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by Angela Sharda
3 August 2017

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‘I have put my heart and soul into the practice’

Ann Neville decided to move into practice management in 2014 after her father fell ill with dementia. Just three years later, she has rectified major problems with access, introduced a workable system for visits and created a risk register that is giving pre-emptive advice to patients who might develop diabetes.  
Her practice, Darwen Healthcare in Lancashire, has nine GPs, 38 practice staff and a list of 12,500. 
Ms Neville has been commended by her peers for her ‘can-do’ attitude and as someone who is both firm and fair in her approach.

How did your father becoming ill draw you towards practice management?

I wanted to make a difference. I came into my practice as a customer service manager to deal with patient complaints because there weren’t any appointments. When my father was ill, it had been difficult communicating with his practice, which was some distance away from me. He had dementia, so there were problems with consent records and I didn’t feel there was flexibility in his practice. Now, in our practice, I like to think that we go out of our way to help patients. I have put up posters explaining that I have an open-door policy and am quite happy to meet patients. If something’s not right, I want to do my best to put it right. 
Tell us about your background.

I worked in a travel agency for a number of years. Team-building was a big element, encouraging apprentices to be trained to be able to sell holidays. And then from there my dad got poorly,
and there were awful communication problems with his GP practice.
I wanted to do something different, something that would change somebody’s life. I started as a medical receptionist where you didn’t need any previous NHS experience. I spent
18 months doing that in a singlehanded practice, then became a medical secretary, then eventually, after six years, head of admin at a hospice.

I always remember the practice manager at the singlehanded practice where I started off. She was amazing. She’s still there now. She was my role model. And now I’ve been in my practice manager post for just under three years.

What would you say has been your biggest achievement?

Watching the staff upskill and flourish into key roles. Instead of recruiting for new roles outside the practice, we upskill current staff. Appraisals are key – instead of ticking boxes, we ask them what they want to do in the future, what other roles they want in the practice. We have a senior healthcare assistant who has spent the past two years on the assistant practitioner course. We have a practice nurse who  is now a nurse practitioner. We have  a receptionist who is upskilling to become a healthcare assistant, splitting her time between the two roles.
Being rated ‘outstanding’ by the Care Quality Commission (CQC) was also amazing, especially as we had no GP appointments for four to five weeks. It’s taken a lot of hard work. The CQC saw we did a lot of work on clinical audit. We continually try to improve, doing an audit on patient services, then creating an action plan. We also communicate within the practice, so every month we send a team brief so that all the staff know what is going on – because part-timers may not know. We make sure everyone is involved in decisions.

Your practice had several GPs absent at once. How did you overcome this?

At one point, a salaried GP went on maternity leave, then six months later a second GP went on maternity leave and a third was to take time off. To organise cover, we relied on word of mouth. Our GPs told people we were looking for doctors. I told the main acute trust registrars, who knew the people who were just qualifying as GPs. I also put it out on NHS jobs. We found a long-term locum and recruited a new salaried GP.

What are the biggest challenges you face on a daily basis?

Finances is number one. Then demand and capacity – having the right number of appointments to meet demand for chronic disease nurses and GP consultations. The other challenges are patient complaints and staffing issues.

How do you tackle these?

Attitude – instead of thinking what we can’t do, I try to look at what we can do. I try to sell that throughout the practice. So for finances, we have monthly meetings with the finance manager. For appointment capacity, we set up a monthly surgery so we can head off problems. And staffing issues arise from day to day with people going off sick and so on.
I have created a robust line management structure and a lot of elements of my roles are delegated. My admin team has 22 members – the medical secretaries, the Quality and Outcomes Framework (QOF) team and three key managers who support me directly. I have a corporate governance adminstrator who deals with complaints and IT. A contract adminstrator deals with QOF results and coding. Rotas are done by other people and I oversee that. The senior receptionists handle reception staffing.

Tell us about the changes you have made in your practice.

We have introduced more flexibility in appointment structures to meet patient needs. I spent a lot of time working on cervical smears. When I was 16, my mum died of cancer, so I wanted to make sure people took up the opportunity of having smears. Back in 2015, we had a rigid appointment scheme where smears had to be done on a Tuesday. We changed that and patients can now come for smears on any weekday. More people are now coming. Exception reporting is down – instead of inviting patients three times for a test, we carry on until we get them into the practice.
I have put my heart and soul into the practice. It has not been a 37.5-hour week. I think when staff see me working those hours that dedication goes through the whole team.

What advice would you give other people looking to become practice managers who don’t have a strong NHS background?

Practice management is becoming more like business management. Now you can get in without NHS experience if you have a good financial background. But I still think that having the background of reception means you understand what the problems are.

How did you build your practice’s home visiting team?

Previously, all the visits were done by GPs. We took on an ex-community matron as an advanced nurse practitioner. She assesses all the visit requests. Sometimes they might be a chronic disease issue that might be delegated to a practice nurse. 

Who does the visits?

We have three advanced medical professionals (AMPs) who each have a two-hour slot at the end of the morning to do visits. Practice nurses also have that time so they can either do admin or go out on visits. We have an assistant practitioner who does visits as well.
We try to make sure there is time for all staff to do what they need to do.
We have a diabetic risk list. We introduced an HbA1c test to find patients in the pre-diabetic range and stop them becoming diabetic, or delay the onset. The AMPs trained the healthcare assistants to give lifestyle information to patients in the pre-diabetic range. They bring the patients back after three months and do another blood test. If the HbA1c has dropped, they do the test again six months later and then annually. We started with  a list of 85 pre-diabetics, and we’re now up to 527 in two years – potentially 450 people who may have become diabetic if they had carried on as they were. This is exciting for the healthcare assistants.

How do you use feedback?

Every month our family and friends group gives feedback on reception and clinical staff, and on clinical advice – for instance, if people have seen an improvement in their chronic obstructive pulmonary disease because of advice they’ve been given.  Every June, I do a staff satisfaction survey and ask them to be honest. They can remain anonymous if they like, but I want them to say what they think of each individual in terms of their role. This year, somebody’s feedback about me said ‘works incredibly hard, needs to work fewer hours’.

What support do you think practice managers need?

When I first came into the role in 2014, if it hadn’t been for the support of other practice managers, I wouldn’t have been able to do this job. We have a robust practice manager forum in the area. I can contact any of them if I am struggling on something. I wouldn’t have been able to do anything without them. This award is for them too.

What does the future hold?

I am excited about the future. We are continually trying to improve. Going forward, I can see practices working more closely together. I’ve said my practice manager colleagues deserve credit for this award, but my practice team does too, of course. What I have tried to introduce is the idea that we work together as one, so clinical staff work with non clinical staff. I am really, really proud of the practice I work in. Although I have some days when it is dreadful, there is no other job I would want to do. My GP partners are amazing – I don’t think  I have ever worked for employers who were as committed to pushing people
to go the extra mile and do something different. I think I am very lucky.

Angela Sharda is Deputy Editor of Management in Practice