Management in Practice is catching up with practice managers, for our Management during Covid-19 series, to find out what steps they’ve been taking in light of the pandemic. Today, we speak with Teresa Graham, practice manager at Oxford Terrace & Rawling Road Medical Group in Gateshead and business partner at nearby Second Street Surgery.

Teresa became business partner at the Second Street surgery, where she works two days a week, just prior to the pandemic, as its GP partner had been planning to retire. The move was a ‘natural next step’ for her career. 

‘I’ve worked in general practice since I was 21, with a gap working in mental health for five years, but I’ve always been in primary care, so I’m really passionate about it. I was really keen to become a partner. It’s something I considered in the last five years.’

Teresa also has a third role as practice manager at Gateshead’s CBC Health GP Federation, and saw the impact she could make to Second Street and the community through this position. As lead for the care of complex young patients at the federation, she had been involved in working with partners from other sectors, obtaining contracts for drug and alcohol services, and improving services for homeless patients 

However, managing three ‘interlinked’ roles, during the height of the pandemic proved challenging. ‘It felt like everything blurred as the challenges in each role were quite similar,’ Teresa says.

As one of a team of six at the federation, she quickly helped set up a home visiting service and a hot hub for the community.

‘My clinical team at Second Street ended up working from home due to being high-risk, so we decided to offer the practice up as one of the hot hubs for the whole of Gateshead. It was crucial for our patients as well, as they also needed to be seen. 

‘Early days were very busy. We worked with the federation team, community services and the CCG to create a project team, which collaborated to help staff the hot hubs, organise rotas, manage protocols and get all the risk assessments done – all the operational things that we needed to do. ‘

Some of these changes were completely new to general practice, so ‘we were revising things constantly’, especially as the guidance was changing on a daily basis, Teresa explains.

‘It was such a difficult time for everybody. It has calmed a lot and things feel much better now as we start to think about what our new normal looks like.’

The two practices Teresa manages also worked together to ensure they both had enough staff to keep open. Three GPs at Second Street surgery moved to working from home at the start of the pandemic, as they were all high-risk, meaning it was left with only a pharmacist, nurse and healthcare assistant. The Oxford Terrace practice had the reverse problem, as most of the nursing team had to do the same, but the GPs carried on working in the practice. 

The two practices agreed on having the nurse run sessions at both practices and for ‘cold’ Second Street patients to be seen by GPs at Oxford Terrace.

‘We have had a history of working together, anyway. We had a bit of an informal federation over the last five years, where we shared a frailty nurse and care navigators,’ Teresa explains.

‘Most of the practices in the area decided to see their own ‘cold’ patients. This has given us all a chance to test remote working, such as video consultations, since GPs from both practices have had to isolate or work from home various times. 

‘Some of the stuff we’ve done, we’ve had to do really fast. Some of it has worked really well and we’re going to continue with it. For example, remote and video consultations and closer working with community services.’

The federation works closely with CGL and Recovery Connections to deliver the drug and alcohol service in Gateshead. Recovery coordinators from Gateshead Recovery Partnership have been able to carry on the drug and alcohol service during the pandemic, over the phone. Some patients did not own a handset, so local organisations put out an appeal on Twitter, and a mobile phone provider responded and kindly donated a few.

‘It was lovely to see everybody pull together – a real community spirit – not just in general practice, but in community services, secondary care and other local services.’