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Networking and Learning for Practice Management – a Scottish success story

3 June 2009

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Anne Crandles

Practice Manager
Morningside Medical Practice, Edinburgh

Practice Development Facilitator
South Central Edinburgh, Local Healthcare Partnership

Local Co-ordinator, Networking and Learning

Anne has worked in general practice since 1985, and in practice management since the last “new contract”. Over this time she has picked up an AMSPAR Diploma, an MBA and the Prince 2 foundation course in project management. Outside of work, Anne goes to the gym and attends a weekly French class. She has two grown-up daughters, who act as her own personal Trinny and Susannah

Scotland is trailblazing practice management with NHS Education for Scotland’s successful Networking and Learning for Practice Management initiative. This educational programme has brought together Scottish practice managers working as far apart as the Western Isles and Dumfries – and every stop in between.

First set up as a pilot in 2003 by the then Scottish Executive’s Health Department, the Networking and Learning programme was originally funded as a one-year project to strengthen practice management in Scotland. The project was such a success it has now become a permanent asset in NHS Education for Scotland’s array of training and development programmes and initiatives for Scotland’s NHS staff.

It has been led since the outset by National Co-ordinator Mary Mitchell, a well-known and proactive former practice manager from Kilwinning in Ayrshire. Mary and her team, or network, of 17 local co-ordinators work in all but one region of Scotland. They reach out to practice managers in city, rural and remote settings, in large health centres and single -handed GP practices alike.

Local co-ordinators
The local co-ordinators are all managers in general practice and have a wide range of skills, knowledge and interests. They are in regular, direct contact with local colleagues, and with one another, primarily via email.

As a result, a series of local networks have been linked together across the country via the co-ordinators with Mary situated in the centre of it all, from her office in Glasgow.

This coverage provides a unique resource for Scottish managers – support and advice are never more than a few keystrokes away and information can be cascaded from Mary to the co-ordinators and out to practices throughout the country in two emails.

The co-ordinators host educational events in each area, providing managers with a mix of topical national and local presentations and workshops. They represent practice management at various fora, eg, community health partnerships, health board planning groups and national IT strategy groups.

They liaise with diverse organisations – primary care contract organisations, secondary care services and local medical committees – and have established partnership working with social workers, voluntary organisations, etc.

Quarterly meetings are held for the co-ordinators to receive updates and advance notice of new initiatives and, of course, to network with one another!

The highlight of the Networking and Learning calendar is a two-day Conference for Practice Management. This is held in various, albeit central, Scotland locations. Again, the conferences are designed and planned by Mary and the team.

This year’s conference, “Enhancing Your Practice”, was held in the Crieff Hydro Hotel, Perthshire on 21-22 May. As well as keynote speakers, it included workshops on motivation and teamwork, leadership, emotional intelligence, personal impact and much more besides.

There was a presentation of certificates for successful General Practice Management Vocational Training Scheme (GPMVTS) trainees, and the announcement of the winner of the annual Bob Scott Brown Award, which recognises innovation and excellence in general practice.

These conferences are always well attended, offering a current and forward-thinking programme that addresses practice managers’ needs for today and tomorrow. They have an atmosphere that reflects Networking and Learning’s ethos – professional and informative, but friendly and supportive. The Thursday evening dinner/discos are legendary!

However, Networking and Learning is not content to rest there. It has also developed and piloted several interesting and innovative initiatives, as follows.

Working with the Institute of Healthcare Management (IHM), practice managers in Scotland and England first provided a vocational training scheme for new and aspiring practice managers in 2005. The two countries chose to run the scheme in very different ways – with very different results.

England encountered problems early on and has had difficulties establishing the scheme but Scotland, under the banner of Networking and Learning, has produced successful trainees each year, and the scheme has gone from strength to strength.

The programme provides a management education that is up-to-date and relevant to general practice. Trainees learn on the job, increasing knowledge and experience while gaining a recognised qualification. The trainers are all active managers in general practice and many are local co-ordinators.

The content of the programme was changed for this year’s course, with increased academic focus – it is accredited by the University of Middlesex at postgraduate level and worth 60 CAT (Credit Accumulation Transfer) points.

This demands even greater commitment from the trainees, who are expected to produce two projects (with word lengths of 3,000 and 7,000 respectively), keep a reflective diary and build a portfolio of evidence. This will undoubtedly strengthen the qualification but will mean an even more challenging year for this cohort of trainees.

Once again Networking and Learning is pushing the boundaries for practice management – producing newly qualified managers, well equipped to deal not only with the current climate in general practice but with whatever comes next too.

