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Secret Diary: My first day as a Practice Manager

"Well, this isn't what i expected..."

That’s the first thing I said to myself when I walked into the practice. Don’t get me wrong, it was a very nice building, and I got a smile from the receptionist at the time, but being used to working in a bigger NHS organisation, I was a literal bag of nerves.

The rest of the morning was as you’d expect – introductions to the staff, a few nervous hello’s, a walk around the building, logging on to a big bulky desktop PC with a TV on it (they hadn’t got around to getting one of those fancy slimline things that all the other staff had, for some reason – should’ve seen that as a red flag..!)

I was being shown around by the previous manager, who had been promoted to a ‘practice director’ position. She wanted to show me how she’d built this place up, made it a success, and how she wouldn’t tolerate any dissent or ‘backchat’ (I soon learned her definition of backchat was more akin to Robocop’s ‘you have 20 seconds to comply’ approach to management).

Yes, being a new PM can be intimidating. Taking on any new role is always a teensy bit daunting, and starting out as a practice manager for the first time is certainly up there in terms of stress. Accountability for the success of the practice, working with people who likely have far more experience than you and having to bring them together as a cohesive team under what would be my leadership would be a significant challenge, but it’s a challenge I needed to be ready for.

I remember having a 3-stage interview process – a phone interview, a face-to-face with this predecessor of mine, and then a panel presentation. It seemed ok (notwithstanding one of the partners falling asleep before I even started talking), telling me how the staff are all such a great bunch of people, work together to solve problems and support each other, etc. – sounds like a dream.

Cut to today, and she says “I’m just about to have a meeting with one of the nurses, so you might as well sit in since you’ll be managing her afterwards”. Right then, I thought, my first new management task on day one.

So for the next 30 minutes, I sit alongside MP (My Predecessor) as she tears a strip off this nurse for writing an email to her about her concerns around clinical staffing late at night (we were open from 8am to 8pm), lack of equipment, not getting paid overtime and a few other topics. Looking at a copy of the email she sent, it didn’t seem unreasonable - it wasn’t the best grammar but the concern seemed genuine. It felt to me that the issue for MP was more a case of ‘how dare you question my authority’, which didn’t really help my situation – sat in a meeting where this nurse I just met is being thoroughly dressed down by her previous manager, with the new one is sat next to her; what if she thinks I’m no different from MP?

Then MP points at me – “…and SHE won’t take your nonsense either!” Well thanks for planting that seed in her mind, MP! I got the sense after this meeting was over (and the nurse walked out in tears) that my people management skills would be severely tested.

“Don’t worry – she needed to be told. Iron fist, velvet glove and all that”.

Er, OK, I thought to myself.

If there was a textbook ‘how not to conduct a meeting’ then that was it. Sometime later I found myself thinking “was that a disciplinary meeting, a one to one, performance review, an interrogation…?”

I spent the rest of that first week shadowing MP, and although I listened intently to what she told me about how she ‘ran a tight ship’, it was clear she was expecting me to follow orders without question, and run the place the same way she did. Some of the staff I spoke to were wary of me, which I expected, but it was more a case of “is this going to be more of the same?”

As time went on, I managed to get a recce of what had previously happened aboard her ‘tight ship’ – friends she’d recruited, corners cut, stories told to partners, bullying of the more timid staff, a revolving door of staff coming and going, promises made and not kept, ‘beefing up’ her pals’ wages but not others, a ‘liberal’ use of the practice expense account which only she controlled.

I soon realised it was an understatement to say “this isn’t what I expected”. I was wholly unprepared for this – but what made it worse for me was that, with no primary care experience under my belt, I relied on her instructions and directions to know that I was doing the right thing. With a touch more soft skills and a more respectful ‘firm but fair’ approach, over the next few months I had got the performance where it was, but with co-operation from the majority of the team.

I’d like to say “I won”, but it was a hard and difficult fight, and I found that MP was interfering more, passing more work to me that had a deadline of (usually) tomorrow, and effectively, I couldn’t take it anymore so I left. I had no job to go to, but I handed my notice in via email to MP, who replied with simply “fine” – I had doubted whether I did the right thing beforehand, but that one-word reply told me I had not.

I sometimes regret not staying on longer, but my own wellbeing was at stake. If anything, it was a harsh lesson for me in how not to work in Practice – I went back to work in the new Consortia which became a CCG, but eventually I had this urge to go back to primary care. I applied for another Practice Manager job and got it, but this time I had the lessons from my experience with MP to reflect on.

Want to share your experience of practice management or have a story to tell in our (anonymous) Secret Diary? Just email us at mail@firstpracticemanagement.co.uk


Imran mir 17/02/2021

I had a similar experience and what I learnt was to develop a ‘thick skin’. Reflecting back, I think I should not have left (neither should have you), and took that as a challenge. My leadership and organisational skills were tested and I think I failed by resigning. If I were you, I would have tried to make the MP resigning and what a delight it would have been to reply by writing ‘fine’ to her. You missed a trick there!

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