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Pilgrim’s progress: life at Totton surgery

22 June 2009

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Practice Manager and Business Partner
Totton Health Centre, Southampton

Do you know my worst fear? Waking up at 5.45am to hear my husband shouting up the stairs: “Have you got the television on?”

It’s one of those all-too-frequent “heart sink” moments, because it usually means one thing: the government or some other public body are either GP or GP-practice “bashing” again!

One day, I will carry out my long-time threat – I will invite one of the senior government ministers along to our practice in Totton to spend a whole working day with us. Don’t bother to bring the press in any guise, just come along and see what really happens in a GP practice – day in, day out. Come and see how many hours each day doctors, practice nurses and the administrative team really work. I don’t for one minute believe that our practice is unique in how hard it works, which is why I am saddened each time I hear a negative report on GP practices per se.

Please don’t misunderstand or misinterpret my words or tone! I am a regular person, a million miles from being militant or aggressive. I have only been a practice manager for seven years – a novice! Then, four years ago in 2005, I was honoured to become Business Partner/Practice Manager.

I came from the world of commerce, so had no experience at all of the NHS or the way it worked. Looking back, it’s hard to imagine why my partners took a chance on me; the only “red book” I had ever seen or heard of was the one that Eamonn Andrews used to spring out of hidden corners and surprise people with!

Seven years on and I still wouldn’t profess to know much about the NHS or the way it works, but is that so important now for practice managers? That’s probably a difficult question really, with no right answer, because all practices work differently. They have to – some are big, some are small, and no two patients in the same area, let alone different areas, are ever the same!

The Totton team
Our practice – Dr MH Darch & Partners – is in Totton, a semi-rural area on the edge of the New Forest. Our list size is circa 12,400. There are nine partners – eight GPs and myself, and we have just over 30 other members in our practice team, most of whom have been with us for many years.

At Totton Health Centre (THC), we are incredibly fortunate to have Eveline as our patient services manager. Eveline is responsible for the reception and patient admin teams; this does, of course, include face-to-face contact with patients.

I am confident that, between them, Eveline, her assistant Yvonne and the reception team know every patient (and their problems) on our list. I have, therefore, been spoilt in that I could confidently look after the business side of the practice, knowing that Eveline and her team were doing everything to look after patient care.

Like many other practices up and down the country, no doubt, our challenge at the moment is being able to provide enough appointments to keep patients (and the government) happy! I would willingly show everyone figures that prove we have increased quite considerably, year on year, both the number and type of appointments offered, but it never seems to be enough.

At practice meetings we continue to discuss how we can improve access to keep everyone happy. Like most other practices, we are working extended hours. But even doctors have home lives, so there have to be limits on what can be expected of them – and of practice teams.

No current cure for cramp
One of the biggest problems we have is lack of space. We should have been in new premises five years ago; our plans had been approved by the primary care trust (PCT), but as I’m sure many practice managers will remember, the government stopped funding retrospectively, so we are still working in cramped conditions.

We are always keen to ensure our patients do not suffer, so we endeavour to offer as many services as possible. However, it is becoming impossible to juggle rooms. We all “hot desk” – doctors, nurses and administrative staff alike. All of the side rooms (very small rooms with no windows) are used as consulting areas, so I am often asked to move out of my room so that an infectious patient can be installed there until seen by a doctor. I never ask what was wrong with the patient that used my room; it’s probably best I don’t know!

The situation is frustrating though. The practice team are willing and would like to offer improved services. Our lead nurse (known in the practice as “Scary Julie”) has recently been trialling nurse minor illness clinics. These have worked really well. We’d like to do more as it enables the doctors to concentrate on those patients who have more serious illnesses and problems. However, Julie and her nurses still need rooms to operate the minor illness clinics so, once again, we are seriously challenged on how we can provide the service in anything but a limited fashion.

In an effort to gain a small amount of space, we are currently in the throes of reorganising our medical records room. All the old storage shelves have been removed, and we’ve installed nice new modern cabinets, which go around the walls. This has left a valuable space in the middle of the room in which the patient admin team are going to live. This new space will allow several members of the practice team to move around, giving more room – we hope – which we will be able to utilise for consulting in some way.

Yet sadly this reshuffle, while helpful, far from answers all our problems, so it is my job to keep looking at how we can improve the situation. In fact, I already have my eye on an unused piece of ground just outside our building and am now looking to find the right PCT person to talk to!

Running surgery
Generally, life is currently very busy at THC. Sadly, our senior partner is retiring. Dr Malcolm Darch has been our practice Quality and Outcomes Framework and practice-based commissioning king, and we – not to mention his patients – will all miss him and his dreadful sense of humour. We’re lucky, though, as we have Dr Sonia Godfrey taking up the reins as senior partner. I’m sure I must be politically correct when writing this piece, so I shall refrain from saying that “girl power” rules!

I have already ear-bashed Malcolm for wanting to leave us and retire. He clearly has no idea how much work this creates for me. So what that he has worked 29 long years as a GP? I will now have to operate so many different bank accounts in so many different names, and ensure – for the next six months – that the right money goes into the right one at the right time. Some people have no consideration!

Our previous senior partner only left two years ago, so I guess I should be thankful that the paperwork needed is still fresh in my mind. Thankfully, Sonia is far too young to be considering retirement in the next few years, so I should at least get a respite from opening and closing bank accounts.

It’s funny, really, I can remember telling a friend seven years ago that I was going to become a GP practice manager – she told me in no uncertain terms that I was mad. As a director in my previous role and used to travelling, she expressed the opinion that I would be bored in no time at all.

My friend could never have been more wrong, and long ago admitted the fact! I can quite honestly say that since I became a practice manager there has never been a day when I’ve been bored. Heavens, there has never been a day when I’ve had time to be bored!

How many jobs are there where no two days are the same? It’s certainly not a glamorous job – one day you can be talking to somebody “important” and attending meetings, the next you have to go and inspect the leak in the toilet!

I know I shall live to regret this next comment because I shall never be allowed to forget it – but how many jobs are there where you get the opportunity to work in a great team? We laugh and sometimes cry together.

Don’t get me wrong, THC is not utopia and quite often something will happen that makes me momentarily tempted to strangle doctors, patients and members of the practice team alike! Thankfully, the urge doesn’t last very long.

Anyway, I have to ensure I look after the practice team and say nice things about them until at least 12 July. We are entering a team into Race for Life and, for the first time, I am going to be a member of that team. It should be said that I am not the fittest person in the world. The most I usually walk is to and from my car. I may, therefore, need the support of my colleagues around the course.

But, like I said before, they are a great team! And you never know – I may see a government minister or two around the Race for Life course. If so, I’ll invite them to THC.