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Spurring on colleagues at Crimond Medical Centre

1 March 2006

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Caroline Ironside
Practice Manager
Crimond Medical Centre

I have worked at Crimond now for nearly two years. Crimond has nearly 3,000 patients, with two partners. Besides this, I also run a successful horse stud business with my husband, selling our young horses to as far afield as Canada and South Africa. As you can imagine, between the two I am very busy!

Before Crimond, I worked as IT Supervisor/Acting Practice Manager at Ardach Health Centre, Morayshire. While Ardach was a new, purpose-built building, Crimond is half the size it should be for the amount of patients and staff it houses.

I faced several hurdles when I started here. Not only did I need to adjust to “cosy” conditions, but the practice had been running for several months without a practice manager. While they had done very well in establishing systems for the nGMS contract, there were many areas that had still to be set up. On top of this, I also faced my first position as a practice manager! Nothing like a challenge to get you going. But I was very fortunate to have a fantastic array of staff at Crimond who adapted very well to the changes I put into place.

We have a monthly staff meeting, which is well attended and gives all staff a chance to bring up any topics of interest or queries. I also have a weekly meeting with the doctors, to discuss any issues that we might not have the time to talk about during the week.

Working in a rural practice has its dilemmas. Sometimes I feel our voice is heard less than it might be if we were a six-plus-partner medical centre with a population of 10,000 or more. To this end, a few of the rural practices within our area get together once a month. This meeting is GP-led and gives doctors a chance to discuss and address issues as a bigger group, with hopefully a louder voice. This also enables us to find out what the other rural practices are doing in the area, and highlights any problems anyone is having. Also, every couple of months all the practice managers in North Aberdeenshire meet to discuss any issues. This form of networking is a valuable source in keeping abreast of what fears or achievements other
practices have.

We are now a part of the Scottish Primary Care Collaborative, which is a two-year programme looking at one clinical area (CHD) and at working towards Advanced Access, which basically means a patient can phone the practice just once and get an appointment on any day or week they choose.

A lot of work goes into this, as the clinical indicators are slightly different to the nGMS contract and you are constantly looking at ways of improving your appointment system with regards to capacity and demand. So far, we have set up telephone consultations for patients, which is like having an appointment with the doctor in the comfort of your own home. We can only do certain things via phone, such as medication reviews, reviews in general or patient queries.

We dispense to roughly 95% of our practice population, sometimes up to 200 items a day. We have a large nursing home on our doorstep, which we also dispense to on a weekly basis. The dispensary is an incredibly busy area and not for the faint-hearted. It is also an area where if one mistake is made it could ultimately be fatal to a patient; this is always at the forefront of our minds.

I am very proud of the staff we have, because they work in tight conditions and always give a first-class service. We have not had one complaint in the two years I have been there. In fact, the doctors cannot remember the last time a complaint was made.

My actual day starts at 5.45am, when my husband and myself get up and attend to the horses. Then it’s off to work, which is roughly a 30-minute drive from my house. This poses logistical problems when it snows in the winter; invariably I end up being snowed in.

I start work at 8am, have a chat to all the staff and make sure all is well. I then go to my office, which I share with the medical secretary and systems administrator. I check my emails and then plough through what I need to do for that day.

Due to the size of the practice I am mainly responsible for all financial and management areas. We have all the systems in place for fraud, etc, but ultimately I have most control over finances – except the cheques, of which I am not a signatory. The doctors get a monthly financial printout so they know what is going on and how the finances are doing, but trust me implicitly with running the show.

I always try to get involved with everyone in the practice to find easier working solutions to make their days less stressful; from implementing agreed changes with the administration areas to looking at ways of helping out nurses or doctors.

My day can end anytime between 3.30pm and 5pm, since I have got into the habit of working through my lunch. I then go home, get changed and get going with the horses again, sometimes not finishing until 8–9pm in the spring or summer.

I feel the past two years have just flown by. We did very well in the nGMS contract, gaining 1,037 points out of a possible 1,050. The only areas we still need to work on are the 80% notes summarised and getting up to 12 significant events. Overall, we achieved 98.7% and were in the top 10 achievers in Grampian.

I feel very fortunate to be in the position I am in. I have a job I love and work with the nicest group of people you could wish for. And if I can help make a patient’s experience of primary care a pleasant one, then I know I am doing my job well.

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