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Crashing back to Earth: from the RAF to the NHS

1 September 2006

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Carl Beard
Practice Manager
Brierley Hill Health Centre

After 22 years of serving Queen and country with the RAF, I thought it time to mothball my Spitfire, hang up my uniform and seek a quieter, more serene lifestyle. I couldn’t find it, so I became a practice manager instead.

I began my new and somewhat challenging career within Dudley South Primary Care Trust (PCT). I’m no stranger to primary healthcare: I was dragged up in the RAF as a “medic” – a position that encompasses both a peacetime role (practice management) and a war role (acute trauma care), depending on where and when we were needed. My peacetime role consisted of running a healthcare practice for the RAF: a simple, quiet job with little pressure. We had a list of 1,000 patients, four GPs and a gaggle of paramedical staff, all vying to keep our Armed Services fit and well to go and fly the flag. In this role, I toured many UK locations, as well as Germany and Cyprus.

The real work in the Armed Forces was putting into practice all you had learned about the pressures of conflict: the lack of communications, the depleted supply chain, the constant routine of warfare and the diehard “make do” attitude that personifies the British soldier mentality (sound familiar?).

Healthcare management meant ensuring the already fit serviceman had every-thing he/she needed to be deployed to areas of extreme difficulty: Bosnia, central Africa, South America, even Rhyl. So we had to ensure that they were physically and mentally ready for the task ahead. Servicemen were trained in advanced first aid, equipped with a good health support programme, given the appropriate vaccinations and medications, and were sustained by a robust primary and secondary healthcare system.

The worst part of the job was the mental strain in times of conflict. There are long periods of boredom broken only by short, intense periods of chaos. The military mind needs to be disciplined and focused to avoid times when reflection takes over and doubts take root. It’s no wonder many servicemen who leave the forces after 15 years or so become depressed, lonely and extremely frustrated. After years of encouragement to bond with the man next to you, live in each other’s pockets and never question authority, many find it difficult to cope with a highly flexible and changing environment.

By the time I left the RAF in 2005, the Armed Forces were shrinking: the RAF alone had halved in my lifetime and the number of aircraft had reduced tenfold. The RAF bases dotted over the globe, most of which I have been to, have also been the victims of their own success. Aircraft can fly faster, further and deliver payloads far greater than ever imagined. There is no need to have bases to support them any longer. In addition, having enjoyed my war-role work in various guises on tour – helicopter paramedic in the Balkans; firstline healthcare adviser in Sierra Leone; and inflight nursing care for the critically injured in the Gulf – I became disillusioned, especially at times when we weren’t actively involved with overseas problems. So I decided to put my enthusiasm into helping those closer to home.

In July 2005, I was invited to an interview for the prestigious role of practice manager at a well-populated practice in Brierley Hill, located in the heart of the Black Country. The interview process was more like a Crown Court trial, as the judge and jury debated over my (somewhat lacking) skills and knowledge base.

My ability to relay information on the new General Medical Services contract (GMS) was something short of pitiful; my overstretched neurons were struggling with acronyms such as “PbC”, “QOF” and “NIHCE”.  This wasn’t helped by my pathetic unfamiliarity with accounts, payroll and employment law, so, along with the now increasing body odour, I was struggling to find form. Imagine my shock and horror to hear I’d got the job.

I relished the thought of a new career – until I was told my staff would consist of 14 women. Don’t misinterpret my angle here, it’s just that I’m used to working exclusively with men: rock steady, predictable, uncomplicated males. I was terrified at the prospect of more than a dozen ladies, especially as my brain pattern was set in rigid, uncompromising military mode. I was going to be eaten alive.

On my first day at the practice, I was like an excited schoolboy on his first trip to Cadbury World. I was so keen and anxious to appear willing – I even bought a new pen! I walked with confidence, spoke with vigour, and gave off the air of someone who knows what he is doing. This lasted until about 10am when I was found out. Nobody told me I had to “manage” too.

Brierley Hill Health Centre comprises four partners, four practice nurses and a healthcare assistant (HCA), supported by a deputy practice manager, senior receptionists and medical admin staff. Altogether, there are 24 members of staff, looking after a population of 7,000 patients.

