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Thursday 19 July 2018
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Blog: Managing a heavy workload

The practice manager role is evolving, so it is vital that you give yourself the best chance to cope with the rising workload

No matter where your practice is in the UK, most practice managers feel they are busier now than at any time in the

past – and the trend doesn’t look likely to reverse.

That’s not to say that practice managers previously enjoyed slack in the working week. Thinking back to when a lot of our work was manual, I wonder how many practice managers remember keeping morbidity registers on blue and pink cards? Payroll documentation was completed by hand and the salaries worked out with a calculator.

Newer managers can be forgiven for thinking that IT made our lives simpler, automated and quicker. It did, but new demands appeared - Read codes to record items of service, repeat prescription systems,

recruiting and integrating new practice nurses, fundholding and the Quality Outcomes Framework and enhanced services. To come right up to date, add the rising list sizes, frequently unreasonable patient expectations, clinical commissioning groups, financial pressures and a diminishing number of GPs and locums. No wonder practice managers are struggling with the weight of it all.

So could we help ourselves by taking a fresh look at our time management?

Time management

  • Time management comes down to planning, prioritising tasks, avoiding distractions and ensuring your routines are streamlined - designed not to waste time.
  • Planning and protecting time - In order to protect your time you need to plan it properly. First, identify how you actually use your time - not just how you think you do. Use activity time logs to perform a time and motion study on yourself. Once you have established how much time regular tasks take, use a diary and activity planner (eg the calendar in Outlook) to mark recurring meetings and events, and to block off sessions to give yourself enough space to do your work. Remember to include preparation time. Once these are in place, start planning in new pieces of work. 
  • Larger pieces of work are best broken down into smaller, manageable steps so that nothing is overlooked. Action plans can be used to help you do this. There are plenty of action plan and time log templates on the internet that can be downloaded free.
  • Prioritising – ‘To do’ lists are key here. Begin by looking through your in-tray and make a list of what needs to be done and by when. As other jobs appear, re-assess your priority list. Always check any requests from other people against your own priorities.
Do not automatically assume that important equals urgent - this is not always the case.
  • The experts recommend that after prioritising you should deal with each paper or task on the first occasion
– not returning to documents several times over. In the same vein, only do one task at a time - eg do not text while on the landline – so that you give each activity your full attention and achieve quality results.
  • Consider each of your tasks and ask yourself ‘Does this task help me to achieve my personal goals and objectives?’ If the answer is no, why are you doing it? Could you delegate it?
l Avoiding distractions – We all have daily intrusions that divert us from the job in hand but some could be made less disruptive. For example, do you respond to emails the moment you hear them arrive? Consider
  • silencing the alert noise and disciplining yourself to only check your inbox at pre-determined times each day.
  • Set your own timelines rather than adopting someone else’s – acknowledge receipt of the email and give the sender a completion date that works for you too.
  • Perhaps you find it hard to say ‘Not just now’. What if you were to say ‘I am doing the accounts, staff appraisals etc and it is vital that I complete this by a certain date. I realise your request is a priority for you and I would like to help, so could we agree a realistic deadline that suits both of us?’ If you can demonstrate that you have the practice’s best interests in mind it should be much easier to negotiate.
  • It’s also a good idea to close the door when you are working on something urgent so that you get peace and colleagues get the message. Could you go elsewhere to do this activity, maybe even work from home?
  • What does your desk look like? Does it suggest control and efficiency or organised chaos? Are there papers and coffee cups all over it or do you file things away as you go and operate a clear desk policy?
  • But bear in mind, you can be too obsessive - regularly arranging and re-arranging is just time wasting. Strike a happy balance.
  • l Routines – When do you do your best work? If you are at your most alert first thing, that is the time to undertake the most challenging jobs, setting aside time for less energetic jobs for your lower point in the day. Do you take meal breaks to allow your body and brain to rest and refuel? No-one does their best work on an empty stomach.
  • Is everyone trusted to get on with their own job? Or do you spend your time checking up on people or even worse, doing some of their work so you know it has been done properly? Micro-managing is time-consuming for you – and morale sapping for your team.
  • If staff are not competent, sort out the performance issue – don’t add to your own workload.
  • Finally, some people see being busy as a proxy for status, displaying a perverse need to be seen to have too much to do, always going to the wire on deadlines, arriving late for meetings. For others observing and putting up with this, it might convey a lack of effectiveness and organisation. There might be smarter ways to work.

Signs of stress

The diversity of the practice manager role has always made for a busy and interesting job, but the practice manager’s environment has become much more pressured. While a little bit of stress helps to motivate us, too much is bad for everyone – including practice managers.

Early outward symptoms of stress (as opposed to those being internalised by the individual) could include anxiety, mood swings, being tearful and losing confidence. If these signs go unnoticed or are ignored, the manager’s performance is likely to decline further and they might become defensive, aggressive, turn up late, take time off and look tired. They might desperately try to turn things around by working even harder, perhaps comfort eating, or using alcohol – or worse - to help them put in those extra hours.

Over time the stress could become so debilitating that the manager might be unable to do their job – with dire consequences.

If this sounds in any way familiar, please seek help now. Start by confiding in one of the GPs. Ask for support, consider agreeing to a redistribution of work, accepting additional help from another colleague or obtaining permission to say ‘No’ more often – and practise doing it!

As before, you may want to think about ways of phrasing the refusal so that people accept that what you are saying is reasonable and that they should take their request elsewhere.

Keep in touch with managers in other practices for support and opportunities to share ideas and best practice. I have noticed that fewer practice managers are attending training events or representing practice management at external meetings and I am told this is because it is difficult to justify time out because of the amount of work to be done.

While I understand the rationale, personal development for
the manager is of huge importance and an insular approach is damaging for both the individual and the practice.

Practice managers who manage their time well are effective and productive. Their stress levels are lower and, generally speaking, they are happier at work. How about trying to do something a little bit differently from tomorrow and see what happens? l

Anne Crandles, freelance practice management consultant in Edinburgh