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Wednesday 26 June 2019
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All change: a new practice manager in a state of flux

Practice Profile

Zoee Heathcote
Practice Manager
St Mary's Medical Centre
Rochester, Kent

Zoee was a sales manager until 1999, when she began working for a company subcontracted to the NHS. She then worked for an acute NHS trust, starting in medical staffing before moving into HR management and then operations management. In June this year, she became a practice manager for the first time

After nearly nine years of working at an acute trust, I decided I was becoming too institutionalised and looked around for another role. I looked at the nonpublic service but was drawn back to the NHS. I needed a new challenge and, wow, did I find one!

When I first read the advert for practice manager at St Mary's Medical Centre, I thought: "No problem, I can do that." The job description arrived and, though it was compact, there was nothing I felt I couldn't do. It described exactly the type of work I was looking for.

The description for the interview presentation was: "How to manage the changes of a practice in transition." During the last year at St Mary's, the most senior partner retired, the practice manager moved onto pastures new and then the next most senior partner moved on to develop his career in service improvement for the NHS. It was all change: two new partners would be joining the practice, along with the new practice manager. I was very involved with change management at the acute trust, and it is a passion of mine – so I went for it.

By the time I started work at the practice, it had been without a manager for three months. It had been managed by the deputy practice manager and the practice secretary, who, to their credit, had done a tremendous job.

Walking in on my first day, I felt I was ready for new and challenging times. For the first three days, I thought: "Great, everyone is lovely. No emails, no diary commitments. This is easy." On day four, though, it was a different story: "Great, everyone is lovely. Oh dear, what have I done?!" Even with nine years of NHS experience, nothing had prepared me for such a steep learning curve.

Within the acute trust, I was very much hands-on. My role was diverse, encompassing change management, performance management, HR issues, dealing with patients' complaints, operationally organising staff and adult protection. Although this is largely the same as within general practice, the hospital environment is, as it states, acute. The service you provide is there and then – there is no planning for the emergencies coming through the door.

Within general practice there is time to plan – however, the environment is much more of a resource centre, with so much information to take in. As general practice does not specialise in one particular area, the work is vast and intense. General practice is not one department, but its own small business with a large healthcare agenda. I am sure any experienced practice manager would agree that the GMS contract in itself is a minefield to get to grips with.

At first, even the most simple practice work demands were alien to me:

  • "The petty cash is low. We need some more money." Don't we all?
  • "We need to know what we are going to do for PbC." Pb-what?
  • "The insurance is due for renewal." What insurance?
  • "Payments for DES and LES are due." Who are Des and Les?
  • "We need a programme for student doctors." Holby City, perhaps?
  • "The lights have gone in the treatment room." Where's the ladder?

With all of this hitting me I decided I needed a clear way of knowing how on earth I was going to come to grips with general practice. So, to start with I asked for one of the partners to meet with me on a regular basis to ensure I was going in the right direction. I always have a task list, I ask a lot of questions and I have protected study time every week. My tips for a smooth transition are planning, preparation and setting SMART objectives for yourself and your staff/colleagues:

  • Specific.
  • Measurable.
  • Achievable.
  • Realistic.
  • Timely.

I found out who my counterparts were at other surgeries and telephoned them, introducing myself. I did the same with the lead for our local PCT, the contracts manager, the PbC lead, the CAB lead, the QOF/QMAS lead and the LMC lead. I either invited them to come and meet/train me or attended their place of work for the same. This allowed me to learn about what I am managing in my own language and at my own pace.

St Mary's Medical Centre has a list of 8,500 patients. It was built in 1990 on the site of an old school. We currently have four partners, all of whom have a special interest to enhance our local services, such as mental health, diabetes, obesity and paediatrics. We also have four practice nurses, two healthcare assistants, one midwife, three shared services counsellors, 11 clerical staff and three cleaners.

When I first started at the practice, I felt communication was poor and I needed to make St Mary's a more transparent place for both staff and patients. The partners now meet regularly to discuss clinical or pressing issues. This allows our weekly practice meetings to address the agenda items only. In addition, I introduced communication meetings for all staff. We are currently looking at having a patient representative meeting so our patients have their say in the way we offer services.

I absolutely enjoy this job. It is so varied, and there is still so much for me to learn. It helps having such a good team around you. So, my message to all new practice managers out there is: hang in there – it can be tough, but it is extremely rewarding.