By Suzannah.Brecknell

19 Aug 2010

This week’s interviewee is a practice manager, responsible for the business and operational management of a major GP partnership

“I work for a large GP partnership: we look after approximately 21,000 patients across five sites. The areas we serve are quite mixed: the main surgery is in a generally white, affluent, commuter belt, but we also work in a neighbourhood with the highest deprivation in the Primary Care Trust (PCT) area. Mine is the most senior non-clinical post: I work alongside the lead clinician and am responsible for finance, personnel, operations and business development.

I’ve been in this role for 10 years, but have worked in the health sector for 24 years; originally I trained and worked as a nurse. This is one of the most challenging jobs I’ve had: it involves all aspects of management, from negotiating new contracts with the PCT right down to dealing with a family of badgers who tried to move into the building. It’s also the job most influenced by politics: every time the PCT receives a new directive it can mean a change in the way that we operate a clinic or introduce a new clinic, new training, changes to the budget and so on.

Working in general practice, I couldn’t not say the NHS white paper is positive. There is a lot of emphasis on primary care and GPs being at the forefront of deciding what services are needed for patients. I think the government is being quite sensible. People in general practice, being independent contractors, have that entrepreneurial spirit. Once you give them something to achieve, they’ll work hard to achieve it.

My concerns are that it’s quite difficult for groups of general practices to work together because their patient groups and priorities are different. So we’ll need to see how the GP consortia work, and whether they will be based on existing consortia for Practice Based Commissioning [or PBC: the scheme which incentivised GPs to commission services for their area]. I don’t think that we’ve got particularly effective PBC groups in our area – they are using the system to tinker at the edges of services at the moment, rather than making large reforms, and if all of the commissioning is going to be transferred to those PBC groups, it will be interesting to say the least.

However, I would hate to see these reforms becoming just a way of moving PCT managers around and employing them in new organisations, doing more of the same. I’ve been around long enough to see PCTs in many different organisational forms, and I don’t think that things have become any more efficient. The duplication and lack of organisation in our current system never cease to amaze me: there are huge opportunities for savings.

There has been a lot of talk about axing targets but I’m not sure that paper actually said we’re doing away with all targets. Some targets will become patient rights within the NHS Constitution, so we’ll still need to provide good services in those areas but we won’t be so closely monitored. For other things it may well be that we’re monitored in a different way; I’m sure we’ll still have to be able to show that we’re achieving good clinical results.

I do welcome this move to a different way of monitoring, because sometimes when new targets are very closely monitored, people try and meet them in whatever way they can, as opposed to actually achieving what was intended. The one that stands out for me is the access target [introduced in 2004 to ensure that all patients would be able to see a GP within 48 hours]. It made me realise just how political our role is when a patient of ours asked Tony Blair a question about the target on TV during the campaign for the 2005 general election.

That target didn’t necessarily give people better access. It made a lot of practices better at organising things, in a way that made it appear people were getting better access: many practices blocked out their appointments and didn’t open them up until 48 hours in advance, which was never the intention of the target. Eventually, when the issue moved out of the political agenda and there was less pressure, practices started to consider the reason why the target was introduced and make real improvements by looking at the whole patient prioritisation process, the skill mix of their clinical team, and making clear pathways, so patients can be seen when they need to be seen, by the right person.

I spent eight years working in the USA and I would say that healthcare at the ‘coalface’ is not so political there; it’s more financial. Healthcare in the UK is extremely political – especially primary care, which affects large volumes of voters who can and do make a difference at the polls in general elections.

But my message to ministers and civil servants would be: please listen to clinicians’ opinions on what is realistic in today’s society. In a service that always has more demand than supply, listen to what patients need as well as what patients want, and put clinical risk and clinical need at the top of the agenda – not what makes for the most popular, vote-grabbing policies.”

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