Adele D'Cunha is the practice manager at the Wellbrook Surgery in London. Here, she shares her approach to the "practice operation and development" competencies outlined in Steve Williams' article:
What type of contract does your practice have?
We are a PMS practice. Before this, we were in a partnership, but we have found the current contract model easier to recruit and retain GPs.
Do you attend PCT meetings?
To be honest, I prefer only to attend meetings I feel will have a direct impact on the day-to-day running of the practice. I am supported by a strategic manager, who will often deal with the policy matters. I do have a contact person at the PCT, and I find that this is useful if I want clarification on any matter.
Do you have any current practice developments?
The biggest change that we are going to face is the relocation of our main surgery. Although our current surgery is still relatively new, the local council has placed a compulsory purchase order on the surgery, and we are currently involved in discussions about where and how the new surgery will be created. However, there are other issues to deal with, such as our list size being capped as patients are moved out. At the moment, it is anticipated that the new development will mean twice as many patients as now, so we will need to adapt our practice over 2–3 years to manage these changes.
Are the clinical services you provide the same every week?
I wish it were that simple. We actually operate out of two sites. We do not look upon them as being the main and branch surgery. They both have different patient needs and therefore are run to address those needs. I have another manager at the other site who ensures that services run effectively there. We do have different clinics at each site and we regularly review services to see whether they need to be amended, reduced or increased.
Who do you deal with regularly?
Obviously, it goes without saying that there is regular contact with the PCT. I probably deal with four or five different departments throughout the course of the month. I have to deal with attached staff, such as community nurses and midwives. I also have to organise visits from pharmaceutical representatives, and plan and organise training events. We share a building with another practice, so I have to liaise with their staff on certain occasions.
Do you really know what the future holds for your practice?
I am fortunate that I have the assistance of a strategic manager who advises me on the majority of policy issues. This allows me to concentrate on running the practice. To be honest, I don't worry too much about the future. I feel it is important to deal with what is happening now, but I do understand the need to be always aware of the changes that affect primary care and in particular general practice.
How many audits do you carry out?
I have been taught that you should be constantly reviewing your practice information. Obviously the Quality and Outcomes Framework has meant that I carry out regular reviews and clinical audits. Recently our PCT has introduced a performance management framework, which means that I will have to ensure both clinical and organisational audits are done on a regular basis. Failure to do so could lead to the practice losing money from its contract sum.
Do you have a good understanding of the practice finances?
I would like to think I do, but I must admit there are times when some of the financial issues seem to be overbearing. I rely on the practice accountant and also specialised staff, but I do take an interest in the overall finance issues of the practice. I need to control the day-to-day spending of the practice and am responsible for staff salaries and authorising overtime. As you know, staffing is a large part of the practice overheads, so it needs to be controlled appropriately.
How do you fulfil your CPD requirements?
I would like to say very easily. In truth, I have to rely on the generosity of my doctor to allow me to attend training events and seminars. I will only attend something if I feel it will benefit the practice. I do, however, understand the need to remain in touch with wider developments within the NHS. An example of this could be the white paper regarding the pharmacy contract. Although this does not directly affect my practice now, at some time in the future it could do. I am now embarking on creating my own CPD register, which covers many of the topics mentioned in this article. This will also keep me informed when it comes to my annual appraisal.