Edward Picot has been a practice manager for 17 years. His website, edwardpicot.com, features a collection of his writing, poetry, short stories and animations
Jack, my employer, is a course organiser, and on Wednesday afternoons he's usually at the local postgraduate centre, training his group of registrars.
Since we're a single-handed practice, this means we have to find cover for him. In the past, we've made do with a patchwork of locums, but it's never been satisfactory. They don't know our protocols, there's no continuity of care, and of course they're very expensive.
Last year, however, we were lucky enough to get a retainer GP called Sally, who came and worked for us all day on Wednesdays, covering the afternoon on her own. Sally has four school-age children, but her mother agreed to collect them from school and take them home for tea every Wednesday.
This summer, unfortunately, the mother suddenly announced that she was too old to do this any more – so Sally had to give the Wednesday afternoons up. We thought we were going to have to go back to employing locums, until I came up with the idea of swapping half-days.
Our half-day is on Thursdays, and on Thursday afternoons another local surgery, run by Dr Justin, covers us for emergencies. In return, we cover for Dr Justin on Wednesday afternoons, when he takes his own half-day. But if we were to swap over – so that we closed on Wednesday afternoons and he closed on Thursdays – we would no longer need cover for Jack's training sessions.
Rather to our surprise, Dr Justin agreed to this idea straight away. Splendid, we thought, all our problems are over – but then we started to realise that our decision would have other knock-on effects, which we hadn't anticipated.
First, we rent out a treatment room, which on Wednesday afternoons is used by a private physiotherapist. Now she'll either have to change to Thursdays or find herself another room somewhere else.
Second, Jill, one of our best members of staff, takes on reception duties on Wednesday afternoons, and she can't swap to a Thursday because she has another job at another surgery.
She wasn't very happy about having her hours reduced, and it was only after talking things over with her at great length, assuring her we didn't want to upset her, that we came up with the idea of her staying late on Wednesdays, in the quiet, to do some scanning and typing.
This seems to exemplify the ways things happen in general practice. Many of the problems you have to deal with come about because of factors outside your control, like Sally's mother.
You have to try and solve these problems by thinking flexibly and creatively about your working arrangements – but whatever decision you take, it's bound to create secondary consequences that you haven't foreseen. Eventually you'll find your way to a workable solution – just in time for the next problem to plop into your lap.