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Friday 30 September 2016
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A singular ambition: life as a new, single-handed GP

Practice People

LALARUKH KHAN
MBBS MRCGP DFFP
GP
Caergwrle Medical Practice
Flintshire

Lalarukh started her career in general practice as a salaried GP with Western Cheshire Primary Care Trust (PCT) in 2003. This gave her a flavour of working in different practices, before she then went on to do sessional GP work. In addition to running her practice, she also works as an appraiser for North Wales and Western Cheshire PC

So, what led me to become a single-handed GP in Caergwrle? Well, before I took over the practice, in October 2006, I was in need of a challenge and was looking for a window of opportunity. It would have been comparatively easy to have moved into a large, well-run practice, but the experience of working in different surgeries as a sessional GP had given me an insight into what I wanted for my own practice.
At present, salaried GP posts are becoming more commonplace, and the choice of partnerships is becoming limited. However, single-handed practices with retiring GPs are often being merged or are set out for tender. So when this opportunity arose at Caergwrle Medical Practice I grabbed it with both hands – but what hard work I had in store!
We have around 1,200 patients now, which is an 18.7 % increase in our list size from when I first took over the practice less than a year ago, so we must be doing something right! In addition to myself, we have four members of staff: a part-time nurse, a part-time office manager, an IT coordinator, who also carries out dispensing duties, and a receptionist. In addition to this, we also have a visiting phlebotomist.
Just six weeks after I had started at the practice, we leapt kicking and screaming into the 21st century – going from 0% note summarisation to 100% (I was even summarising in my sleep). Credit goes to my IT administrator, Kevin Studwick, who has been instrumental in inputting data on the computer and sorting IT issues out – ranging from creating a new practice leaflet to planning a practice intranet.
I supervise the Quality and Outcomes Framework (QOF) data myself, and actually enjoy it! Within six months of the handover, we went from having the lowest QOF points in the area, to having one of the highest. This has required extremely hard work from my whole team. We compressed two years of work into six hectic months, with many late nights.
Seeing my motivation, my staff also put in 110%. The practice has been a model of teamwork – when the going gets tough, the tough get going!
From the beginning, we had an instant empathy with our patients, who appreciated my knowledge of their problems, and were tolerant and supportive to the changes in the practice. We have a very active patient forum, and the appreciation shown by the patients has been overwhelming.
My typical day starts at 8.30am – checking emails prior to morning surgery, dealing with telephone queries, organising home visits and doing admin work. Then, I have a quick update with our office manager or IT coordinator about how things are going, and brainstorm for any ideas.
I am also training the practice nurse, Sue Clarke, to run a minor illness clinic so any interesting cases are shared. In a small practice, it is very easy to share patient care between the nurse and GP, as they can be seen on the same day.
I have an open-door policy, as I believe it helps staff confidence and develops team spirit, which is such an integral part of working in a small team. I work hard and I expect my staff to do the same.
If I have any time left after the morning surgery, I try to keep abreast of my appraisal work, but that is mostly done at home. Then it is time for afternoon surgery before the day ends (thank God there's no out-of-hours!).
Dispensing was a completely new area that we have entered into. We are part-dispensing, something that has been integral to my quest for cost-effective prescribing. Patients love the dispensing service we provide. Medications are ready at the end of consultations, and I am available for any queries. We modified the service provision, put standard operating procedures in place, and did not look back. Learning about dispensing has been exciting but challenging.
As a GP, I have had to learn a lot about practice and staff management, and it has not been easy. Practice management duties are shared between our office manager, our IT coordinator and myself.
The field of employment law and staff procedures is, in itself, a minefield. The staff response to change was variable – longer-serving members, who were used to working in set ways, found it challenging to accommodate. I had to decide where we were, where we wanted to get to, and how to achieve it. We had to devise a positive cycle of change.
I feel that, as a single-handed practitioner with responsibility for the practice, I have had to develop more of my leadership abilities. At times, there have been hard choices to make, and ups and downs. However, the support of my team and my kids has kept me going. My two daughters have been very tolerant of my haphazard hours and my obsession with work!
To younger GPs, who may be interested in pursuing their own single-handed practice, I would say that if you are not afraid of hard work, can deal with uncertainties and, above all, you have a vision for the future, then go for it!
In the ever-changing political environment of health centres and mergers, I don't know what the future holds for our practice. But whatever may happen, I know my job satisfaction is 100%. The whole exercise has given me more insight into my abilities and also into what my patients want.
It is a privilege and I am passionate about it!
In terms of my plans for the future, these are: to increase our list size to the extent that we are able to take on more GPs in the practice; to develop our existing premises to make them more environmentally friendly and modern; and, above all, to stay sane, keep smiling and look after my family!