In a separate article this issue, we profile the current manager of Wolverhampton's Thornley Street Surgery. Here, Dr Simon Carvell speaks to Judy Dean, former manager of the same practice until 2000. Her years of experience reflect the astonishing change in primary care, as well as the transformation of the practice manager's role
Simon Carvell: Thank you for agreeing to talk to me about your life as an "outsider" since retiring as a practice manager in 2000. Let's start at the beginning: how and when did you first get into practice management?
Judy Dean: I became a practice manager in 1986. I had previously been one of only two part-time receptionists at what was a busy two-partner surgery in King Street, Wolverhampton, where I started in 1974. It's hard to imagine now that any GP surgery of any size could manage with only two part-time staff!
When the doctors were forced to relocate their premises to Thornley Street in 1986, the senior GPs asked me to become the practice manager. It was a challenging time, as our move meant expansion in patient numbers and obviously there was the necessary increase in administration staff and receptionists – all this meant that the practice grew quite dramatically in just a few years. It was – and still is – the only town-centre practice
SC: What qualifications did you have to become practice manager?
JD: I had no formal qualifications. It was a big decision to become a practice manager. In 1986, there were probably about six practice managers in our town, and their role wasn't clear. It was often something that I discussed with the senior partner as we tried to thrash out details of my duties/role.
Different practices had different views of the role of the practice manager. As partnerships and surgeries grew, the appointment of a practice manager grew out of necessity. Someone was needed to oversee staff to marry the doctors' ideas with the staffs' duties.
Prior to my appointment, I thought I could be a good manager; I knew my shop-floor experience and good rapport with people would stand me in good stead.
SC: What qualifications should someone have in order to become an effective practice manager today? Do you think practice managers can do their role on a part-time basis?
JD: I guess, ideally, they should at least have some shop-floor experience. A receptionist is always the first point of contact for patients, and an ability to understand the "front of house" is
As I neared retirement, I understood how important good IT awareness was becoming. When I started in general practice, all accounts, payroll and appointments were handwritten. Before I retired, these were becoming obsolete and l felt that a new generation of IT-literate staff was essential.
I understand that formal qualifications are also available to would-be managers. Anything that prepares you for the diverse challenges of becoming a practice manager sounds useful. When I was a practice manager, there was no way that I could do the job part-time, so unless things have changed dramatically l can't imagine that the role is now a part time one.
SC: You mentioned that in 1986, the concept of a GP manager was still in its infancy. What was the role like then? How did it become more defined?
JD: Following the premises move in 1986, our dynamic senior partners resolved really to drive the surgery forward. We moved to converted terrace of four "back-to-backs". Initially, as a fledgling practice manager, I was something of a "Girl Friday" to the GP partners: I was a receptionist and an organiser of training for both new staff and the GPs.
I typed the GP letters (on a typewriter), organised the pay roll and helped with the accounts. I also, believe it or not, tested urine samples! But as time went by, although l sometimes sat in reception to listen to patients' concerns, my role became more "upstairs". I met with other practice managers every month, and it was obvious that practices saw their managers in a number of different roles.
SC: What are your views on practice managers taking the next step and becoming partners in general practices?
JD: Before I became a practice manager there were no managers. The demands on a surgery, I guess, were not as great.
Of course, having a practice manager has now become an essential part of any effective general practice as demands from patients, local primary care trusts and central government have increased exponentially. If a practice manager is well trained, effective and involved in making key strategic decisions, I can't see a reason why they shouldn't be partners.
SC: What were your biggest career challenges?
JD: I saw a big change in the NHS in 1991, when the Patient's Charter was introduced under the Conservative government. This Charter opened up access and outlined the standards that patients should expect both in hospital and in the community. It opened doors for patients and had big workload implications for our surgery.
The GP had always been "everybody's friend" and was seen as "part of the family". Then, through necessity, the GP became more accountable and scrutinised. I saw greater communication develop between the wider primary care team; district nurses and health visitors were more visible at the surgery, and that obviously meant more meetings.
SC: What are your views of the NHS now, as an "outsider"? Have you any views on Choose and Book, the NHS Spine and practice-based commissioning?
JD: I worry that decisions that are made now about the NHS are taken by people who have no experience working for the NHS. The way forward in the NHS should be determined by those who work inside it – be they clinicians or perhaps even practice managers, particularly if the decisions are made about primary care. I'm afraid I'm not particularly aware of the new initiatives that you've just mentioned.
SC: That's concerning, particularly when the NHS Spine affects all of us and the government initiative represents a £12bn investment for the NHS. I wonder if the fact you're unaware of this is more a reflection of the failure of this initiative, as it suggests it has not been properly advertised to everyone?
JD: My main concern with government IT projects is security, and I worry about breaches in security and hacking. I don't mind my records being seen by doctors when there's a clinical need, but can that be guaranteed?
SC: Do you miss being a practice manager?
JD: When I retired in 2000, I did at first miss the company and the day-to-day challenges of general practice. I knew before I decided to retire that if I'd wanted to carry on then I would have needed to develop my skills, particularly when it came to using the computer, but I knew that at my time of life it would be a challenge too far. I contemplated perhaps returning in a lesser role – but at the end of the day, "once a practice manager, always a practice manager."