Practice Manager and Partner
Dr Astbury and Partners
Graham has been a practice manager for three-and-a-half years. Previously he worked for 33 years in the banking industry, in a variety of managerial positions. He is now also a practice partner
After spending 33 years in banking (30 years with NatWest and the final three years with the Royal Bank of Scotland), I had the opportunity of taking early retirement. During that time, I was fortunate enough to have a huge variety of roles: from operations and lending manager, to working in the NatWest consultancy arm and project-managing Y2K, the millennium rollover, for the manufacturing division of the bank.
On reaching retirement, I initially looked for a role in schools management, but was advised that GP practice management was very similar. With that knowledge, I started applying for jobs, looking for a 20–30-hour per week position.
I had absolutely no knowledge of what the role entailed, but managed somehow to get through the first round of interviews. For the second interview, I was asked to deliver a presentation entitled: “The impact of personal medical services (PMS) on the practice”. Not surprisingly, many hours of internet research were necessary.
As they say, the rest is history. I was offered, and accepted, the job on my silver wedding anniversary – a good omen, my wife informed me.
Before my first day arrived, I had a one-hour chat with the previous practice manager, who had been on maternity leave for the preceding 12 months. When I started, the reception team told me that I was the seventh practice manager in eight years, and that they were considering starting a book to see how long I would last!
I hadn’t been aware of the size of the practice, which is the largest in Northampton, and didn’t realise what a vast array of skills would be required – from staffing and finance, through to premises and equipment. It certainly wasn’t a 20–30-hour-per-week job! However, I think most practice managers would agree that the job does become addictive.
What became obvious from a very early stage was how strong the partnership was. At this time, there were six partners. Fortunately, they showed a great deal of trust in me from the outset and were very quick to give me the autonomy I needed to do the job. I am also lucky to have a very strong management team supporting me, which includes my assistant practice manager, lead nurse, reception supervisor, administration supervisor, and – by no means least – my financial assistant.
After working at the practice for two-and-a-half years, two of the partners made informal remarks as to whether I might be interested in becoming a partner. As this was a second career, it was something I had not really thought about, but I was honoured that they might consider it.
At that time there were eight partners and it was clear that they all worked very well together. I was therefore concerned I should not disturb the equilibrium of the partnership as a whole, and spent the following weeks discussing the possibility of joining the partnership with the other partners. Without exception, they were very supportive.
It was then suggested that I approach the practice’s accountants and ask for them to act as “honest broker” for both parties, a role they have undertaken on a number of occasions.
The accountants devised a formula that was acceptable both to the existing partners and myself. Initially, I became a full equity partner but not a property owner. Recently though, following the retirement of the senior partner, I decided to become a property-owning partner as well, and I am currently in the throes of this transaction.
You may ask why the partners were so enthusiastic about me becoming a partner, as in many ways the day-to-day operation of the practice has not changed; nor has my commitment. In my opinion, practice management is becoming an increasingly complex area, and the other partners now feel more secure that in these times of enormous change they will have continuity of management. Of course I, in turn, feel that I am a part of, and have a real say in, the future of the business.
A typical working day for me would start at 7.15am. It’s a Monday and the “early bird” surgery has already started. I open the door and my first thoughts are: “It’s jolly cold”. The receptionist confirms this by telling me the heating isn’t working. It has been very windy over the weekend, and I suspect the pilot light has been blown out. After grovelling on my hands in the cellar, where the boiler is situated, my suspicions are confirmed. I eventually get the heating going again, then go up to my office. By then, Sarah, one of the health visitors, has arrived, and a welcome cup of freshly brewed coffee is on my desk.
After switching on my computer, the first job of the day is to go through my emails: only 42 on outlook and 14 on EMIS. Because we have two sites, we rely upon the EMIS email system to communicate between the surgeries. Many emails contain information that needs passing on to the clinicians; I am sure most practice managers will agree that at times we are more like postmen!
As it is a Monday, we have the weekly partners’ meeting at lunchtime, and I need to produce the agenda and pull together all the supporting documentation. Our first two standing items are “significant events”, followed by “complaints” and “compliments”; we think it is particularly important to discuss both, to keep a balance.
My office is on the first floor, and I very much encourage an open-door policy. Staff and doctors know that if the door is open they are welcome to come in; it is only closed if I am making a confidential call or have a meeting. At this stage of the morning, I like to walk round the building, see that everything is OK and have a quick chat with those available.
I recheck my emails and find that one of the doctors has asked for another item to be placed on the agenda for the lunchtime meeting. I learnt a long time ago not to print the agenda off until just before the meeting!
My post arrives – the primary care trust (PCT) has sent a spreadsheet advising me how much money they are going to pay the surgery this month; will it be correct? As usual, I will need to check it carefully.
It is now time for me to move over to Duston Medical Centre (DMC), where the partners’ meeting is to be held. To make things equitable, we hold these meetings at each site for three months at a time. However, whether there is a meeting or not I go over to DMC most days. I plan to spend the morning at Harlestone Road Surgery (HR) and the afternoon at DMC. While my office is at HR, it is important that I go to DMC most days as well. A key part of my role is to ensure the staff work together as one practice and do not operate independently.
The meeting goes as planned and is finished around 2.30pm. I now have a weekly meeting with the lead nurse, Theresa, who by this time will have had a meeting with the other practice nurses. Theresa advises me that the nurses have agreed a rota for the Saturday morning flu surgeries, and that these are now all covered, for which I am very relieved!
I now need to see my assistant practice manager, Mini, to review the monthly Quality and Outcomes Framework (QOF) results. Mini monitors these throughout the year and badgers whoever is necessary to achieve the highest scores we can. We have slipped back a little on one or two of the clinical areas, but Mini assures me that “it’s all in hand” and we will be back on track by next month.
I tend to “hot desk” when I am at DMC, so I find an available desk and start the minutes. I have to leave by 6.15pm as one of the doctors has challenged me to a squash match. Jo, the reception supervisor, wants to have a quick word with me. She supervises both sites and has a team of 12 receptionists. Our new receptionist has just completed her two-month review; Jo is very pleased with her progress. I thank Jo and say she has made a good decision in taking her on.
Before I close, it would be quite wrong of me not to mention my staff. When I started as a practice manager three-and-a-half years ago, my knowledge base was zero. All the staff and doctors have been marvellous, on numerous occasions giving up their time to explain the vagaries of the NHS to me – none more so than my aforementioned management team, to whom I am truly grateful.
I look at my watch – will I complete those minutes? Suddenly it’s 6.15pm and I have to go. Never mind, I’ll finish them first thing in the morning. My mind switches to the important squash match. Now, how can I manage to win?