As I cuddle the youngest of our four children, it is difficult to remember the life-changing decision I had to make five months after she was born. My husband had decided to take on a single-handed practice, near to our home, which had recently been run by the primary care trust (PCT). In the three months before taking it over, the practice suffered enormous upheaval: the practice manager sadly passed away, the salaried GP, one of the practice nurses and a member of the admin team left.
In a small practice, this can have devastating effects on staff morale and the level of the service provided. This practice was struggling, and the daunting task of becoming its manager was not something I took lightly. However, it was soon apparent that things could improve – I can remember walking in on a cold December morning and being welcomed by a very grateful admin team, who were only too happy to put in the work required to bring the practice back up to standard. I can honestly say that the number of hours I worked over the next few years would put me in good stead for the exciting and demanding future I was about to embark upon.
Our priority was to make sure that our lovely village had at its heart a welcoming and caring practice. I am a passionate believer that if patients have a reduced choice of practice to register with, due to location, then it matters more than ever to strive for excellence in the service you provide. From that very first day to this, I have always walked into our practice from the front door. I always want to see what our practice looks and feels like. This follows through to how our lovely team works. I try to inspire the team to look at their own roles in the context of what we do from our patients' point of view.
Patient and community links
One of the most enjoyable parts of my role has to be interacting with our patients and local community. My colleagues and I acknowledge that we are often dealing with patients at some of the most challenging times of their lives. We try simply to treat them just as we would want to be treated; for us, it is no more complicated than that. Part of that is having 'hands on' experience of what it is like to work on a very busy reception, when dealing with patients' needs. I like to do this on occasion as it gives me great insight, although I am not nearly as good at it as our great admin team.
We like to innovate and be part of pilot schemes, and with this vision we jumped at the chance to pilot 'Virtual Patient Participation Groups' – this involves emailing surveys to patients so they can record and send back their opinions in their own time. We were delighted to find that we could easily recruit 100 patients to this virtual group from varying backgrounds and ages who would be happy to complete very quick surveys. These are conducted throughout the year.
In all it took very little time and now provides us with a ready stream of input. Our aim is to sign up as many as want to be involved. I have no doubt that in the near future we will have our surgery on Facebook, adding another method of communicating with our patients.
I have really good links with the local parish council and meet with them regularly. They also invite me to attend one of their public meetings once a year. This helps to keep them up-to-date both with practice development and issues in the wider health economy.
I enjoy discussing some of the things we deal with, such as the number of patients who do not attend (DNA) appointments, even though they have received a text reminder for it. Often our local community are shocked when they hear their fellow citizens sometimes don't value the services provided to them. No doubt these longstanding issues will become more important as budgets are stretched.
Speaking at these meetings is always a challenge: as we are in a village, everyone knows one another, so I have to remind the audience that I can't talk about specific individuals. The amount of patients in the audience who then proceed to talk about their husband, daughter etc in front of everyone is an excellent reminder of how some of the rules of confidentiality that I uphold are not necessarily ones all patients appreciate.
I have been a 'beta tester' for a GP IT system supplier for a number of years. I really enjoy it when I can see an enhancement coming through their products as a direct result of my feedback. Practice efficiency is always near the top of my priorities and IT that works and is intuitive is hard to come by. When it does, you tend to be protective of it. Indeed, when we were required by our PCT to change our clinical system I agreed only on the proviso that I would be able to keep certain products we had been using successfully for a number of years.
My interest in IT and the quality of data it generates is an area I am hoping is going to be utilised in the dawning of the new agenda of GP commissioning. The quality of the data we will require to make appropriate commissioning decisions will be one of the biggest challenges we face. I am aware that a number of consortia feel the same way. Sharing examples of what good quality IT commissioning support looks like should be a priority for all of us involved in making those decisions.
Indeed, as part of my roles for The Family Doctor Association and The Practice Management Network, I am able to work alongside individuals involved in decisions being made about the future of commissioning care for our patients. Being a 'frontline manager' – a term that I believe creates a distinction within the various NHS management roles – means that I am able to bring frontline experience of what it is like, day to day, delivering services to patients.
I envisage the role of practice managers changing over the next few years as we all get to grips with our new responsibilities. Like GPs, however, there will be those who lead and those who support. Our local consortium has six GP clinical leads, two practice managers and one nurse. However, we have already asked at our first board meeting for names of interested GPs and practice managers who want to be more involved but do not necessarily want the commitment of being part of the executive of the board.
Network and support
As someone who came into general practice without any previous NHS experience, I recognise only too well how easy it is to become isolated, so I recommend to any practice manager – new or old – to make contact with their local colleagues. One of the delights for me working with my peers on the Practice Management Network is in highlighting the numerous local organisations that exist between practice managers. Indeed, our interactive map on www.practicemanagement.org.uk shows where they are.
As an active member of our local practice managers' group, I am proof of how important it is to network and support each other. Indeed, if it hadn't been for my local colleagues all those years ago on that cold December morning, I might not be sat here with the sun shining and with a thorough enjoyment of the varied roles I am privileged to undertake. My aim for the future, with my northern sense of humour, is to give some of that support back to any of my colleagues who may want it.