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Great facilitations: a practice manager with locality interests!

1 September 2007

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Practice Manager
Morningside Medical Practice
Practice Development Facilitator
South Central Edinburgh Local Healthcare Partnership

Anne has worked in general practice since 1985, and practice management since the last “New Contract”. Over this time she has picked up an AMSPAR Diploma, an MBA and the Prince 2 foundation course in project management. She is currently “enjoying” studying the European Computer Driving Licence (ECDL) syllabus in computing skills. Outside of work, Anne goes to the gym and attends a weekly French class. She has two grown-up daughters, who act as her own personal Trinny and Susannah

You would think that being a practice manager in a busy five-partner practice would be more than enough to keep me entertained – but apparently not! For the last four years I have juggled my job as practice manager at Morningside Medical Practice with four sessions each week as the Practice Development Facilitator at South Central Edinburgh Local Healthcare Partnership (LHP). And I love it!
This seconded position is unique in Edinburgh, and when I first took up the post it was pretty much a blank piece of paper. The main remit was that I created links between the then Local Health Care Cooperative and the 15 practices in the locality.
This part of Edinburgh has a predominately high elderly population, with relatively little deprivation. The demographics set it apart from the other localities in the city, and the GPs in South Central Edinburgh felt that they should work together to meet the needs of their patients, rather than amalgamate with other localities and lose that focus.

Role and responsibilities
My role requires me to attend various LHP fora – for example, the Edinburgh-wide Business Continuity Planning Workgroup – as the practice manager representative. I give the LHP a practice manager’s perspective (whether they want it or not!), and act as a conduit of information between practice managers and the LHP. I am sure the other managers in South Central must all groan when they see how many items I add to our regular practice manager meeting agendas!
I spend lots of my time reading articles, government papers and various sets of minutes from the Community Healthcare Partnership and Lothian Health. Each month I offer my colleagues summaries of relevant documents or (if they are really lucky) send out the whole paper!
I am always available to answer colleagues’ queries, and if I don’t know the answer I will research the topic further or make use of my extended network of colleagues. This means I learn lots and am constantly finding new fountains of knowledge!
I have also been able to put these resources to good use when organising locality-wide Protected Learning Time sessions. These happen on a quarterly basis, and are open to both clinical and administration and clerical staff. The sessions cover a wide variety of subjects that interest the whole team – for example, child protection guidance or handling aggressive patients.
As well as arranging multidisciplinary events, I identify practice manager training needs and set up appropriate educational sessions. The most recent of these was entitled “Risk assessment for managers”.
From time to time I have worked with individual practices on specific projects, eg, participating in recruitment processes and providing conciliation services. At an individual level, I have mentored and coached colleagues, have offered a listening ear and carried out peer appraisals.
Wide-ranging issues
The flexible nature of the job means that I can turn my attention to whatever is next on the horizon for primary care, research it, assess the impact for general practice – in particular practice management – and raise awareness in the local practices.
I have looked at (and continue to monitor): the new General Medical Services (GMS) contract in general and its effect on all members of the primary healthcare team; Agenda for Change; the Kerr Report’s recommendations; practice-based commissioning and Choose and Book (neither of which are instantly applicable here in Scotland but are “in the fridge” just in case!); and most recently, the Community Nursing Review.
That blank piece of paper I started out with four years ago is turning into a book with a great beginning and many empty chapters. It is really taking shape!

Gains for all
I believe there are benefits for all of the stakeholders involved in my secondment – the LHP gets not only a practice-manager perspective, but also a boundary worker who understands both points of view; someone who can keep things grounded, pointing out practical implications, highlighting how practices might react to actions and/or plans and, if necessary, suggesting ways to make these plans more practice-friendly.
The practice gets a manager who is enthused about what is happening in the outside environment and its impact on general practice, and is keen to implement new initiatives that would be to the practice’s advantage. Morningside Medical Practice has an opportunity to provide feedback to the LHP system, which is not as readily available to other practices, and I am able to represent the practice wherever I am in the locality, further raising the practice’s profile.
My peers are able to use me as a central resource. I cascade information, act on their behalf and liaise with health service colleagues in other areas of primary care – and, occasionally, secondary care. I like to think that these people gain a better understanding of what practice managers currently do, and come to realise that, as generalist managers, we are specialists in our own right with something to contribute to the future planning of services, and that our role can lead to improved communication and regular multidisciplinary working. In other words, I aim to help practice managers lose that “Cinderella” image.

Relishing the challenges
For my part I have varied, interesting, exciting and often self-determined work. I am challenged and therefore remain engrossed and focused on all aspects of my job. I have an understanding of how the other side works and how it is possible for us to all work together.
As a result, I am willing to try out new ideas, experiment and am more supportive of new measures than I might have been in the past. I have had numerous opportunities to extend my personal networks, to grow professionally and self-develop, and I am more widely known in Edinburgh than before!
I cannot deny that there are times when working two different roles causes me difficulties. The most challenging issue is time – there is never enough! I am constantly prioritising the work that gathers in two separate intrays in two separate offices. I suspect that I am always in the wrong office whenever someone is looking for me.
The same suspicion applies to email – I have two separate inboxes, which often makes me something of an AWOL recipient! I am always discovering emails that had arrived just after I had left for the other office.
The boundaries of my two roles can become blurred. For instance, I sometimes take LHP phone calls in practice time and vice versa. My coping mechanisms are, first and foremost, the good people working with me in both organisations, and support from the GPs in the practice and the managers at the LHP.
Second, I try to prioritise work – good old time management stuff – and back all of this up with a good sense of humour (an essential requirement on every NHS job specification) and the occasional moan when that humour evaporates.
I would love for this post to go on indefinitely – it broadens me,
strengthens links, and I enjoy the contrast between the two cultures and organisational styles. Leader in one, cog in the other!