Daniel: I was a practice manager for 12 years and partner for five years. Two weeks into a new Darzi Centre opening, the practice manager had left. I was a data analyst at the time, but decided to give it a go and found a job that I truly loved. That was an APMS contract for five years. I then got offered a job at a rural dispensing practice. It was really interesting and quite a different business. Like everything else in the NHS, that's become even more challenging. I was there for two years and got offered a partnership from another practice. I'd always wanted to own my business so I spent five years in that role.
Daniel: It was a partner role in the sense of owning the business and then all the responsibility of practice management as well. You have to do everything the practice manager would do, and you also hold the risk. Ultimately that's why I decided I didn't want to continue as a practice manager because it was becoming too risky. You know, as a partner you have your house on the line, which, quite frankly, is the only reason that primary care and general practice is the only part of the NHS that doesn't have a deficit. Because if you have a deficit as a general practice and as a partner, you lose your house. So, it's quite the incentive to balance the books. I was not enjoying it anymore and we had the CQC who was very interested in us. That meant that my job became ticking boxes and jumping through hoops. Then, the pandemic hit and what was already a challenging job became nigh on impossible. It was 24/7 and looking after a team of 40 I was not able to look after myself.
Daniel: Well, I had a really supportive team of directors. Being an APMS contract, it was a limited company, but actually it was five local practices who had bid for the contract. So, I had five experienced practice managers available to support me. If I didn't know anything I could ask them. I did the primary care diploma at the time, so that gave me base knowledge of how stuff works. But it's fair to say that I didn't know what I didn't know. For me, that was processes such as PPA claims. I didn't know that you had to claim those back then. That’s what I do now most of the time, along with other things. GPs and nurses are so busy, so my team can go through and help find everything that hasn’t been claimed. I consider myself an entrepreneur, because I've set up a novel business that's serving a particular niche.
Daniel: I was burnt out. I felt as an individual that the practice management role was no longer sustainable for one human being. As soon as I’d set up my business and was starting to have some success, I felt I was in a position to share the good news with others that you can leave.
“I called it, ‘I’m a practice manager, get me out of here.’ But then I discovered another way. You don't have to leave entirely.”
Actually, if you get out of the practice a couple of times a week, it reenergises you. You’re with a different set of people. You have a different type of responsibility and quite frankly, you get stuff done. You can tick things off the list, and then you can bring that back to the practice. So, our mission at Locum Practice Manager is not to encourage practice managers to leave because it's an unsustainable position. If you start opening up to portfolio working as an opportunity, you bring that energy, the contacts, and the opportunities that come with it back into your practice.
Daniel: The variety was why I loved the role when I started but eventually it becomes quite wearing.
I reckon it probably took me a year to even feel like I had my feet under the table and then every single day in those 12 years I learned something new. That's because you’re not only looking after so many people in your team, you're also looking after thousands and thousands of patients. Of course, people are complex. You have all these wonderful processes and procedures to deal with 99% of patients’ needs. But every day there's always going to be one patient who doesn't fit into that, and you have to find a way to make it work. Because that's what we do in primary care, we make it work.
Daniel: When we had the CQC heavily involved with us, it took me away from the thing I loved about primary care, which is you're on the frontline and when something is not happening you can make it happen. Then you end up in this world of policies, procedures, governance and meetings. You lose contact with the people who matter who are the patients. Those other things are not my passion. However, they are some people's passion.
“That's why I think practice management delivered as a team works.”
You find that person who loves those elements and you bring them into your team. You can go off and do the thing you love in another practice, or it might be your PCN. You've got a group of people who've got a wide range of skills. Some people love HR. Some people love premises. Why not trade your time and swap it around? People doing what they love will do it far better than if they are hating it. Locum Practice Manager is really about helping practice managers to find their passion, and then to do that as often as they can. General practice is really interesting because although you are essentially competing businesses, why not share the things that make sense?
Daniel: If I'm perfectly honest, that's the thing that burnt me out. It was so much time looking after 40 other people that I forgot to look after myself. I spent a day with Doctor Andy Cope, the doctor of happiness. A lot of what he said really hit me. One of the things was that we measure job satisfaction but that's not a very high bar, is it? I don't think we're even achieving that across primary care. Most people are not satisfied. So, how can we get to joyfulness and things at work that make us really happy? People want that, but it is so tough out there that people barely have time to think. There's a QOF QI module on staff workforce and wellbeing so I've written a workbook that takes people through what they need to do step by step, because the guidance is relatively large. If we can do something that will make a difference, hopefully we can just edge dissatisfaction up to satisfaction and give people a bit of headspace to push a bit further than that if they want to.
Daniel: I sat on the PCN board for probably two and a half years from when they were invented up until the point I left. Essentially, it was a collection of people who were already working in primary care, so we understood each other. We used the same language. We had our competing business heads on at times, but we all knew what we were talking about. When we ended up with the CQC really interested in us, we suddenly had the ICS and CCG interested in us as well.
“People would just ring up and ask, ‘How are you today?’ As we went through that process, we came to understand that we had made it onto their risk register.”
Nobody explicitly told us this though and it might have been helpful to explain it. It was a really big learning experience for me on how being a commissioner is a totally different ball game to being a provider. Once I understood where they were coming from, it opened up a whole load of resources that we didn't know were available. We were able to bring in a QI practitioner from the CCG and an IPC specialist. We didn't know any of that was available to us because we'd never hit the risk register point. When you hit that point, they start offering you these things but they're there for you to access the whole time. We might not have got to the place we got to if we'd had access to those resources before.
Daniel: I think the thing that changed everything for me as a practice manager was attending the General Practice Improvement Leaders Programme, which is all about using quality improvement in your work to make change. I went from providing all the solutions to saying, ‘Here’s the problem, here are some options I found. What do we think? How are we going to implement this? What's our change program?’ All of a sudden, the team started running with it. That QI process and involving the team in change and letting them lead is great. People loved it.
Daniel: If someone is being offered a role in say, a 6000-patient list size practice as the only manager, I don't think that's sustainable anymore. If you're going to an organisation that says this person looks after these things and these are your responsibilities and we can juggle them around, that's what I would recommend. You can bring your experience to that. We have people from all walks of life coming into practice management now and they bring that energy. A lot of existing practice managers out there are really tired, and actually, a new person coming in from another industry can bring in some different ideas and they can learn the process stuff.
“It used to be relatively easy to run a profitable practice. Now, it’s really difficult. You need to make sure you are claiming everything you can.”
You need to be looking at the other opportunities that are out there. You need to be on top of your staffing, and that's a really hard ask. A lot of the CQC reports coming out now are simply saying that people do not have enough clinical staff. Well, you’re lucky if you can get them and if you can, the demand is outstripping the finance the standard contract provides.
Daniel: Until we've got lots of different people talking about it, that one practice manager saying to their partners, ‘I want to work differently,’ is going to be a really tricky conversation. I think it's a crying shame that there are more and more people feeling like practice management is a job they can't continue to do. It was once a wonderful job. I Iook forward to a world where it can be again, because practice managers are key to the sustainability and success of primary care. So let's find a way.
To find out more about Daniel visit: www.linkedin.com/in/somersetpm.
Learn more about how Suvera can support your practice, PCN or ICB here.
