The Lavender Hill Group Practice
I started in practice management quite by accident. My husband and I came to the UK from Australia for what we thought would be a year or two. Four years later, we are still here and I am very happy working as a practice manager in London.
However, my first experiences with practice management left me feeling nervous and even scared! There was so much to learn and do. Shortly after I joined my first practice (a 1,500-patient, single-handed GP practice) the GP resigned due to illness and the primary care trust (PCT) found it hard to recruit. After much trial and error, we proposed to the PCT that we become a nurse-led PCT personal medical services (PMS) practice. Eventually we were allowed to go ahead.
But after two and a half years at this practice, I felt I needed more of a challenge and applied for a post at a six-partner practice – my current employer.
Our practice, based in Battersea, provides care for 12,000 patients. Our clinical team is made up of six partners, two salaried GPs, one flexible career scheme GP, three nurses, one and a half healthcare assistants (HCAs) and two GP registrars. Our admin team consists of an assistant practice manager, a reception supervisor, and nine reception and admin staff.
All staff contribute to the development of the practice in different ways. We are currently instituting a performance- related bonus structure, which will reward staff for their varied contributions. With this many staff and partners, things do get a little hectic around here, but at least I can say that my job is never dull!
Over the last 16 months, many positive changes have occurred. A lot of hard work has made this possible. The partners have been incredibly supportive of the proposed changes and are always on hand to assist with thinking through new ideas. To help, we instituted a development group meeting, which takes place every six weeks. All interested staff are invited to attend. New ideas for future developments in the practice are put forward, and all who attend talk through these ideas. Ideas can be implemented immediately or deferred to a partners meeting for consideration.
Through this group, we have developed a walk-in blood pressure clinic with our HCA and nurse-run acute care clinics (in consultation with a GP), found a way to make repeat dispensing work for our practice, and even talked through how best to accommodate the practicalities of Choose and Book (this is still a hot topic for us as we have had major computing problems and space is at a premium).
This group has also provided ideas for streamlining our recall system for chronic diseases and piloted the use of a touchscreen monitor for self-service check-in. It is useful to have all staff involved because it is easy to concentrate on the clinical implications, so sometimes implications for other staff can be overlooked. It also gives the staff an opportunity to input into the development of their practice and creates a real feeling of shared ownership for those who choose to get involved.
Further positive development has been the setting up of a patient participation group. The practice runs an over-65s group with sessions facilitated by our nurses. It allows patients to discuss their ongoing health problems and provides information on diabetes, hypertension, and so on. Although still quite a small group, we plan to increase the numbers.
We also have a regular meeting for all staff, which includes district nurses and health visitors attached to our practice. Our clinical staff meet daily to discuss complex clinical cases seen that morning and to distribute request lists for home visits. This has proved a useful learning experience for the clinicians, and such meetings generate a real team spirit and encourage peer support.
Through regular meetings we have kept on top of our Quality and Outcomes Framework (QOF) and achieved full points. We are so proud of the work that staff have contributed to this achievement and look forward to doing the same this year.
An average day for me starts at around 7.30am. I plan my day ahead and try to fit in some reading for my doctorate degree. My actual working day starts at 10am (indulgent I know!) and continues until 6pm. I do try not to work too much later than that, and sometimes I actually manage to get that right!
I must admit I had a few difficulties when I first started out in my new post. In the PCT PMS practice, the PCT wasn’t around every day and you could pretty much make and implement a decision without ever talking to anyone. I was so used to doing most things by myself that the hardest thing for me to get used to was consulting six partners. I have been lucky because they have always been extremely helpful.
From the varied experiences I have had working as a practice manager I have learned the following very useful lessons:
- Make sure you write everything down.
- Have a regular “mind dump” – for me it’s weekly. This is where you write everything on your mind down on paper – and I mean everything.
- Order the mind dump into a “to do” list and then start “to do”.
- Don’t be frightened of trying out new processes or technologies.
- Confront problems as they happen.
- Surround yourself with positive and helpful peers.
- Be upfront about your expectations and feelings (you’re a person too!).
- Most importantly – remember to have a laugh (even if all you can manage on some days is to force a smile). It keeps you sane!