Well, here I am again. After a long, laborious day, I have reached the point I think we all sometimes reach: rather than sitting back and thinking positively about what has been achieved, I am reflecting on all the things that weren't done. That includes, most importantly, this article, which was promised days ago.
Like all the rest of the "stuff" there just wasn't time for, there is no excuse for it. But just where does the time go? After all, you dealt with the other things that brought you in early and kept you behind after home time – and you waved goodbye to that lunch break when you planned to nip to Tesco or the bank. You had to spend time at the desk or in a meeting in order to save precious time ahead. You know this because you had it all planned out.
I planned ahead. I had made lots of notes and had plenty of ideas. I know the print schedule, the time and the deadlines. I even had ideas left over from the last column! Surely others would be doing Darzi, the NHS Constitution, etc? So avoid that. Though no doubt when the copy of the magazine arrives, those topics will be back on the agenda and you haven't even touched on them.
A safe item on the agenda this time is the season. The end of the year. A time to reflect. A good time to look back at this year's issues of Management in Practice and consider some of the key issues.
The spring edition highlighted a "thinktank" meeting, in which a new association to provide practice managers with a unified voice was put forward. I had hoped to attend this meeting, but London transport problems meant my connections would not allow me to spend sufficient time there. Others attending undertook to keep me informed of developments.
If there is anything I have learned since coming into the sector, it is the single-minded determination to reinvent the wheel. There is nothing more infuriating than turning up to a meeting in which people are unaware of each other's work, which turns out to be duplicated.
On one comical occasion, for instance, I attended a meeting in which we began by introducing ourselves one by one around the table. It turned out that two people were there from the same small organisation and hadn't met each other before. Both of them were there looking to spend resources. Fair enough if it is your own money – but this is generally public money we are talking about.
The thinktank idea had legs, but I don't know where it has reached. In the same issue of the magazine, I addressed the fact that members are the driving force behind any organisation. To this extent, infrastructures already exist that have channels of access to the powers that be. If people are unhappy about progress, the members have it within their power to change direction.
What is the point of spending time and resources going through the rigmaroles of setting up another organisation? AMSPAR, the Institute of Healthcare Management, the NHS Alliance and indeed Management in Practice are all here for you.
We do speak to policymakers – it's being heeded that is the problem. Consultations come and go but I feel decisions tend to have been made beforehand, despite the propensity of government and bureaucrats to go through the motions of "listening" exercises.
Democracy vs bureaucracy
Over the past year, I have been attending a Strategy Implementation Group coordinated by NHS Security Management Services (SMS). This body looks at ways to improve security of property, premises and personnel. One long-running project has been the financing of alarm systems for lone workers. Although the government has said the money is available, so many obstacles have had to be overcome that, years down the line, none of these alarm systems can yet be issued through the project.
At the recent annual SMS conference, a civil servant was left to take the flack on another funding issue when the government minister was unable to attend at the last minute. Earlier in the year, a lump sum of money was announced to boost security. When queried on the money, it was emphasised that this was not "new" money but was in existing budgets. Trusts claim to know nothing of this and the Department of Health could not direct them to earmark the sum for security. Where does this leave security managers in finding the resources for their work?
Rather than reflect on the negative, let's look at the positive developments of the year. Lord Darzi's Next Stage Review was published, which provided something tangible to work with. We also had the opportunity to comment on the NHS constitution through a consultation. However, the constitution only applies in England and will have no legal standing.
In the last issue of Management in Practice, I had the chance to recount my own experience of the NHS and its value, in light of some NHS dental treatment I had recently. I'm sure you have been waiting with baited breath to hear the final outcome. Sadly, the venture did not end happily – and I suspect that an outsourcing of the secretarial function was involved.
A letter referring me back to my own dentist to conclude the treatment arrived 10 weeks after my final visit. On top of this was the evidence of "top and tailing" – the letter showed the previous month's date and was addressed to an unknown doctor. Yet the argument used for outsourcing is usually "efficiency".
Moving forward in 2009
Another highlight of the year was the inaugural Management in Practice Awards. Just as you begin to feel world-weary, you are reminded of the exciting, fresh work that is being carried out around the country. And don't be modest. It's more than likely that you too are achieving great things in your own practice. Take this onboard when the entries open again next year.
That new year is almost upon us, so reflect on what you have achieved in 2008. There is always more to be done – that is the nature of the job. But you have contributed much to the wellbeing of others, something you should be proud of.
Be positive and resolute in working.