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Nora Elias

by Nora Elias
18 April 2019

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‘We’ll need good managers to drive us forward’

Teresa Chapman, winner of the 2018 Practice Manager of the Year award, talks to Nora Elias about her experience of innovating to turn around a practice struggling with GP shortages and funding cuts 

‘I’m very lucky; I have a good team to support me. And I like  to be busy.’ Teresa Chapman, practice manager at Parchmore Medical Centre in Croydon, south London, is discussing how she balances the many tasks in her intense schedule.

In addition to her practice manager responsibilities Ms Chapman, who has been at Parchmore for 25 years and became a managing partner in 2016, is also network education and training lead and a director of the local GP collaborative, Thornton Heath Network.

Ms Chapman also won the Practice Manager of the Year category at the General Practice Awards 2018, organised by Management in Practice publisher Cogora. She believes an involvement in matters beyond her individual practice is an advantage in the job.

‘I think it’s important to be outward looking, so you keep abreast with changes and potential opportunities,’ she says. ‘It helps you be strategic in your thinking and avoid any icebergs.’

Reflecting this approach, Parchmore Medical Centre is already engaged in many of the initiatives that the recent long-term plan and GP contract highlighted as a focus for primary care; including working at scale, creating a multidisciplinary team, and social prescribing.

The last few years have seen Parchmore – which also won the Managing Workload and Improving Access category at least year’s General Practice Awards – implement a number of changes that have turned it into an innovative practice.

Ms Chapman’s Practice Manager of the Year nomination, submitted by senior partner Dr Agnelo Fernandes, emphasised her crucial role in driving this process – which she says was kick-started by necessity.

‘Create a positive atmosphere’

A few years ago Parchmore was, Ms Chapman says, ‘going through a difficult time. We had lost three GP partners and had funding cuts; we had to no different ways of working.’

This has included incorporating a wider range of other professionals, and the practice now has an in-house pharmacist, which has helped to smoothe the prescription process and supported the receptionist team to improve the system for repeat prescriptions.

Parchmore is a training practice and recently employed a physician associate who had been at the practice as a student. The practice also has several healthcare assistants and a range of nurses and has recruited three GPs, two of whom are former trainees at the practice.

While Ms Chapman explains that this has certainly ‘helped create a positive atmosphere’, there is more to this transformation, which began in 2016 – around the time she became managing partner.

The changes include streamlining admin processes to reduce GP workload, implementing a daily urgent care clinic backed by the multidisciplinary team; encouraging GPs to use a rapid response service to reduce emergency hospital admissions; introducing reviews for patients with complex care needs; holding weekly multidisciplinary team ‘huddles’ where staff share experiences and concerns; launching group consultations; and introducing social prescribing.

Another measure has been daily pre-referral meetings, which are ‘a touchpoint and an avenue for mutual peer support and learning’. The meetings also involve exercise, a recent development that Ms Chapman explains is the result of one of the GPs, Dr Alex Maxwell, taking an interest in the active lifestyle concept.

‘Transform the practice’

Social prescribing, which the practice has doing for about 18 months, has, Ms Chapman says, had a significant impact.

The practice’s group operational manager Brian Dickens has spearheaded it, setting up three community hubs that offer activities including dance and fitness, gardening classes and debt advice – a commitment for which he was last year nominated as a regional champion in the NHS70 Parliamentary Awards’ Excellence in Primary Care category.

Parchmore is currently exploring offering staff more opportunities to become involved with community-based social prescribing.

‘We’re looking at whether we can introduce leave for our staff to do voluntary work because they’re very proud of the social prescribing initiatives and keen to get involved,’ Ms Chapman says.

At the moment, the practice is conducting research to assess the impact of social prescribing so far, although Ms Chapman explains that it will be another few months before the data are ready.

Parchmore’s evolution over the last few years has led to measurable improvements – a 4% reduction in emergency hospital admissions following the introduction of the urgent care clinic, and a 20% drop in hospital outpatient referrals, which the team traces back to the daily pre-referral meetings.

Ms Chapman says the results have helped ‘transform the practice to where we are now’ and boosted staff morale.

‘When you’re on the front line and you’ve got a shortage of GPs it can be very stressful: it’s hard if you’re managing patients and trying to find the best option for them, but haven’t got the capacity to fit them in.

A combination of admin restructuring, expanding the multidisciplinary team and social prescribing has, Ms Chapman says, made quite a difference. While she admits that ‘general practice is still very busy and stressful,’ she says the changes have really helped improve staff morale.

‘Improve health services for the population’

Ms Chapman, who has been a practice manager since 1991 – after working in the admin and reception team for several health centres and completing a diploma in practice management – says she has seen ‘too many changes, too many new contracts’. Asked what the biggest changes have been, she highlights the financial situation.

‘When I started, your income was more or less guaranteed but recently there have been funding cuts and there’s a lot more uncertainty,’ she comments.

‘I spend a lot more time chasing overdue payments and worrying about cash flow than I used to.’ Ms Chapman is nevertheless positive about the direction in which primary care is currently moving. ‘There is some additional investment coming to general practice,’ she says of the long-term plan pledges. ‘The devil is in the detail but overall it’s positive compared with where we’ve been for the last few years.’

Working at scale won’t be an issue for Parchmore which, along with five other practices, is part of the Thornton Heath Network. The network was already embarking on the National Association of Primary Care’s primary care home model when the announcement was made that all GP surgeries should join a primary care network (PCN) by July this year.

‘It’s an exciting time and general practice will be at the forefront of the changes; working to improve health services for the population,’ says Ms Chapman.

‘Working hard in the background’

So far, opinions differ about whether PCNs will relieve or add to the workload for practice teams but Ms Chapman thinks they will be a help. She admits there could be teething problems and that it will mean a considerable change in terms of how they do things.

Instead of working in their individual practice and focusing on their own patient list, practices will be taking decisions as a network and serving a wider population. However, she also believes that collaborative working will bring new support.

‘I think we’ll be able to share resources and fill gaps in specialties,’ she explains, adding that they will also be looking at sharing some back-office functions. Ms Chapman does, however, feel practice managers are still underappreciated, a view shared by many of her colleagues. ‘We read a lot about the pressures on GPs and early retirement, but there is equal pressure on practice managers.’

The role of the practice manager will, she adds, be essential to working at scale. ‘I think the role does get overlooked. Even in the new GP contract and with the PCNs, there is a lot about a clinical director but not about good management – which we’ll need to drive us forward.’

Winning the Practice Manager of the Year award was, she says, not just a win for her. ‘I love my job. I work hard to make a difference and of course recognition of the work I do is important to me.

‘However, it’s important for all my fellow practice managers,’ she says. ‘Practice managers work hard in the background under difficult circumstances to provide a quality service to patients but are not always valued and recognised.’