Practice managers come from diverse backgrounds and Claire Oatway really made a career change when she decided to join the profession.
Leaving behind a career that had included roles as a police intelligence analyst and in local government because she found herself moving too far away from working with people, she made the shift to practice management.
On 1 April 2014, Ivybridge Medical Practice, Plym River Practice and Ridgeway Practice, based in the Plymouth and South Hams area, merged to become the Beacon Medical Group.
When she joined the group in July 2014, Ms Oatway helped the partners put a bid together to become a primary care home – a new system to aid collaborative working between healthcare professionals – a status they achieved in January 2016.
She continues to play a key role in decisions that directly impact how patients receive care.
How different is the chief operating officer role from that of a practice manager?
It’s the same. I joke that because I’ve got 39,000 patients across five sites we’re a super-practice, and so I’m a super practice manager. It is much the same, although a lot of day-to-day work is delegated to the team. I’ve got an HR and training manager, a finance manager and a head of operations. Altogether, 150 people work in our organisation.
What is your career background?
My background is in performance management and strategy. I worked for the police service in intelligence analyst roles and then moved to local government, where I stayed for about 15 years. After that I did performance management supporting the Children and Young People’s Trust. I worked with citywide partnerships for some time but then I realised that I was moving further away from people and the kind of work I find really exciting and that’s the reason I decided to become a practice manager.
I’ve never looked back. The ability to make a decision and implement it has been amazing. At Beacon Medical Group, our aim is to cut down on bureaucracy, helping people do their jobs effectively instead of spending their time filing in forms. It is genuinely refreshing to be leading a team that [has that objective].
What does a typical day at the practice look like for you?
No two days are the same. I might check in with other team members to see if there are any problems, then I’ll have staff meetings, where we meet representatives from the different surgeries. I do a lot of work with our hospital partners – University Hospitals Plymouth NHS Trust and the Devon Partnership NHS Trust – and community providers, including community pharmacies and Livewell South West [a social enterprise] and I’m the lead for information governance and data protection. I delegate, but I hold on to the links with the patient groups. I think it’s important to find out directly from patients what’s going on.
Did you face any challenges when you first joined the practice?
It was challenging to get used to the GP practice ownership model. Working in local government you are used to accountability and slow decisions [because it’s] a public body. That’s not the case with general practice, where a group of business owners make commercial decisions. That took a bit of getting used to.
Are there any practice achievements you are especially proud of?
I am proud of our achievements at the 2016 General Practice Awards, where we were shortlisted in seven categories. We wanted as many staff as possible to feel part of that, so we hired a minibus and took 28 people from Plymouth to the dinner in London. We all left at midnight and got back at five in the morning, which was crazy but wonderful.
What does it take to make the switch to a primary care home?
Anyone with between 30,000 and 50,000 patients – either a single practice or a group of practices – can apply to become a primary care home through the National Association of Primary Care. You need support in principle from your clinical commissioning group (CCG) and the commitment of your partners, such as a hospital or the voluntary sector, to start changing things for the whole area. It’s an extension of what goes on in a typical general practice.
We employed a practice pharmacist through the Prime Minister’s Challenge Fund in 2014. His skillset stretched well beyond polypharmacy and medicine optimisation and he had the capacity to see far more patients. He later became part of the urgent care team we introduced in June 2015, after we estimated that 50% of demand was from patients requesting same-day appointments. We also found an advanced paramedic practitioner who understood community services and risk and who made sensible care plans.
We funded a care home service for two years (a service that just came to an end), in which a clinical pharmacist did a weekly ward round. She made a huge difference to patients’ lives and because she was coming in every week the care homes residents would save up their queries for her, so that reduced the number of practice and hospital visits and medication costs.
What impact did the care home service have on workload and medication costs?
The service had a positive impact on workload in the practice, as well as the hospital [University Hospitals Plymouth NHS Trust]. We saw a reduction in visit and last minute medication requests, an increase in vaccinations and better medicines reconciliation.
We also saw a remarkable reduction in hospital admissions. A recent evaluation showed that in a period of [growth of non-elective procedures] admissions from the six care homes dropped 34%. That’s a saving of 60 admissions, which equates to 738 bed days, a notional financial saving of £103,000 and a saving of £15,000 through avoiding ambulance transfers. The other financial saving comes from medication costs – we saved £83,000 from 514 medication reviews done for the six care homes.
Tell us about the set-up of your practice management team
We were a merger of three practices and then we took on another one in April 2017. Each time we’ve grown, we’ve managed to do it without making redundancies; we’ve found that there’s more than enough work to do. In admin we have 27 people overall and in the reception team, we’ve got 37 patient advisers working across our different sites. We’ve got a small finance team of three people and many of our practices have a lead receptionist, to push decision-making and management as close as possible to the front line. The lead receptionist is responsible for recruitment, retention and appraisals. They have team meetings, where people make suggestions and changes, which don’t have to wait for my approval.
We have an HR and training manager and an estates manager for our buildings and we’ve appointed a complaints manager and implemented a massive management reorganisation to take us forward for the next four years.
The complaints manager role is a brand new one that we introduced because our operations managers, who were previously responsible for handling complaints and linking with our patient groups, didn’t feel that they [had the time to] do that to the best of their abilities. So we’ve appointed a 22-hours-a-week patient liaison and engagement manager for complaints.
Is the primary care home model the future of general practice?
I think primary care homes are important to the future of general practice because whether it’s done as one practice or several practices joining together, it really does make a difference to patients’ lives. General practice holds a special place for patients and we should be the ones to advocate for what they need.
Being a primary care home means we can show the rest of the system how important primary care is. It’s not the solution for everyone, you need to have a patient list of at least 30,000 and that might be too much for many practices, and you’ve also got to have the right personalities among your partners, and the right location. There is a lot that needs to be in place. So I can’t see every practice shifting to be as big as we are. However, they might work with other practices, through a federation, to do more back-office work than they do now.
What do you find inspiring?
On my wall, I’ve got a picture of a young man called Kid President [a YouTube star whose real name is Robby Novak]. He’s just awesome and he does inspire me, even though he’s only 14. There’s
a quote on the picture that says: “Sure there’s bad stuff in the world, but there’s also you, you can be anything you want today. So be bold, be kind, be awesome, repeat, it’s like shampoo, but with your life”. I think that’s a real motto for leadership, and for GP practices, because our patients depend on us, and our teams need us to be bold, kind, and awesome.
Valeria Fiore is a journalist intern at Management in Practice