Confessions of a Practice Manager

This practice is proving a frantic place to work. Today is no exception; everything seems to be happening all at once, and already the team are tetchy and flustered.

It’s breast-screening week and there are two enormous temporary facilities taking up most of the car park. As a result, patients are arriving late, complaining about having to park on the other side of town.

We also have a steady stream of ladies coming into the surgery by mistake, having somehow, in their anxiety, missed the giant vans and signage outside. One lady even made it into a doctor’s office and was starting to take her top off before she was noticed and redirected outside. To add to the mayhem, one of the nurses is off sick today, which means appointments are running an hour behind and the waiting room is crammed.

This particular nurse – let’s call her Scarlet – has had every Monday off for the last 2 months. At least, I reckon she has, but Delia, the administrator, has ‘mislaid’ the sickness records. Has she really lost them, or is she just causing trouble for me? It’s hard to tell.

Nurse Scarlet is always missing in action. If it’s not her regular Monday malady, it’s a problem with her car, or some other emergency. She has had so many days off for funerals that she must be running out of relatives. Someone should sit her down and talk about her attendance, but without proper records it’s very hard to manage staff absence properly.

You may have gathered that I’m trying to find my way in a new practice. Some things here are superbly organised, like the online training platform, but other things, like our HR records, are a total mess. I find myself saying over and over: “In my last practice we had a system for that” in a way that must be quite irritating for other staff. So, I’m doing my best to hold my tongue and get things sorted out one step at a time.

The senior partner, Dr Dodson (in my head I call him Dr Dodders), does not help. He continues to manage things in his own particular shambolic way, leaving me to run around undoing his mistakes and trying, belatedly, to get the paperwork straight. Today, he tells me to sort out the payroll for one of the nurses, who is complaining that she hasn’t been paid correctly. On investigation, I discover she did three extra shifts last month and no one thought to tell me.

To some clinicians practice management is a black art and they are very happy to say: “Here you are, the practice is yours to play with”.

I want to cast the blame at Delia, as she was the one who sent off the payroll files, but there is really no point. She’s worked here for over 20 years and she can do no wrong as far as Dodders is concerned. What we really need is a proper system to record working time and then there’d be no such arguments.

One thing I can’t stand is a last-minute panic. In my last practice (there I go again), we had an online calendar so we knew exactly who was working when. I also recorded all the special clinics, such as breast screening and vaccinations, so we could plan ahead for when things were going to get busy. Today’s screening seemed to take everyone by surprise, even though it must have been known about for months.

Another problem is that no one seems very clear on who does what, least of all me. Nurses and doctors know their duties, of course (whether they actually do them is another matter), but we mostly fall down on administration. We have medical secretaries, receptionists and dearest Delia, all responsible for different parts of the process, so when there’s a problem it’s hard to know where to start.

I’m told there are job descriptions ‘somewhere’ in Dodders’ office, but I bet I’m not the only one who hasn’t seen them; I haven’t even seen my own. One thing is clear: I am responsible for anything that goes wrong.

I am also accountable for managing costs and negotiating with suppliers. It would be that on this already crazy day, there are two supplier meetings lined up. The first is with a medical recruitment company. They ask me lots of questions about staffing, many of which I can’t answer. I excuse this lapse with the fact that I am new, but really it’s because I don’t have access to any HR data. Embarrassing. Still, at the end I manage to agree a good rate for future advertising.

The CQC highlighted a problem that I had already voiced to my boss so many times before. It's infuriating!

My second meeting is with our training provider. They demo a new HR platform that sits alongside the online training modules so that everything is in one place. It looks like just what we need, but I must figure out how to get Dr Dodders to agree.

When everyone has gone home, and I am free from Delia’s beady eyes, I have a rummage through the filing and find a bombshell: the DBS checks are out of date, with two staff due for renewal 3 months ago. I also find the sickness records, which are noticeably incomplete.

I grab Dr Dodders first thing next morning; the best chance of catching him in a good mood is before any patients have had a chance to annoy him. I’ve carefully prepared my case. Setting up an HR system linked to our training would make sure the DBS renewal oversight can never happen again.

It’s also possible that we can save money on staffing costs if we manage everyone’s time better. Best of all, improved systems would mean that doctors and nurses could focus on medical matters without getting drawn into tedious paperwork.

With a reduced workload, doctors might get to leave on time more often, perhaps even while it’s light enough to play golf. Dodders looks up at that. I think I might have said the magic word.