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Upton girl: an award-winning practice leader

9 April 2010

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Practice Development Manager
Upton Surgery, Worcestershire

It’s a privilege to work in Upton upon Severn, a small town of great character and charm in a beautiful rural part of Worcestershire (and it has the best-ever butcher’s shop). My drive to work on rural roads gives me magnificent views of the Malvern Hills, with all its changing seasonal colours. Today, with three inches of snow, it is all white.

Upton is famous for its annual jazz, blues, folk and water festivals that attract people from overseas, as well as from all corners of the UK. This impacts on our temporary resident requests: last year we had 565. Upton is a favourite for TV cameras whenever the river Severn floods. In July 2007, we dealt with the disaster that floods caused for Upton, and tested the flood plan on our new site (without actually being in the building). Fortunately, the flood’s record 100-year high would still need another 3ft depth before the practice building could be breached.

We moved into our new premises in October 2007. It was officially opened by the Prince of Wales and the Duchess of Cornwall in June 2008.

A personal medical services (PMS) dispensing practice, Upton Surgery has 10,600 patients spread over a large geographical area covering over 70 square miles. We dispense to more than 6,000 patients. The practice has six GP partners and a team of six nurses.

Entering general practice
For me, primary care management came via a career in acute nursing followed by public health education roles, clinical governance with a primary care group and a spell as Head of Clinical Services in a private hospital. Experience across organisational healthcare settings gave me a sound knowledge of how NHS health and social care systems work.

I joined Dr Everitt and partners at Upton Surgery five years ago. For the first four years there was no such thing as a “typical” day. When I joined, the new surgery site was still a field and the old surgery included a Portakabin. The move had been at the planning stage for 10 years, and so was the priority.

The new build took 14 months, and I was very involved throughout the process. The day before we moved in, I walked around the beautiful empty rooms with a sense of pride. The following day was a very surreal experience as my “baby” was invaded; it “grew up” in the space of a week as patients arrived.

The new surgery is on a three-acre site and has 14 consulting rooms, three treatment rooms, a minor operations room and accommodates community NHS services including a physiotherapy gym, podiatry and a child-health suite. The local dentists are also located in the building and we have a suite of training rooms on the first floor.

This “one-stop shop” approach for the building and its services was the ethos from the start. With the additional space and excellent parking facilities, we took a strategic decision to bring services “closer to home”.

As a rural location, transportation is a problem for many in our practice area. The enhanced facilities of the new practice building have meant we have benefited our patients by offering extra services. This was the main theme of our entry to the 2009 Management in Practice Awards, in which we won the Customer Care Award and were announced the Practice of the Year.

Having moved in, the possibility of a “typical day” remained elusive, as my role became focused around facilities and IT (linked with policy development and business continuity planning), as well as flood plans and helping patients, staff and other building users get used to their new home.

Strategically, we developed an increasing involvement with practice-based commissioning (PBC). Other issues that took up time were organising a senior partner retirement party for 200 guests in January 2008 and a royal visit in June that year – a daunting but deeply rewarding process, which involved the whole town, schools and community groups.

In July 2008, a daily routine finally emerged!

The “typical” day
A sunny day will begin with an inspirational high as I glance at the image of the early morning sun streaming through the coloured panels of our stained-glass windows in the waiting room. Against the white wall it is a magnificent sight; I just hope my reception staff and the patients appreciate this visual treat as I do!

Our practice features some interesting art: aside from the stained-glass panels (designed by Norgrove Studios), we have 10 commissions from the Paintings in Hospitals charity. During my daily walk around the building to meet the staff teams, I still enjoy the sight of the striking paintings on display.

I try to visit each area of the practice and check on any immediate issues – absences, appointment availability in relation to demand, patient issues and IT problems are all common. The IT help and remote support is much improved these days; essential as we are totally reliant on IT with auto-check-in, Envisage call systems and EMIS LV supported by Docman.

Our communications room is like the Starship Enterprise and requires 24-hour air conditioning to keep the ambient temperature correct. In our old building, we had one server and a shelf with a couple of network systems; scanning was not established and notes were regularly pulled.

