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by Angela Sharda
2 May 2017

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Interview: ‘The future is ours for the taking’

Virginia Patania hasn’t used the title ‘practice manager’ for about a year, but instead refers to herself as a ‘transformation partner’, which she describes as ‘someone who is deeply invested in the practice’s change and transformation, but has a stake.’
Her approach is different from the conventional practice manager, but she is also keen on making a difference in her community and in general practice. Her positive approach, she says, comes from the people around her and from generating results.
By adopting this distinctive approach to practice management and having a positive mental attitude, she has seen a radical change in the past three months. DNA rates have dropped, average waiting times for patients have decreased, and the time to turn around repeat prescriptions has decreased.
The Jubilee Street Surgery is a practice in the heart of Tower Hamlets in London’s East End, which is one of the most deprived areas in the UK. Just from speaking with Virginia for five minutes, her positivity, enthusiasm for her role and her passion to make a change shine through.

Q: What do you see as the role of the practice manager?

A: The role of the practice manager has a lot of different contexts. You have practice managers who substitute for receptionists when someone is off sick; practice managers who work out rotas; and practice managers who are business and development managers – which is where I see myself.
I have tried to release my administrative functions to the admin staff. The value I add is in leadership culture and development. The rest, everybody else can do.

Q: How would you describe your approach as a practice manager?

A: I think my approach works well for this practice. I think we feel very positive about the future. We have become notorious for our loss of minimum practice income guarantee (MPIG), so our finances are quite restricted. We work with 1.6 fewer full-time GPs than we did in 2014. And yet I feel like the future is ours for the taking. I think whatever I am doing is helping the practice.

Q: How would you describe your method of working?

A: We work with something called circles. Every line of service has a team that manages all its own decisions, its budget, its change in protocols, its data tracking. We have circles for human resources, finances, each chronic disease, patient engagement and self-management. My role is in quality improvement and strategy.

Q: Is that a more successful way of working?

A: I don’t believe in hierarchical leadership structures. I think in general practice you tend to employ people who have a good knowledge of local services. In Tower Hamlets, many of our employees are local.
Our receptionists haven’t been abroad for a Fulbright scholarship, or on an Erasmus swap in America. They are local residents who are now working at the practice. Their intellectual potential is untapped.
When you open the doors, you start taking away the boundaries that traditional management imposes, you find yourself with a team of human resource specialists, data analysts, website developers, creative designers. They are all in the practice already. They go home feeling they make decisions, they do what is meaningful for them, and that they made a difference.
I love that. It gets me out of bed in the morning,

Q: What is the key to having a successful practice?

A: The first is enabling positive leadership. I come in with the joy that I expect to bring out by the end of the day, I genuinely believe in people. And people believe in me.
We are very strongly data driven, we measure everything – how many patients we saw, how our conversion ratios were, how many calls we missed, lab links, documents, any clinical work. We constantly measure it to change it. We celebrate success and we change behaviour where we haven’t achieved. But data-informed practice is absolutely key.

Q: How would you describe your patient feedback?

A: We were recently visited by a ‘mystery shopper’ from HealthWatch. We came back as one of the top two practices in their exercise because of patient access and the ability to see a doctor.
I have a deep belief in patient engagement and citizen engagement. When our patients give us advice, we do something with it. If they say there is no reason why we shouldn’t have a bike rack, we will have a bike rack. It’s got to be small wins, but wins that make it clear to patients that their views are fundamentally important.
I feel really frustrated that patients are suffering from the lack of resources in general practice. They shouldn’t be suffering. My sole reason for being at this practice is ensuring patient access – and I mean same-day access, I don’t mean access within two weeks. If you are sick on a Tuesday you get seen on a Tuesday.

Q: How do you make sure that happens?

A: We do this by using an adapted telephone triage system. Anyone who rings on the day gets seen on the day, unless they ring late afternoon, in which case they get seen the next morning. There’s nothing pre-booked. We manage it constantly as it comes. That’s a pledge to the patients.

Q: What are the major challenges you face?

A: Major challenges are entirely predictable; they are financial. There is such a paucity of resources in general practice now.
We published our earnings to the Guardian in 2013, just to ensure that there was transparency about these alleged GPs taking home six-figure salaries. That is definitely not the case in a practice like ours.
As time goes on, we are able to afford fewer and fewer GPs. We make maximum use of skill mix, but the way a practice like this delivers quality is because of goodwill and overtime, people working weekends at no extra cost, on admin staff coming in to do Care Quality Commission (CQC) preparation. The second major challenge is the difficulty of collecting data easily – and having the skills to use these data.

Q: How would you build that culture?

A: It’s a step-by-step process. I am only at my practice two days a week. In the other three days I work at trying to scale what has happened at Jubilee Street elsewhere around the clinical commissioning group (CCG) and in other CCGs around London. If you pick up a basic quality in improvement methodology and start following it through in a disciplined organic way, change in general practice can be delivered – rapidly and at scale with bottom-up involvement.   

Q: What is your view of the state of the NHS?

A: I find it concerning. I would like to see an NHS that is similar to the Bank of England – independent and separate from government and politics and elections because we continue to base our change on two-to-five-year cycles. I have a lot of time and respect for the NHS England chief executive Simon Stevens. I think he is an absolutely visionary leader for the NHS.

Q: What is the future of practice management?

A: I still think we need a visionary leadership to align with future challenges. I don’t think we need one practice manager per practice to offer this. I think leadership can sit within different people. It can sit with a clinical partner. The skillset needs to vary. We always think about taking work from GPs. I see it as a much bigger endeavour – giving work to everyone,
to administrators, physician associates, medical practitioners, practice nurses. That’s our untapped resource – these are the people who still have enthusiasm, who haven’t been ground down by the work and that’s where I see the hope.

Q: Where does your positivity for practice management come from?

A: It comes from generating results. I get energy from the joyful people around me.
In the past three months, some of the things we have achieved across practices and in this practice are to decrease the number of patient contacts per whole-time-equivalent GP per 1,000 patients. We have also decreased DNAs, average waiting time, the time to turn around repeat prescriptions and the number of lost prescriptions.

Q: What advice do you have for other practice managers?

A: Believe that it can be done, that it is possible. I deeply believe that everything is possible. This level of belief is something you either have or you don’t have. Be the person that you want to be in two years’ time. Be the part of the system that will change its image. If I went to bed at night and someone asked me to draw my ideal job, this would be it. 

Angela Sharda is deputy editor of Management in Practice