Clive Cropper, a retired practice manager, reflects on his 43-year-long career in the NHS.

On 30 April 2020, I finally retired from working in the NHS. It took me 43 years to get there – and it was still a difficult decision to take because working as a practice manager in Cannock, Staffordshire and trying to help develop primary care services across Cannock Chase had been the most enjoyable, challenging and rewarding period of my career.

Over those years, at various times, I managed four practices, the main one being Moss Street Surgery in Chadsmoor. I joined Moss Street Surgery and Rawnsley Surgery having spent the previous 20 years in managerial roles in several hospitals, latterly as a directorate manager for surgery.

I became increasingly frustrated and burnt out there and needed a fresh challenge. Not for the first time, I got lucky. A former colleague tipped me off that a couple of practices in Cannock were looking for a part time manager to share. I met up with Moss Street’s senior partner for a chat about the post and after a formal interview, we both decided to take a chance. I started in November 2000.

I hadn’t worked in primary care before and they’d never had a practice manager, so it was a probably a marriage made in heaven and a case of learning all round.

‘A breath of fresh air’

The first step for me was to put a management foundation in place, which involved setting up and formalising the policies and procedures to support the excellent clinical practices that already existed. Today, since CQC inspections of GP Surgeries have been introduced, these are a must have.

After working in hospital management roles for the previous 20 years, it was like a breath of fresh air – finally being given the responsibility, and more importantly, the trust of my employers to make decisions affecting the business of the practice. Responsibility for financial management, human resource management, business development and supporting patient services actually made me feel like a manager. No more lengthy, frustrating, fruitless meetings. Joy!

Procedural building blocks in place, I set about ensuring that the doctors, nurses and myself, were supported by a competent and confident team of administrative and front of house staff.  It was important to me to have a committed workforce who felt supported by myself and the doctors, and who felt that their interests and development were important to us.

I like to think that I had an open-door policy and that staff could feel comfortable discussing their concerns, problems or aspirations with me. I always encouraged staff to develop and aim to move on to more challenging roles, if that was what they had an appetite for.

In building up the team, the importance of good communication cannot be stressed enough. We had regular staff meetings that we used to discuss what was happening or about to happen in the practice and what impact that might have on staff. For example, flu vaccination season, significant events or ‘near misses’, and proposed developments.

‘Improving patient care’

I always tried never to take my position for granted. For me, respect must be earned for who you are, what you do and have done and not just from a job title.

I hope that I never lost sight of what we are all trying to do in the NHS – look after the people who need our help the most. As an example, Moss Street set up a patient participation group a couple of years before there were any LES payments to encourage us to do so.

We recognised the benefits of sharing our aspirations, our difficulties with our patients and seeking their views (verbally and via questionnaires) on how the practice worked for them. It was encouraging to find out that the vast majority felt that we had got it right and were supporting them well. Constructive criticisms, we tried to act on as far as possible.

As an illustration of our patient care, when the QOF was introduced in 2004/5, Moss Street Surgery was the second highest achiever out of 30 Practices in the locality.

‘Forge good relationships with commissioners’

In 2007, I left Rawnsley Surgery to take on a larger, newly merged practice, Heath Hayes and Chase Practices, based on two sites – still keeping Moss Street as my comfort blanket.

Alongside my practice management roles, I had also carried out project management work on a number of major projects for the various guises of the locality commissioners.

Then, from 2006/7, I also became involved in getting practices to work together, to provide support to each other but also to take a lead role in commissioning. This focused on providing improved services for our patients and taking some of the workload pressures off our clinical and non-clinical staff. That role continued right up to this year.

What those experiences taught me was to try to forge a good working relationship with the commissioners, however long their title. Working closely with them on projects in the early years meant I was able to earn their respect (and gratitude I think), but it also allowed me to observe at close quarters genuine, decent people. People who were also trying their best to do their bit to help patients while restricted by the bureaucratic timescales and financial chain that meant relationships with practices inevitably become strained. While I voiced my frustration many times, I also knew that I wouldn’t swap places with any of them.

That positive, albeit mutually challenging relationship served me and the practices I worked at very well over the years, through to my retirement from Moss Street in 2018.

When I spotted an opportunity to move things forward I firstly tried to find likeminded allies; doctors, nurses and other managers to add weight to the case (and help with the work) and then use the positive relationship to ‘persuade’ the local commissioners (or NHS England) that you had something that they couldn’t refuse. Many times, the trust and grudging respect resulted in a positive response and a development to the benefit of patients and the people working in primary care.

As I reflect on those forty-odd years, the one thing that I found invaluable is the benefit of having a sense of humour. It really does help you get through the darkest of days. You can’t win them all and you certainly can’t please them all, but a rueful smile and a shake of the head can help move you on to the next challenge.