Peer appraisal
Based on the GP Appraisal system, this pilot is moving into its second year, building on the lessons learned in year one. During the initial period, 12 practice managers from four health-board areas – Ayrshire and Arran, Dumfries and Galloway, Lanark and Lothian – were trained to appraise fellow managers. Each appraiser was asked to appraise four local colleagues, and a full contingent of 48 managers volunteered to be appraised.

The evaluation of the pilot, carried out by an external consultancy company, was very positive. Managers found the experience extremely valuable – for many of the appraisees, this was the first time they had been able to discuss their performance and development plans with someone who understood the role and what practice managers did every day, what the problems and frustration were and what the high points and rewards were likely to be. Plans for personal development were focused and relevant.

Constructive criticisms were taken onboard. This year’s exercise will include opportunities to be appraised by a manager from another area and the paperwork will be more user-friendly. Even more managers have been trained to carry out this year’s appraisals, and some of last year’s appraisers have undergone further training – developing their skills to an advanced level.

This is very definitely a case of “if it’s good enough for GPs, then it’s good enough for practice managers!”

Significant Event Analysis peer review for practice managers
Several of the local co-ordinators have undergone training in Significant Event Analysis (SEA): how the documentation should be written, evidenced and presented, and how practice teams can learn from the particular incident; in other words, how to make the analysis acceptable for the Quality and Outcomes Framework (QOF) reviewer!

Practice managers are encouraged to submit existing SEAs to the national co-ordinator, who sends the documentation onto two SEA reviewers. These reviewers independently assess the SEA, suggest ways to improve the document and return the SEA and report to Mary Mitchell.

She then collates the comments and sends the documents and assessments to the practice. The practice can then decide whether or not to take this advice onboard.  Best of all, this service is free!

Multi-Source Feedback (MSF) pilot
This tool is being piloted as part of this year’s GPMVTS, and all trainees must participate in the process. Performance reviews from all levels of staff, team members and the trainee him/herself are collated to provide the trainee with an insight into his/her management style and behaviour.

This allows the trainee an opportunity to make any necessary changes, improving the effectiveness of both the individual and the team. The feedback is given at a meeting set up specifically to discuss the outcomes from the review. No doubt this is sometimes a little painful – but how can you correct a weakness if you are not aware of its existence?

MSF will be evaluated again at the end of this year’s GPMVTS. Assuming this is positive, training to support MSF – eg, “giving and receiving constructive feedback” – would be made available and then the tool would be rolled out across Scotland.

Coaching and mentoring
A mix of local co-ordinators and practice managers attended separate training course for coaching and mentoring. This has resulted in a series of informal local arrangements in many areas but, to date, Networking and Learning has not co-ordinated this activity on a formal basis.

The Networking and Learning team plan to revisit both coaching and mentoring again during 2009.

Assistant Practice Manager days
To date, there have been four hugely successful Assistant Practice Manager events. These have been held in both the east and west of Scotland, and have been fully booked on every occasion.

The programmes have been specifically designed to meet the needs of assistant practice managers – eg, in areas such as finance and the new General Medical Services (GMS) contract. Networking and Learning recognises the need to train the managers of tomorrow now and is working towards providing this.

Protected learning time/staff training
Many of the local co-ordinators also arrange events for practice staff – eg, induction, receptionist training – and organise protected learning time events for practices in their areas.

Networking and Learning provides opportunities for education and support throughout a practice manager’s career – from the outset, with GPMVTS, and on to ongoing support through local roadshows, cascading of information, specific projects, staff training events and a national annual conference.

It offers local co-ordinators opportunities to develop existing interests and skills, to feed this knowledge back to colleagues and to represent practice management at the highest levels.

Networking and Learning has put Scottish practice management on the map. Practice managers from other countries have attended the annual conference, arranged exchange trips, invited Mary to speak to them and replicated Network and Learning.

Other disciplines here in Scotland have also initiated similar systems – most notably the Practice Nurse Learning and Network pilot under the steerage of NHS Education for Scotland National Co-ordinator Fiona Bell.

Other stakeholders see the value of the network – NHS boards, local health partnerships and community health partnerships frequently ask to present at roadshows. Banks, insurance firms and clinical IT systems providers are all keen to be associated and provide support. This is testimony to Network and Learning’s position in Scottish primary care and its success in general.

So, what next for Networking and Learning? At the moment, no one knows. Mary Mitchell has announced that she is to retire at the end of this month (June 2009). It is hard to imagine Networking and Learning without this quiet yet determined lady at the helm.

There is no question that without Mary, Networking and Learning would not be the success story it is today. On behalf of practice managers throughout Scotland, I would like to wish Mary a happy retirement, best wishes for the future and an enormous thank you. We are all going to miss you!

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