Viewpoint: A day in the life of a practice manager: life goes on

A bank holiday weekend has ended and we are back at the practice writes practice manager Heike Burnett.

Heike Burnett: 'Patient expectation is reaching levels often well beyond the service’s capacity.'
Heike Burnett: 'Patient expectation is reaching levels often well beyond the service’s capacity.'

After a quick cup of coffee we are all bracing ourselves for the post weekend onslaught. Phones will be ringing relentlessly, convoluted often incomprehensible A&E and NHS 111 discharge summaries will come flooding in and patients arrive at the desk having seen that very nice out-of-hours doctor only three hours previously who politely advised that a GP must be consulted within one working day.

With funding and appointments in short supply a brief discussion ensues as to the best access model to benefit patients. Applying a triage system and assessing medical need first is concluded to be the way forward still and one of the GPs has a brief word with the waiting patient.

Patient expectation is reaching levels often well beyond the service’s capacity

It has not escaped our attention that patient expectation is reaching levels often well beyond the service’s capacity. We live in a world where the immediacy of an outcome is taken for granted, where learning points become a constant companion and common sense and fact-based decision making is perceived as unjust and inconvenient. Innovation, effective change and applied intelligence are what is called for.

As a service provider would we not all dearly love to be able to see every patient with a pimple on the knee on the day and at a time of their choosing or for our midwife to move in with that anxious first-time expecting mum for nine months only hindered by funding cuts, red tape not to mention the recruitment crisis general practice finds itself in.

How did we get here? It has often been quoted that ‘general practice lies at the heart of care delivery in the British NHS, a gateway to other services and vital part of the huge machine that is the NHS marvelled at around the globe’. Extensively trained clinicians, specialists in family health, who care for their patients from cradle to grave often undermined by questionable media output.

Did we miss a particular turning point in time where perhaps intervention would have been advisable to prevent a further inch on the slippery slope? The door opens and our medical student for the day with a name that would sit comfortably on an Oxbridge list of students enters to say hello.

How to best put burnt out partners out to pasture

Two of the partners wish to retire and the partnership agreement needs an overhaul. I immerse myself in parity, seniority, assets, final accounts stipulations and how to best put burnt out partners out to pasture.

The future of the partnership model is currently being debated as part of the new general practice design. Is this still the best way forward? Federations, limited companies, mergers or mere strategic partnerships are current buzzwords and regular invites to events offering a learning opportunity somewhere up in Manchester clog up my inbox. Does life in general practice present the same challenges in Greater Manchester? What is Cheshire doing to survive? The fire alarm sounds and the future of our local primary care provision will have to be considered another time.

I am delighted to receive an email from a former AMSPAR study buddy who is pointing out that it has been too long and we must meet up again. At this point it is worth noting that readers may be forgiven to think that some of the following is fictional to enhance the storyline.

I have been in general practice for many years and am passionate about what I do. Nothing amazes me more than the realities of my daily experiences in a GP practice. An email informed us recently that a patient wished to complain because the visiting doctor that day had inadvertently kicked her hedgehog’s cage and unsettled the animal.

An apology was sent with a polite suggestion to, upon recovery, move the animal beyond the reaches of clumsy doctors. I cannot help wondering what this patient would make of our Friends and Family Test?

My fellow practice manager tells the story of a mum phoning the practice for her baby’s immunisations. An appointment is duly made when the mum asks the receptionist: ‘Do I have to bring the baby?’ We decide that general practice needs to be flexible and that there may be a business opportunity to devise an innovative way of remotely immunising babies if only we put our minds to it.

From my office window I catch a glimpse of the squirrel family whom I have named John, Paulina, George and Ringo as they look ‘fab’ enjoying the sunshine four in a row. Just beyond their drey, work has just commenced for new housing. The town, demand on healthcare and patient expectation is growing and so must our services provision.

  • Heike is a practice manager in East Grinstead, West Sussex.

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