeps information secure, accurate and accessible only to those who need it.
Ask yourself: Is our information secure, with access properly controlled?
7. Stakeholder Engagement
Successful practices depend on positive relationships with patients, staff, NHS organisations, other practices and partners. Good governance means listening, involving the right people and using their views to improve decisions.
Ask yourself: Do we listen to and involve the right people?
How strong is your business governance?
Most practices already have some good arrangements in place. But there will almost certainly be opportunities to improve.
Bring your partners and senior managers together and set aside time to review each pillar. Ask four questions:
What do we do now? Identify what’s already in place and working well.
What do we need to improve? Be open about gaps and weaknesses.
What action should we prioritise? Choose what will make the greatest difference.
Who will be responsible? Give each action a named owner.
You don’t need a complicated plan. A few clear actions, with named responsibilities and a commitment to follow them through, can make a significant difference.
Make governance part of how you work
Governance isn’t something to review once and forget. It needs to be part of how your practice is routinely led and managed: reviewing performance, monitoring risks, checking compliance, making decisions and following up actions.
It’s a shared responsibility of partners and senior managers, not something left entirely to the Practice Manager.
A great practice isn’t built simply by working harder, seeing more patients or introducing more services. It’s built by creating a strong, well managed business that supports its people, delivers excellent patient care, meets its legal, regulatory and contractual obligations and remains financially sustainable. Strong business governance helps make all of that possible.
If you want to assess and improve your own governance, my Business Governance Improvement Framework provides a practical starting point. It takes you through the seven pillars and helps you identify and prioritise improvements.
About Gary Hughes, MBA, PGCMDE
Gary Hughes has spent nearly 20 years in primary care, leading, supporting and strengthening general practice as a Practice Manager, consultant, educator and facilitator. Through Leadership in Practice, he helps practices become stronger, more effective businesses.
Gary developed the Business Strength Model, a practical framework that enables practices to assess the strength of their business across seven key areas. He also designs and delivers workshops and education programmes, speaks at industry events, and hosts the Leadership in Practice podcast.
If you would like to understand the strength of your business and identify opportunities for improvement, contact Gary here to arrange a free Business Foundations Health Check.
About us
THC Primary Care is an award-winning healthcare consultancy specialising in Primary Care Network management and the creator of The Business of Healthcare. With over 20 years in the industry, we have supported more than 300 PCNs through interim management, training and consultancy.
Our expertise spans project management and business development across both primary and public sectors. Our work has been published in the London Journal of Primary Care, and we have authored over 250 blog posts sharing insights on primary care networks.
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