I allocate time for emails each day; post gets less and less important. We have a local practice managers’ group that I chair. We meet bimonthly with a business agenda and also to share ideas and problems. It is an easy job to get isolated in. I have set up an “e-group” – queries from other practice managers in the group are emailed to me and I forward these on to the others, so communication between us is not an issue.

On the other hand, communication in our new surgery building has been a challenge. You would think that having moved from our old site, which had two buildings opposite each other, to being in one building would have made things easier, but it has created new problems.

Staff, who now work on two floors, have had to adapt to a completely different environment. We have an open administrative office shared by seven staff, and with the introduction of digital dictation a communication divide is emerging, with less face-to-face interaction between the downstairs and upstairs staff.

These kinds of issues are discussed at monthly meetings of our departmental leads, a recent but now well-established surgery initiative. I have leads for nursing, dispensary, reception, administration and IT, and all lead a small team of staff.

Investing in training for the departmental leads has now reaped its rewards. They appraise their own staff groups and make day-to-day managerial decisions. They come to me for support on the more difficult issues, rather than on every issue that needs a decision. It is not possible to run a building this size efficiently alone, and it is not good for the business to have all knowledge invested in one person.

My day will include some attention to strategic planning of one sort or another. Upton Surgery has developed a five-year strategic plan linked to NHS national and local health priorities. I feel it is essential that primary care moves in the same strategic direction as the local and national NHS, and funding is often available to pilot innovative work.

My real skill, so my partners tell me, is horizon-scanning and developing strategies that translate into action. We are an ambitious practice that strives to deliver the best-quality range of services. I review our Patient Survey frequently on NHS Choices, and make sure we are not dropping significant approval percentage points in any area.

Every week I will be involved in some aspect of PBC. Myself and one of the GP partners are the PBC leads for our local cluster of 21 practices that links to the larger South Worcestershire group. PBC has been an important funding stream for our Healthy Living Centre and Care Closer to Home initiatives. 

We have worked with a number of agencies since we moved to this building, including Age Concern, Heartstart, Challenging Pain and expert patient groups. We have started three different exercise schemes: a short-walks programme, a Tai Chi class and a referral for gym-based exercise. New services we have established include consultant clinics in paediatrics, rheumatology, an audiology service, and older-age medicine and psychiatry. We also have a thriving private chiropractor clinic.

It takes time and effort to get these services started. There are always barriers to work around but there is a real sense of pride the first day the new clinic or service starts.

Sometimes a patient wishes to raise an issue with me, for which I always make time, but there is a fine balance between having an open-door policy and being able to complete a day’s often-ambitious targets.

I prepare agendas for the weekly partners’ meeting. Other meetings require more organisation – such as our patient participation group meeting. There are staff and patient newsletters to prepare and business cases to write. With Quality and Outcomes Framework (QOF) returns and a practice accreditation visit to prepare for, much time is spent on finance-related issues. You have to accept a bit of slippage in this job; something always comes along that becomes a priority, however hard you try to plan.

By Friday, I sometimes feel I have done a week’s work twice over. I take home my “bedtime reading” – this might be the medical newspapers or an NHS document such as NHS 2010-2015: from good to great or the NHS Operating Framework.(1,2)

Some of you reading this may not want to read such NHS rhetoric for all sorts of reasons. Time is a big factor of course. I tend to read these documents at the hairdresser; some of my best ideas have come from the hairdresser’s chair. It’s more productive than reading Hello magazine.

For me, primary care was a great career move. Of all the NHS and private organisations I have worked for, I feel most at home in general practice, and closer to the patient. I am constantly looking to the future and accept there are always challenges.

I would advise people who prefer the safe status quo not to even consider this as a career move. Primary care is not a safe haven of tradition; change in the NHS means change for us. The challenge can be all the greater in general practice as the team is smaller and the day job never goes away.

In reality there is seldom a “typical day”, but there is always the unexpected. Now that the snow has stopped, I’m off to the car park to help clear a path …

1. Department of Health. NHS 2010-2015: from good to great. Preventative, people-centred, productive. London: DH; 2009.
2. Department of Health. The NHS in England: the operating framework for 2009/10. London: DH; 2008.