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No manager is an island: surgery spirit on the Isle of Wight

1 January 2007

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Catherine Barton
Practice Manager
St Helens Medical Centre
Ryde, Isle of Wight

Catherine came to practice management in July 2000, quite by accident, having spent more than 11 years working as a secretary at a local independent school. She finds being a practice manager has been and continues to be an enormous challenge – what other profession is so diverse? To relieve stress, Catherine exercises six days a week, which includes circuit training, swimming, badminton and running. She has a place in the London Marathon this year

I cover my ears trying to block out the shrill of the alarm clock … just another five minutes … and then I remember, I need to get to the practice early to enable our clinical software technical support team to do some work before everyone comes in and logs on. I leap out of bed.

Unlocking the door, a sense of peace and calm pervades. It’s the best time of the day: no phone to interrupt, nobody knocking on the door – and I see “Dr X” hasn’t turned the central heating thermostat up to boiling point! Someone has stuck some Micropore tape over the dial – what a good idea! Why didn’t I think of that?

Then it’s to the phone. “You are in queue position four,” says a voice coming back down the line from the software suppliers. What, at 7.15am? Obviously I am not the only practice manager about.

An hour later, one of the doctors phones from the branch surgery, saying the lights are not working in the waiting room or the reception. I answer that the switch has probably tripped, then try to explain where the fuse box is and what to do, but then realise it’s probably quicker to jump in my car and go and sort it out myself.

I pick up today’s post on my return (did I do yesterday’s?) and consider making a start on the paperwork needed in advance of the Quality and Outcomes Framework (QOF) visit in January. I can’t keep putting it off, but then I’m on holiday next week, so better do the end-of-month invoices and sort out staff and doctors’ pay.

I quickly flick through the comments on the patient survey … I must collate the results as soon as possible, have had 52 emails since I went home yesterday. The phone rings: “No, I’d rather not know that Choose and Book is down yet again. Don’t forget to log attempt.” I replace the receiver.

Next call: “Is it OK for Mr Bloggs to have a flu jab?”

“Is he over 65?” I ask. “Is he in one of the ‘at-risk’ groups?”

I’m told the Bloggs’ grandchildren are coming for Christmas and “they bring all sorts of bugs home from school”.

I decide to have a cup of coffee. That will get the grey matter going. I walk out of my office door into the waiting room. What’s this? A toddler is playing football with one of the baubles off the Christmas tree – and he’s even got a piece of tinsel draped round his neck. His mother is laughing. I survey the wreck of the Christmas tree in the corner and mumble something about health and safety.

“‘Scuse me – don’t like this music, it’s too dirgy,” exclaims a patient on the opposite side of the waiting room. Instead of the usual Christmas Slade offering, I had thought a little T’ai Chi music might be more soothing at this stressful time of year. I apologised and tried to explain. “Pardon?” replies the patient. “What’s that? Can’t ‘ear very well – it’s me ears you see, need syringing.” Right …

I can hear my phone ringing again as I go to push the staffroom door open, and am about to return to my office when one of the receptionists calls out: “I’ve got Mrs Smith, she wants to make a complaint.”

“Is she here or on the phone?” I ask.

“Down here.”

Mrs Smith is what is fondly known as a “DFL” (down from London). I tell her that I’m sorry but you do have to see the nurse to get your HRT prescription. No, the receptionist is not being awkward and neither am I. Well, maybe your specialist in London does let you have it without seeing you, but sorry, we cannot … I take the patient to the reception desk to make an appointment.

Then a receptionist’s head appears around the door. “Consultation Manager keeps crashing – codebase error.”

“OK, I’ll reboot the server”. I then wait for the phone to ring from 11 different rooms around the practice as doctors, nurses and staff try to find out what’s going on. Fifteen minutes after ringing the technical helpline, still no joy. “You are in queue position 1.” Great – shouldn’t have too long to wait. I hold the receiver away from my ear as music blasts out. This is followed by “helpful” messages: yes, I’m well aware it helps to check the printer is plugged in and switched on before ringing the helpline – what do they think I am?

After sorting this out, the phone rings again. One of the receptionists asks: “Could you please bring Mrs Jones down on the stairlift – I can’t leave the desk as I am on my own.” Mrs Jones is struggling with her walking stick and the seatbelt. Off we go. Halfway down the stairlift grinds to a shuddering halt. I bring it back up, send it down again – Mrs Jones is having the ride of her life – but it stops at the same place. Fortunately, Mrs Jones is able to negotiate the stairs with an arm either side. Critical incident/significant event? What would we have done if the occupier had been a wheelchair user? Fireman’s lift? Better write a procedure for when the stairlift breaks down, should have thought of that before.

Back to the office, and I glance at the clock. Is it 12.00pm already? I look at the pile of post on my desk, still untouched, 52 emails still unread. But there’s no time, got to get to the practice-based commissioning (PbC) meeting, which is 11 miles away at Whitecroft.

In the winter it takes me 25 minutes to get to Whitecroft, but in the summer (with holidaymakers on the road) it can take anything up to an hour. It’s a lovely route over the downs, with wonderful views, but I am invariably in a hurry while everyone else is on holiday (or so it seems).

However, there’ll probably be only one or two more visits here. Once the site of a former mental hospital, it had been derelict for some years but is now undergoing redevelopment, with primary care trust (PCT) offices on the periphery – although not for much longer. Our PCT and NHS trust have now merged to form a unique organisation: the Isle of Wight NHS PCT. It’s a bit like the Mary Celeste at Whitecroft now, as staff there are gradually moving to St Mary’s Hospital in Newport, which is three miles away.

Despite high winds and cancellation of ferries, the two drug reps have battled the elements to bring lunch for 18 doctors, their practice managers and various PCT staff, nurse and patient representatives.

Concerns are raised about the anticoagulation clinic recently taken on at short notice by practices. Yes, our fingers have been burnt, but it won’t happen again. Next time we will take on a service when we’re ready, and we’ll not be coerced into doing so too soon. Patients love the clinic, though, as it’s much easier for them to get to the surgery.

My files are testimony to the number of trees that have had to be chopped down since we embraced PbC. We move swiftly on to finances and stats – after 10 minutes my eyes start to glaze over – I really must get to grips more with all these figures and graphs.

I check my mobile as I leave the meeting – no messages, good – and head back to the practice. All quiet on the Western Front. I manage to get through yesterday’s and today’s post and read 79 emails. At 6.30pm it’s time to go home, or rather out for a run. I must do six miles this evening. I entered the London Marathon for the first time and, hey presto, got a place! Having entered tongue-in-cheek, my bluff has been called and now I’ve got to get on with it!

What will tomorrow bring? Who knows? Perhaps that’s part of the attraction of the job …?