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Change and consideration

17 October 2011

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Lorraine Hughes

Practice Manager,
Hunter Family Practice, Craigavon, Northern Ireland

Lorraine became a practice manager in 2003, when she ‘retired’ from the army. Since then, her practice has achieved the Royal National Institute for the Deaf’s (RNID) Charter, “Louder than Words”, MiP awards for Customer Care and Innovation in Training, the RCGP Quality Practice award, and the RCGPNI Practice Administration Team of the Year award. Lorraine herself was named RCGPNI Practice Manager of the Year 2010

We all understand that organisations must embrace change to survive. General practice has seen many changes in recent years and it is usually the practice manager who has to make sense of it all, and ensure changes are implemented as painlessly as possible.

In Northern Ireland, the hard facts are that the budget settlement between now and 2015 will leave a huge gap between available resources and the demands upon them. So health and social care services must be radically reshaped to maintain a quality service to patients and clients. The Review of Public Administration has led to a new commissioning system, involving major reorganisation.

A new Health and Social Care Board has been established, regional offices reorganised and staff drastically reduced, leading to frustration for many practice managers as it is difficult to know who or where to go to for help. For example, instead of speaking to a local IT officer, who knew the practice and was likely to be available almost immediately to help resolve a problem, queries must now be reported to a service desk at the ‘Business Services Organisation’. Details are recorded, a reference number given and you might then wait for days before someone in IT rings back!

Providing evidence for the Quality and Outcomes Framework (QOF) in April this year proved to be a worrying and demoralising experience for many practice managers. In the past, if a piece of evidence were missing or incomplete, we would have received a phone call from the local office and given an opportunity to put it right.

Now, everyone has one chance and simple errors have cost many practices money. This is devastating for practice managers who have worked extremely hard to ensure the work has been done to achieve the points – they feel isolated and unsupported.

We appreciate that change is necessary, but is it not possible to introduce it in a timely fashion? Last year, for example, changes were made to enhanced services halfway through the year, when practices had already done a lot of the work. Read codes and templates are never updated in time for the start of a new year.

This year we have the new quality and productivity points. The detail about these was not available at the start of the year, and then there was a further wait to receive the necessary statistics to begin working on them! Granted, deadlines have been extended, but the trouble with this is that the date practices will receive the money for achieving the points will also slip.

Prescribing budgets have been cut drastically and practices told they must make big savings. Yet everyone in Northern Ireland receives free prescriptions. Surely the reinstatement of prescription charges would have a two-fold benefit – a reduction in the number and nature of prescription requests, and an increase in revenue?

The biggest issue for practice managers in Northern Ireland appears to be lack of recognition for the wide-ranging skills needed for practice management, the scope and range of responsibilities, and ever-increasing demands.

Many practice managers I have spoken to feel their skills are taken for granted; they would like to see a proper career structure and remuneration that reflects this difficult and important role. Practice managers juggle personnel, accounts, staff training, interaction with patients, planning clinics, maximisation of QOF points, enhanced services, clinical governance and many other balls – including fixing anything that stops working as it should!

Usually, all this is accepted and carried out without complaint. However, at present morale appears low. Managers feel undervalued and unsupported. If the planned changes are to be successfully implemented we need better communication networks between health boards and practices, consultation with practice management representatives at the planning stage, more information sessions to introduce and explain new requirements, and more time allowed for implementation.