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by The latest Practice Profile
11 December 2007

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Management in the Midlands … our editor reflects on the day job

Cathryn Bateman
Practice Manager
Worcester Street Surgery
Stourbridge, West Midlands

Cathryn has been the practice manager of Worcester Street Surgery since 2002. Prior to this, she was Business Manager at a Birmingham university health centre after working as a practice secretary/receptionist. Cathryn is a coauthor of the Royal Society of Medicine’s Handbook of Practice Management, and is the Consultant Editor of Management in Practice


I think it’s fair to say that my entry to general practice wasn’t exactly engineered. After leaving school with a selection of O-levels and CSEs (as they were then), I fell into a series of clerical jobs, and thought myself lucky to have done so.

It was the early 1980s, and unemployment was rife. Many of my friends were either unemployed or felt forced into further education, due to the lack of employment opportunities available.

Over the next few years, I moved from job to job trying to find my niche in life, and – hey presto! – in 1990 I thought I had actually found it! Not within general practice, I hasten to add, but in a small office within a factory that manufactured giftware.

It was so detached from anything I had done before, and I loved the banter with the factory workers. Little did I realise at that time how important that job was to be to my later life – it taught me resilience!

After only a few months though, work began to drop off, and yes, you guessed it, as the last one in, I was made redundant! It was not a nice experience, but I picked myself up, and found what I thought was actually going to be another mundane clerical job, this time at a doctor’s surgery.

How wrong I was! I quickly settled into life in the surgery as one of three secretaries. I loved the variety of general practice, and the challenges that patient contact had to offer, as I also spent some time in reception as part of my role.

I was lucky that the practice was forward thinking and supportive of its staff. The practice manager at the time allowed me insight into her role, and it wasn’t long before I was embarking on the AMSPAR practice management course. With my pass in my hand, and an excellent grounding, I embarked upon my first practice management role, at a university-
based practice.

Apart from my AMSPAR certificate, at that time I had no management experience to speak of, so this was an excellent place to start. The workload wasn’t too heavy, the team too large or the patients too challenging. In fact, I had a wonderful induction into life as a practice manager.

Worcester Street came following attainment of my Masters, which my previous practice had supported me to get. I felt that I had become educationally rounded, and had now gained enough experience to return to mainstream practice.

The only problem is that I jumped in with both feet. A more sensible individual would have stepped up to a slightly larger practice than the one they had left, with just a few more staff and a reasonable team of partners – not 10 (who incidentally are all very different)!

It’s challenging, and I don’t think the role is particularly typical, if indeed there is such a thing in practice management. I am very much part of a management team, which consists of:

  • The partners (three of whom take a particular interest in the management of the practice).
  • Four team managers.
  • An operations manager, responsible for IT, appointments and diary management, health and safety, building maintenance, and so on.
  • A patient services manager, responsible for reception and secretarial staff.
  • A nurse manager, who looks after our nursing and Quality and Outcomes Framework (QOF) administration team.
  • An education manager, who maintains the practice’s involvement in teaching through strong links with Birmingham University, together with her charm with the students.

With such a large team, the most important factor in keeping the “ship afloat” is communication. Indeed, the organisation and operation of the practice wouldn’t work without a communications strategy, which consists of a weekly management meeting (attended by all team managers, one of the partners and myself), a weekly partners’ meeting (which is short and sharp), a monthly partners’ meeting (which is neither short nor sharp, but we are working on both), biweekly staff meetings, and, of course, good old email (where would we be without it?).

In addition to my practice management role, I am also labelled Practice-Based Commissioning (PBC) Manager for our cluster, which consists of … well, it consists of our practice! With a reasonable list size, we deemed it appropriate to maintain our own identity as a practice, and although we don’t have the economies of scale that the bigger clusters have, we are managing to tick along quite nicely.

As PBC Manager, I work with a team of other PBC managers who are employed by the primary care trust (PCT) to realise changes that are generally directed by the clinicians, through a clinicians’ commissioning forum.

The PCT financially support a proportion of my time to allow me to fulfil this role. It’s not easy though – the day and a half I am funded for doesn’t allow me to make a huge hole in the workload necessary to realise our commissioning plans. It is easy to take time that should be spent on practice work just to do that. I have to be very disciplined not to.

I am extremely lucky that I have a team of managers to support me, and that the partners have been forward-thinking enough to allow me to take on this role. There is no doubt that there has been a lot of learning to do over the past few months, and my commitment to PBC has definitely detracted from the practice.

However, this role has been important – I for one feel that PBC offers general practice the opportunity to take some of the control back. We can be masters of our own destiny, and do what we feel is right for our patients. After all, we (or should I say our clinicians) know our patients the best.

So what’s my typical day? You all know the answer to that – there isn’t one. I do try and have a typical week though, structured around our meetings and my PBC commitments, to which I dedicate a day and a half. The rest of my remit centres on practice finance, personnel, strategy, and being the practice’s link to the outside world, usually through email.

Yes, I am the practice postman! It seems that any communication from the outside world has to come through me, despite having nothing to do with me at all! This in itself just goes to show how little the outside world knows about general practice – and I include the PCT in that statement. How I bet you can all concur with that, as it seems we practice managers do and know everything! While I very much see myself as a general manager, we all know that that’s not true.

We couldn’t do our jobs without the backroom and frontline support that are our staff. They do an excellent job, which often goes unappreciated. So well done team at Worcester Street!

Among the day-to-day stuff, there is always time for a bit of banter (I told you the resilience I learnt in my previous life would pay off), and a lot of humour. The diversity of the personalities of the partners and the quick wit of many of the staff make this a great place to work. General practice is a difficult job, and it’s necessary to let off steam somewhere.

As a team, the girls ran the Race for Life this year, raising more than £1,000 for cancer research. The current hot social topic is our annual local primary care quiz, organised by a couple of other local practice managers – including Sonia Clark, who has written one or two articles for Management in Practice.

The quiz involves thinking up a team name and dressing accordingly – among others, we’ve been “Alice in Worcesterland”, and “A Pink Lady”. I am not sure what the theme will be this year, but I am sure someone will come up with a suitably derogatory costume to put me in, and an equally derogatory name for our team!