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by Gloria Middleton
14 July 2008

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Is there an artificial intelligence behind primary care politics?

Management in Practice is keen to provide a platform for practice managers to air their views, get things off their chest and share their experiences.

This week, accomplished practice manager Gloria Middleton has been left dazed and confused by the political machinations and buzz words coming out of primary care. Do you feel the same? Read on …

Gloria Middleton

Practice Manager

Gloria has worked in general practice for 18 years. She is the first practice manager in Sunderland to become a nonclinical partner, and has three practice sites to keep her busy. Gloria has just stepped down as the Institute of Healthcare Management’s National Primary Care Sector Chair after being in office for two years. She was the founder member of the North East Practice Managers’ Communication Forum, which had over 100 members. This networking forum recently merged with the IHM Management Network Team. Over the years Gloria has been co-opted onto the local LMC. She is the current chair of Sunderland’s independent Practice Managers’ Group. As of July, Gloria has decided to take a well-earned breaks from sitting on  committees/boards etc and concentrate wholly on the practice

Well, here we are … week two of extended opening hours. We did an inhouse survey to ask when our patients would like us to open, and the verdict was late evenings. And yet I’ve almost had to bribe patients to come in. However, I’m putting this down to the fact that the rain has been torrential and not even the birds will come out for their seed. But I’m sure that, once patients are aware we are open, we’ll be inundated.

So while it’s currently quiet, I have time to read the local paper featuring a write-up of the first “public” consultation meeting on the Darzi polyclinics (it’s very hard for me to write that word and I dare not mention it out loud – I tried it today and one of my doctors said a very rude word!). The report read that “over 50 people attended”. If you count the 24 PCT staff and 12 practice staff (including myself) who attended then, out of a population of approximately a third of a million people, a grand total of 14 patients came. Embarrassing. But the PCT can say they consulted the public.

What amazed me was that every table had a little microphone to record every word said so this could be documented. I look forward to reading the final report, and I am sure the jokes said around the table contributed a hell of a lot to the evening. I think it was our trial run for Britain’s Got Talent, just in case we are sold off to the private sector.

The word “Darzi” is one we cannot escape, no matter where we turn. Boy, what I would give to bring this man to the shop floor – without the PCT interfering – and let him see what truly goes on in general practice.

I would want Lord Darzi to work in my practice for a week. I could introduce him to the PBC Cluster so he can see what excellent work is going on – and yet we have no funds to redesign services or be instrumental in making changes.

And why is it that nurse practitioners are not included in the staff head count? Many years ago, Sunderland was classed as “underdoctored”. Back then, the PCT told us we could employ nurse practitioners rather than doctors, so long as it improved access.

Yet when it now comes to measuring the number of patients against the number of GPs, nurse practitioners don’t count. So one minute they do, then they don’t. When I challenged this I was told it was a national decision. So why does Lord Darzi state it’s down to local PCTs to decide?

Then again, it will probably come down to local interpretation, and we have all been on the sharp end of this one! What goes in Durham is not how it’s interpreted in Sunderland, and we are on the boundaries.

Talking of interpretation – can someone tell me what’s with the new buzz word “intelligence”? The three most-used words from the PCT this month are “intelligence”, “robust” and “transparent” (although “transparent” will move out of the top three soon as it has been around for a little longer). 

IM&T now has an “intelligence manager”. At the public consultation meeting, someone from the PCT said they worked “in the intelligence area”. What made me laugh was an email I received from someone at the PCT, who I had not heard of before, asking us if we knew “of any other intelligence”.

So I call on all my colleagues to see how many times they hear the three magic words. Unless of course you have your own top three being circulated in your area.

Big Brother is calling and, as I obviously haven’t a lot of intelligence, I hope I have been transparent enough for you to understand I am robust enough to accept I need to switch off.