The health centre itself is a throwback to the 1970s’ open architectural fashions that became dated in the erm… well, in the 1970s, and little seems to have been done since. The LIFT (Local Improvement Finance Trust) project has been put on ice and little (if anything) can be done to improve our working environment.

My office is no bigger than a guinea pig cage. I did toy with the thought of hanging a picture or two to make it more personal, but the decrease in space would mean I wouldn’t be able to actually fit in.

My first six months at the practice was a baptism of fire. The combined experience of the surgery staff amounted to 250 years; I had one year to catch up. My working day began at 7am and I was often seen dragging myself home late into the night with a takeaway tucked lovingly under one arm and the new GMS under the other. My initial knowledge of NHS primary healthcare protocols and employment and Health & Safety laws was equivalent to a Rich Tea biscuit’s understanding of Einstein’s theory of relativity.

Fortunately, the PCT were rather forward thinking: they accommodated my every need and were perceptive in preparing all my IT and training needs. This was an encouraging start. I built bridges with key players at all levels, arranged to have visits with the appropriate departments, and joined in meetings prevalent to our goals. A worthwhile exercise was to do nothing but assess who, what, where and why things are for a month or two. This quickly paid dividends, even though I promptly forgot most of them.

Practice managers from neighbouring surgeries greeted me like a long-lost brother and they couldn’t do enough to help me. I’m constantly amazed as to how helpful and supportive people can be. Some are geared towards people management, some financial and business, but the overriding factor driving all practice managers is the need to ensure patients are the priority. Not a bad testament, considering the horrors we have to endure every day in our surgeries from disgruntled and agitated patients.

Unlike The Da Vinci Code, there is an open order of practice managers, with its roots firmly locked into medical history that will never be deciphered: a brotherhood (or sisterhood) of total, committed faith in delivering patients’ needs, regardless of money, protocol or logistics.

In my first few months, I was often found slumped over my desk with a number of journals, contracts and related papers strewn around. Cold cups of coffee and stale sandwiches (a regular diet for any discerning practice manager) for sustenance, and the odd prodding with a stick from my receptionists, gave me the feeling that I ought to be somewhere else (though preferably not Rhyl).

Now, as I look back on the last year, I grimace at the thought of how we all managed under my umbrella of incompetence – not to mention the complexity of practice management, working with 14 women and a condemned, throwback building held up only by the sheer will of those working inside it.

Two main and extremely important factors contribute to the fact that I’m still here doing the job. First, I am ignorant of previous regimes and protocols of the NHS. My upbringing was purely healthcare MoD (Ministry of Defence): a completely different beast, one of intense discipline with agendas and goals set towards acute and trauma needs of patients in far-flung places. The NHS, by contrast, is a continual flow of change to meet the needs of the culture of the country. I am aware of, but not bound to, previous protocols such as Items of Service (IoS) or the Red Book. The NHS “reinvents” itself so often that I feel I should study every aspect of the primary healthcare agenda for the next millennium. The bags under my eyes are testimony to the bedtime reading one enjoys nightly.

Secondly, 250 years of knowledge is not to be sniffed at. My colleagues have played a substantial part in guiding me through the quagmire of the now-famous three-letter acronyms of PCT, NHS, CAB, QOF and ETP. But nothing could prepare me for the level of support I was afforded by the women of the practice. They all played a major part in my transition from military to medical, being kind, understanding, encouraging and extremely supportive. Their continued, uncompromising belief in me has proved to be the backbone of my working ethos. In turn, this has given me the ability to continue nurturing my passion to help others. Without this leap of faith from the staff I would surely have withered under the strain of demand.

I have found practice management to be a diverse, challenging and rewarding responsibility that has changed my life, and I did it twice. The transition has not been easy, and I’ll never learn fully the intricacies of the NHS agenda – but mind you, who will? However, it’s a fact that after 25 years I still look forward to the challenges the job has to offer. As our society expands and incorporates differing cultures, we must be ready for changes and flexibility along the way.

In my opinion, practice managers from all walks of industry thrive on challenge, change and opportunity. I regained my passion to learn, to encourage others and to make the best of any situation. I’ve also regained that little buzz of excitement you get every time you achieve something, no matter how small.