Primary Care
Faraz: I’ve been a practice manager since 2012. I was managing a practice in Chelsea that was part of a private company. At that time, they were managing approximately 50 practices across London I think and as one of the largest providers. Then I got promoted after a few years and I became a deputy senior manager for their Northwest London region. There were 12 practices in that region in areas like Kensington, Chelsea, Hammersmith and Wembley.
Faraz: It was quite a senior role and very challenging because I was looking after six practices directly. I had a few practice managers who were reporting to me but some of the practices did not have a practice manager and had an administrator role instead. As a result, I was heavily involved in their practice management work. It could get quite hectic because some of the practices were on SystmOne and others were on EMIS Web and they were all part of different PCNs. But it was managed well and I learned a lot from it. It was quite a forward-thinking company too. They were very advanced in terms of IT and had a department who developed business intelligence and triage software as well as tools to process documents. We were trying to be as efficient as possible using technology, so it was quite a good experience. In 2017, I decided to leave and I went to UAE for three years. I worked in a private hospital as a practice manager there.
Faraz: Although the role title was similar the nature of the work was very different. I worked there from 2018 until the end of 2020. It was entirely the opposite of what I was trained to do because everything was private and everyone had insurance. My whole experience was in primary care previously. There, I was managing the gynecology department and pediatrics in a hospital. Then Covid came around and they had to lay off staff members because private hospitals got hit really hard. Very, very few elective procedures were happening. I came back in September and I joined Half Penny Steps Health Centre as a practice manager.
Faraz: That’s right. Three years ago, Meanwhile Garden Medical Centre enlisted us to provide management services. Then, in October last year, another practice asked us to take over their management side of the business as their practice manager had left. We interact with each other a lot during our PCN meetings and the practices have about 2-3000 patients each. They did not want a full-time practice manager, so we thought, okay, let's see how we can do this. I have my assistant manager, so we divide the work.
Faraz: Half Penny Steps is my main employer. I would say 60% of my time is dedicated there. We have a weekly catch up with all the partners at different times. So, for example, Thursdays I have a weekly management meeting with Meanwhile Garden Medical Centre. Then, there's another weekly catch-up with the other practices. Basically, a typical day depends on which practice needs me most on the day. Let’s say new software is being implemented at one of the practices and they want me to be there. For example, one practice was using landline phones, so my plan was to switch them to a digital cloud telephony system. It was a major development and although Mondays I usually spend my day at Half Penny, I went there to make sure everything went smoothly. It really depends on the day where I’m needed most.
Faraz: I would say CQC requirements and compliance, the documentation parts especially and updating policies too. So, making sure HR files are up to date and all the audits like infection control audits and health and safety audits are complete. The compliance side of the business takes up a lot of time and energy and they keep making it more strict. That's quite challenging and time consuming. In fact, just last month, we had a targeted inspection for one of my practices just for the responsive side of things. The handling of complaints is another challenging aspect which requires investigation, drafting of responses and getting back to patients under tight deadlines.
Faraz: I address the issue before it escalates to a point where a patient has to write to me. I try to deal with things before it reaches that stage because once it's a written complaint you have to follow time bound procedures. I also have an open door policy for staff and patients. I’ve put up my sessions on SystmOne where patients can book an appointment and speak with me. I call them back every day and I look to de-escalate any issues very early on in the process.
“What I've learned is that if you address complaints then and there, you can diffuse 90% of them.”
Also, if they want to go on our website, there is a form which they can fill in and a telephone number for complaints too. That number actually connects to my direct line as well.
Faraz: I think workload in general has increased. We receive a large amount of documents from various sources like community services, hospitals and labs. And then there’s requests from different agencies, housing letters, work and pension letters, social services and safeguarding letters. The amount of administrative work has increased over the last few years. I have to dedicate a lot of admin resources towards just making sure we're up to date and don’t miss anything because there are various means that different organisations can communicate with us. With SystmOne, the whole idea is for community services and hospitals to use the same system where they communicate with us directly rather than through letters and things like that. But we still receive a good number via email and post. Also, patients bring in lots of letters and we have online requests. We need to look for those things on a daily basis and make sure we process them in a timely manner. Plus, Half Penny has around 7500-8000 patients so we receive around 300 calls a day. I have to ensure we have dedicated resource just to answer calls and make sure that admin staff are adequately trained to deal with those calls as well.
Faraz: It’s helping a lot actually, especially our cloud-based telephone system. We can monitor the busy, busy, busy times. It has a callback facility. We know how many phone calls we’ve missed. Sometimes you call those patients back and it really helps. We also have software where you can send messages to patients and they send us pictures for things like dermatological issues. It can happen over the phone rather than face to face, so it’s definitely helping.
Faraz: I think one area that the role of the practice manager will continue to evolve in is how we interact with PCN practices, collaborate and work towards similar goals. There are lots of targets now, especially clinical targets that were incentivised to individual practices previously. Now, they are PCN-wide targets. As a PCN we need to work together to ensure we are meeting them because if one practice is doing good, but the others are not, you do not get the financial incentive. So, supporting other local practices and sharing ideas will continue to evolve in the coming years and I think practices will work more closely together. The other thing that will evolve, especially in London, is around the transition of patients. Practice list sizes are not very stable. Once a doctor starts getting to know the patient, the patient moves to a different area. For example, we have a lot of student accommodation in our area. They come for a couple of years and then they go. There’s a high turnover of admin staff and GPs as well in London especially. No matter how much you try to keep your staff members, it's probably the most challenging part of the role. I would say keeping a stable patient list size, admin and clinical team is the big challenge.
Faraz: If you want to be a practice manager these days you need to be a quick decision maker because things change rapidly. You plan your day but I would say that 50% of that time it doesn’t go the way you planned. There's also a lot of information flow too. My inbox, no matter how much I click, there can be 400-500 emails. It can quickly jump into those numbers if I don't check it for a couple of days. So, they need to understand how to communicate. Written communication is very important. You can miss things out very easily because there are lots of meetings, lots of communication, lots of data coming into you. There’s demand to provide data too because GP practices hold essential data. So, the agencies and the federations, they ask for random things throughout the year. Then there's a demand from the partners obviously. They want to make sure that they also maximise their financial incentives for providing services. You have to make sure that your staff members are properly trained, stock levels of consumables are up to date and IT software is working. At Half Penny Steps we also provide multiple services like physio and health coaching. We are a teaching practice too so we have junior doctors and medical students from three medical schools. For CQC as well, they want to see how innovative the practice is and how much you are involved in the community. They look at it very closely, so we are involved in multiple community projects as well.
“It's a lot of things and a pressurised job, but you stay calm and just focus on one thing at a time. It comes with experience.”
To discover how Half Penny Steps exceeded hypertension QOF targets working in partnership with Suvera, read their case study here.
Read more practice manage perspectives here.