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Secret Diary of a PM : My Practice Experience

I have worked in primary care for just over 5 years, and I’ve always found the work I do to be rewarding, challenging, frustrating—but essential.  When I started working as a practice manager (PM), I didn’t understand the role, nor why some PMs could command such a high salary.

After 2 months in the role, I understood why an experienced and dedicated manager could negotiate a high salary. The role was challenging and you were expected to have a working knowledge in almost every area of management and business function. I have recently changed surgeries, and reading the job description I had a little chuckle—if only that was all I needed to do!

I’ve had several positive experiences in primary care that stand out. If you’re goal-driven, as I am, you can make real change happen at your surgery; for someone who feels a sense of achievement by accomplishing the goals they set themselves, it can be an extremely rewarding career. Some partners and surgeries can be more challenging than others and seeing some of my colleagues cracking with pressure was frustrating. But with a group of like-minded professional managers, support was never more than a quick call, email, or WhatsApp away.

My first surgery had very supportive partners; they listened, encouraged and allowed me to manage the surgery in the way I saw fit. This trust incentivised me to ensure I always worked as hard as I could to maximise income and secure the surgery’s future. When I first took up the post, certain team members had become used to working in particular ways, which wasn’t the way I intended to keep working. I slowly implemented change and engaged with staff to highlight the need to do things differently, and the benefits that the change would bring to them. The personalities that resisted change, and those who could sense the gravy train was coming to an end, soon left. I was then able to recruit to fill the gaps and restructure the team.

This change had a huge impact on morale; the new team blended in with the old remainers and the standard of work increased week on week. That change in personnel and the support we got from the partners was a definite highlight in my career, and when my time to move on came I was very sad to go.

Recently I moved to a new surgery, with a considerably higher patient population, more partners and more staff. However, there is one similarity, in that not all team members are working as I would want. So I’m back to reviewing what changes need to be made and in which order they need to be made, to have maximum impact on our efficiency.

When I moved surgeries, I also changed CCGs. The old and new CCG operate next to each other, but in many ways they couldn’t be further apart. The problem doesn’t seem to be the people—the team at the new CCG are responsive and supportive—but they are held back by out-of-date, inefficient processes and systems. They are bringing systems in to support primary care that I have been using for 2-3 years in the old CCG. I suppose it goes to show you don’t know how good you have it sometimes. Primary care has been bombarded with ‘collaborative working’, encouraged to share best practice between surgeries and we do this extremely well—maybe the CCGs should take some guidance from primary care?

I have two massive issues, however, with working as a practice manager, both of which could drive me out of primary care. The first is staff; we are blessed sometimes to have some great team players that just make our lives so much easier. They are intelligent, driven, supportive and understanding of the pressures everyone is under and they do not create extra work. But sometimes I’m left scratching my head at other staff members; I do not understand certain attitudes—confrontational, abrupt, rude and wanting to do the minimum (sometimes not even that much) work. It’s amazing how those few staff members can spoil your entire working day/week and how much additional work they cause.

The second issue is with some of our patients. I’m not sure if this is caused by a lack of understanding, ignorance, or the press and government using primary care as a scapegoat.  In my opinion, a positive advertising campaign in support of primary care needs to be created—especially after we received such bad press at the start of Covid, with the public being told we had closed our doors.

With the recent appointment of the new NHS Chief Executive, there’s a perfect opportunity for the relationship with primary care to be repaired and strengthened. As I say, I think a positive advertising campaign is needed in support of our staff and GPs. I’d also be keen to see a zero-tolerance policy pushed out on national TV and in the press; nobody should tolerate hate crime and sometimes the abuse that we receive is as bad as that. A reduction in the bureaucracy of the NHS would also help, as would easier reporting, a more joined-up approach, clear financial support and not hiding funding behind the big header of GMS! 

Do I think anything will change? No, nothing at all will change because general practice always manages to make do; we always just get on with it, making the little information we receive work. The sadly inadequate funding is subsidised by GMS income because we need to care for our patients. It is our resilience that continues to provide a safety net for patients who are discharged from hospital early, without enough medication or a proper support package in place.


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Practice Manager - London

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