BSc(Hons) MSc DMS CSci FIBMS
Finch Hill Health Centre
Douglas, Isle of Man
Finch Hill Health Centre opened its doors to the public on 1 March 2005. At that time, the practice was staffed by one fulltime male GP, two female practice nurses (employed for a combined 45 hours a week), two receptionists (16 hours a week each) and myself, the practice manager (working 30 hours a week).
The surgery is centrally situated in the town of Douglas on the Isle of Man, and joins five other practices serving the same highly populated area. The high number of practices is due to demand outstripping supply – before we opened, the other surgeries were pushed to their limits, unable to take more patients without impacting on patient care. So our story began …
As you can imagine, the early days were surreal! We had the luxury of two weeks' training prior to our opening, which enabled us to attend child protection sessions, learn how to use the computer system and the electronic telephone system, and also familiarise ourselves with the different contacts within the profession.
Dr Geoff Sharpe was appointed to establish this new practice, and made a conscious decision to recruit experienced staff with proven track records in patient care – but not primary care. The two practice nurses were highly experienced district nurses with no general practice experience. The two receptionists had backgrounds in customer care, teaching and working in family planning clinics.
As for myself, I had managed a pathology department in a private hospital in England, and had many years' experience as a biomedical scientist in addition to holding management qualifications.
I was also the only non-Manx worker on the team.
Dr Sharpe's decision to appoint staff who had not worked in general practice before worked perfectly. Our inexperience in primary care proved to be the winning formula, because what resulted was a practice modelled on how the staff felt their ideal practice would be, with no preconceived ideas or habits to change.
Even today, our patients comment on how it is like visiting a club or extended family, and say they feel like a person who matters, not just a number. As our list grows, we hope to maintain this. Today, three years on and having treated more than 3,000 patients, we are still on track.
That was then …
As practice manager, most of my time in the first year was spent working on reception, and establishing policies and protocols in between dealing with patients – who initially were few and far between.
Patients just walked in, registered and were seen with a wait of no more than 10 minutes, which was only necessary to allow us time to register them electronically and scan the completed medical questionnaire. If they needed to see the doctor, he would undertake their new patient registration check at the same time; otherwise, each patient saw the nurse for this initial check.
At this point, we began laying the foundations for the Quality and Outcomes Framework (QOF), taking all the necessary measurements along with the medical histories. I remember the first few patients: a young couple expecting their first child, a Polish family consisting of mother, father and one child, and a handful of young professionals – most of them are still registered with the surgery.
Within the first four weeks, we registered more than 140 patients. Some transferred to our practice because their current surgery had moved out of the immediate area. Others had moved out of their practice catchment area; the remainder were new residents.
Clinic times didn't really exist due to the gap between patients, but we did establish opening hours of 8am–12:30pm and 1:30pm–6pm Monday to Friday. It is almost unheard of for a surgery to close for lunch. However, to this day it has proved to be one of the most valuable things we have done. Not only do we have time to meet as a team informally, but we can also have formal staff meetings, multidisciplinary meetings, see visiting lecturers and, probably more valuable, have a chance to step off the treadmill and relax. Even the doctors get a chance to have a relaxed lunch break between surgeries and home visits!
… and this is now
In the three years that have passed, we have established various clinics (some nurse-led) and have tested different developments for GP surgeries on the island. We have also gained another doctor (giving us the ideal combination of one male and one female GP) and a health visitor, and provide a midwifery clinic once a week.
The nurses have passed various diplomas, and I have passed the Primary Care Management Development Programme. We all achieved these by distance learning and complete support from our colleagues.
While we have a growing list, our growth has slowed to around 60 new patients a month. The practice population is quite unusual for the island – more than 50% of our patients are under 35, there is an almost 50:50 split of the sexes, and around one-third are from outside of Britain.
My role involves the complete management of the practice, leaving the doctors to "just worry about seeing the patients", as one of the partners phrased it. Due to the variety of my role and the time I still spend working on reception, I have no such thing as a typical day.
A day of reckoning
As most practice managers will relate, some days you achieve a lot and other days comparatively little. Currently, I am in the "little zone", although spanners keep appearing in the works. My day today, for example, should have been very straightforward – just catching up on my 40 emails after a week off, dealing with Items of Service (IOS) returns and Quality Management and Analysis System (QMAS) returns, then clearing the backlog of outstanding accountants' information – but it didn't turn out that way.
I arrived at work at 7:45am. All was calm, so I logged on and started to run through the emails. At 8:20am, Dr Sharpe's wife called to inform us he had been unwell during the night, could not come in today and may even have to go to the hospital!
As luck would have it, the locum from the Department of Health and Social Services was booked for this morning to provide an extra pair of hands, as the other partner is on holiday in Zambia. The receptionist switched all the morning patients to the locum, and I managed to arrange a locum to cover the surgery in the afternoon. The locum concerned provides full cover, and actually worked here just a few weeks ago. In fact, I had already booked him to cover surgery all day tomorrow. First crisis avoided!
A short time later, when checking the appointments, I discovered that Dr Sharpe had planned a home visit to a patient on the Gold Standard Framework (GSF) who has been deteriorating over the last few days. On checking with the home, the patient sadly passed away during the night. Unfortunately, we needed to organise a death certificate and
Again, fortune intervened – Dr Sharpe's wife called again with regards to this. She is a GP herself and actually visited the patient last week when providing cover for her husband – so she would visit the home that morning to organise the death and cremation certificates, then the locum would provide the second signature. After various phone conversations with the home and undertakers, it was all sorted.
It was nearly 10 o'clock before I could buy some tea bags from the local shop (I did a supermarket run the night before for surgery coffee, but never thought about tea bags as we usually have lots). On the way, I also banked various cheques that had arrived while I was away and dropped prescriptions into the pharmacy.
Back at the surgery, all was running smoothly. Our nurse had arrived for her clinics and list of telephone consultations. I updated her regarding the GP. Over the last few months, both our nurses have undertaken triage training through work and distance learning, so she is happy to triage minor ailments to help.
Another of our GSF patients had just been seen by the locum, and he stopped for a brief chat with me before heading off to the pharmacy. After that, I dealt with the QMAS return and then went back to the emails – only eight left to read, and the morning had nearly gone!
By 2pm, I finally got around to eating lunch, having spent the last hour or so responding to accountant queries. I finished the day off by completing the IOS returns and a police check form on the new employee, paid some invoices before touching base with the locum and our sick doctor, before heading home at 4pm. I can honestly say I love my job and wouldn't swap it for all the tea in China!