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A tough balancing act

29 March 2012

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I am in the privileged position of working with different practices all over the country, either as a management/HR consultant, a recruitment consultant, a trainer or facilitator. It has been nearly seven years since I left the practice where I had been the business manager/partner for 11 years. General practice has always been stressful and busy, but since I left practice management I have noticed that the workload of GPs, managers and staff has become more pressurised, more demanding and more target-led – and there’s more of it!

The atmosphere for people working in practices can feel threatening, with demands from the government, the primary care trust (PCT), the local commissioning group, the patients and the public. At the same time there is less sympathy for the often-tireless work done by clinicians and their staff in extremely busy practices.

Practice finances are under threat in every direction, putting extra pressure to keep the partners’ profits from falling while morale amongst the staff can be low due to limited pay rises, although everyone is expected to work harder and harder with no extra resources. In the face of all this, is it possible to achieve the golden egg of a good work-life balance?

According to data from the Office for National Statistics, UK employers work some of the longest hours in Europe.1 In 2011, full-time workers in the UK worked an average of 42.7 hours a week compared with the European Union average of 41.6 hours.1 While some employers face problems with staff not attending work as regularly as they should through sickness and other absences, for many employees in the UK “presenteeism” (coming to work in spite of illness) is also becoming an issue. With increasing unemployment in the UK, the culture in the workplace is changing to an expectation of attending work even if employees should be off sick or on holiday.

In a recent survey, the proportion of employees in the public sector who agreed or strongly agreed that they achieve the right balance between their work and home lives was only 57%.2 Clearly there is a long way to go.

Spinning plates?
Many practice managers I work with say they regularly work longer than their contracted hours. Some say they have found taking their annual leave difficult. This demonstrates the huge commitment practice managers have for their jobs and for the practice. True, many managers enjoy a degree of flexibility, often well earned through years of hard work, which permits them to take some time off when they need to or work flexi or part-time hours. However, something must be wrong if an employee is regularly working longer than they should just to keep on top of the job.

Sadly, managers tell me that despite the extra hours and taking work home they still feel they do not have enough time to get through all the different tasks they should be dealing with. Many managers speak of an overwhelming sense that if only they had more time they could get to the bottom of their in-tray or read and action the email inbox, and go home with a feeling of having completed all outstanding items.

These feelings are often compounded by having to juggle priorities, often on a daily basis and sometimes on an hourly basis. Trying to accomplish project/strategic work during regular crises can prove challenging, since someone is required to sort those crises out. That someone is often the practice manager.

In an ideal world, every practice should have a manager able to concentrate on strategy and management issues, and a deputy manager who can concentrate on operational issues and the day-to-day running of the practice. Depending on the size of the practice there might also be a reception manager, an office manager and/or a nurse manager. Some practices operating on several sites have developed the role of ‘site manager’.

With the right organisational structure, the practice should operate smoothly and everyone should be able to manage their workload. Reviewing the organisational structure to assess if it is working well can be a valuable exercise. Sometimes, creating a better use of the staff you have is the pragmatic solution: it helps keep costs to a minimum and has the additional benefits of providing a career path for staff and developing individuals to extend their skills and experience.

Sometimes, the practice has to admit that the structure is not right or that the skills needed are not available within the practice. Recruiting from outside to fill the gaps can ensure the right skills are brought into the practice, which often brings new ideas and energy to the team. Changing the structure can be a bit daunting and it might mean extra staff costs need to be agreed by the GP partners at a time when finances are being squeezed. However, sometimes people just need to be honest and accept that more or different resources are needed.

Staff trust and delegation
Some managers find it difficult to delegate and are possibly not using their staff to their maximum potential. Delegation is an art in itself, but I believe the best managers are the best delegators.

Good delegation means being able to let go and to pass on the task – but not the ultimate responsibility – to someone else. It means trusting that person to produce the right outcome but encouraging them to find their own way of doing things. It means guiding and mentoring them at the start and then slowly pulling away as they become more proficient and confident, and finally providing support when needed from a distance, so that they really take ownership of the task.

Effective delegation offers huge benefits for the manager in distributing the workload, but it also confers benefits to the individuals being delegated to, who can develop new skills and confidence. If you are finding it difficult to delegate, ask yourself some honest questions: Are you a control freak? Do you want to take the glory for everything? Do you always want things done your way? Do you not want to bother anyone else or make a fuss? Are you becoming a martyr?

The busy manager should also try to delegate at home as well as work. The more we do for others, the more they expect us to do or just accept that it is our job. Running a home is a job that can be shared by everyone involved. Asking for help, either at work or at home, is not a sign of weakness; it is just about finding practical solutions.

Along with effective delegation, keeping life in balance often involves being able to say “no”. If you are someone who always says “yes”, you are likely to be dumped on for everything and feel overloaded. This is about being assertive when you need to be; it is not about being difficult or inflexible. Provided you say “no” with integrity and for genuine reasons, you are likely to be more respected. Of course, you might be able to offer an alternative if you can.

Another important area to manage is the interruptions. Good managers are proud of their ‘open door’ policy – but is the door just too open? Does everyone and anyone think it is ok to interrupt what you are doing at any time with telephone calls, requests for information, urgent emails or just barging in? Do they ever consider the impact it is having on you? Try to create some ground rules about interruptions to allow you some quality thinking time.

Those who consider themselves perfectionists are more likely to suffer from a poor work-life balance. Try taking the option of ‘good enough’ over ‘perfect’. Ask yourself if it really matters – some things need to be good, but others can tolerate a bit of corner-cutting with no real detriment.

Work-life tips
If you are still finding it hard to manage a work-life balance, here are some more tips:

  • Make sure you have an annual appraisal so that you can share your difficulties in managing your workload. It’s not just your problem and you may need help finding a solution.
  • Draw a line between home and work. Try and leave work behind. This means not reading work emails at home or sorting out problems outside work. It also means switching off from work in the evening and enjoying a meal and relaxation time.
  • Make a ‘to-do list’ and keep a diary; organise your life with a plan and stick to it.
  • Keep the weekend free and plan to do things that are totally different from work. Spend it with your family, friends or just enjoying your own company.
  • Take up a new hobby or interest and be passionate about it. For those who think they do not have time for anything else, this can be a lifesaver! We can always make time for things that we enjoy and the stimulation of doing something completely different or learning a new skill can invigorate other parts of our lives.
  • Book a holiday, a weekend away or a night out so that you have something to look forward to.
  • Get out of the practice in the middle of the day for a walk in the fresh air. The change of environment will do you good and give you more energy for the rest of the day.
  • Get a cleaner for your home if you can afford it. You will be amazed how much a good cleaner can achieve in two or three hours. Get your groceries and other purchases online – unless, of course, you find a bit of retail therapy a great form of relaxation!

Patricia Gray is a Management Adviser, Trainer and Facilitator, and is an HR specialist in general practice. She was the managing partner of a large practice for more than 10 years, and now provides HR and management advice and training.

1. Office for National Statistics. Hours worked in the labour market – 2011. London: ONS; 2011. Available from:
2. Chartered Institute of Personnel and Development. Employee Outlook: Winter 2011-12. London: CIPD; 2012. Available from:…