Managing and Communicating

Your Questions Answered

Lyn Longridge

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315348742
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Presents information and advice on the extended role of the practice manager for both those with experience and increasing responsibility, and for those new to the primary care team. The book: identifies the various members of the primary health-care team; describes their individual roles; explores the management skills needed to manage the team and the practice; provides examples of real problems experienced in general practice; and examines communication in all its forms.

1

The Primary Healthcare Team

The services available in primary care have increased dramatically over recent years. GPs’ lists have had to fall as the doctors come under growing pressure from their ever more demanding patients who consult far more readily and more frequently than before. The number of practice nurses employed has risen as they have been required, in addition to their normal treatment room duties, to take on the care of patients with chronic conditions such as asthma and diabetes, as well as organizing immunizations and cytology testing to ensure targets are met.

It is not uncommon for physiotherapy, acupuncture, counselling, chiropody, osteopathy and homeopathy to be available under the same roof in general practice. The number of ancillary staff required to run these busy surgeries has also increased with most practices now employing a practice manager, and many having another manager whose sole responsibility is to control the fundholding budget or the financial side of the business.

The introduction of fundholding has meant that practices are even more involved with their attached staff. They are in effect ‘buying in’ the service of these community staff and thus are able to influence the level and quality of service they receive. A closer association between the different professionals such as health visitors, midwives and community nurses and the GPs themselves has been a welcome consequence of this.

New managers can find it a little daunting at first trying to identify all the various clinicians and members of staff who come and go in the practice. In this section, I have attempted to describe the roles of the ones you are most likely to meet while, at the same time, answering some of the more common questions posed about who does what and for whom.

Question 1: Partners: directors or coalface workers?

It is difficult to know just what role the partners should be playing running their practice. Am I being unrealistic when I expect them to take an interest in business management as well as the treatment of their patients?

General practice is one of the few businesses where the coalface workers also constitute the board of directors. It is because the GPs are having to work every day seeing patients, that they are rarely available and are often unwilling to take on a supervisory role in the running of their practices. They find it difficult to get an overview of the way the practice is developing because they are so very much involved in the day-to-day treatment of patients and the pressure this puts on them.

However, it is important that you, as practice manager, are not left alone to run the business without any support. After all, it is the GPs’ practice – not yours – and as such, they should be prepared to make reasoned decisions on its development. In the answers to other questions in this book, you will find some suggestions on how to involve the doctors more in the running of the business. The reply to Question 2 makes suggestions on individual management roles that the partners might take on. Replies to questions about team-building (see Question 22) and leadership (see Question 23) should also help you to find ways of involving the GPs more in the management of their practice.

The occasional case of fraud perpetrated by a practice manager which is revealed in the medical press, can make GPs take time to consider whether they are monitoring the finances of their own practice adequately. They might also have cause to wonder whether in fact they have sufficient expertise to spot possible instances of embezzlement were they to occur. This is just one good reason for you to persuade the partners that they should monitor your management closely and, if necessary, encourage them to undergo some basic training in financial management.

Question 2: Partners’ management role

In our practice the senior partner tries to oversee all aspects of practice management but he is a busy man, and I seldom have the opportunity to sit down with him and discuss specific problems. What can we do to ensure that I have some regular support and contact with at least one of the partners?

One possible answer might be for the other partners to agree that the ‘executive partner’ be allowed one half day a week of protected time in order to oversee the management of the practice. He could then be sure of having time to discuss any problems you might have encountered during the previous few days. The other partners would then either have to cover for him or agree to pay for a locum in order to release the necessary time. If the doctor is also responsible for monitoring the budget, and he also uses this time for fundholding, then at least part of the expense of a locum could be repaid to the practice from the management allowance.

Another solution for many practices to this problem, however, is to divide up the various management supervisory functions among all the partners. Thus one partner would be designated the overseer of the finances, another could be allocated the responsibility for help with staff matters, another might take overall charge of the development and use of information technology within the practice, and another might help with managing the maintenance of the premises. These particular roles can be rotated after an agreed period, or the same partner can remain in charge of one particular area if that is what suits them all.

The practice manager will gain from the potential support of all the partners in this way. When a problem arises with the staff, it should be possible to have a brief meeting with the designated partner in order to get a second opinion on the best course of action to take. It is helpful if you can persuade the finances partner to do occasional random checks on the accounts so that he can reassure himself and the other partners that everything is as it should be. Too many cases of fraud have occurred in general practices because the partners have left the manager totally unsupervised. It is not fair on them, or you, if you do not have one partner who understands the financial systems you use and is able to keep an eye on things.

Question 3: A new partner

Our senior partner is due to retire in six months’ time. Can you offer any advice on how we might go about recruiting a new partner?

First, the partners should decide whether they actually need to replace the retiring partner. Could they manage with fewer doctors? Is the list falling? Could the practice area usefully be reduced and the list with it? Would a cheaper option be to employ an assistant or another practice nurse? If the decision is made that a new partner is required, does he have to work full-time? Would part-time or three-quarter time be acceptable instead? How about job-sharers? All these points need to be considered before actually deciding to recruit a new partner.

Once the partners have made the decision, you will need to start the recruitment process. The first step should be to consider just what sort of doctor you wish to attract to complement your team. What special clinical interests might you wish to attract? What additional qualifications might be desirable? When you have established this, you can consider advertising. You will need to word your advertisement carefully in order to attract suitable applicants. You are not permitted to specify the gender of the doctor you are seeking and should be careful not to discriminate in any way when short-listing. The British Medical Journal is the usual place for such an advertisement but the weekly GP newspapers such as GP, Pulse and Doctor (affectionately known as ‘the comics’) also have columns of vacancies.

Gone are the days when any partnership vacancy in a favoured part of the country attracted over 100 applicants. Today even the most attractive practice will be lucky if they receive two or three reasonable applications and some practices have advertised several times and received no response at all.

When the closing date for applications has been reached, a decision will have to be made on who will be short-listing the candidates. This will probably not be a very onerous or potentially contentious job given the probable response. However, in addition to the original job description, the partners should by now have prepared a person specification so that a suitable candidate can be found to fit into the existing team of partners. In this person spec you will have itemized all the qualifications and qualities that you require from a new partner.

You should now be ready to select a suitable interview panel. It would not be advisable for all the partners (if there are more than three) to be present at interview, although all will naturally wish to meet and have a say in the final selection process. When making the decision it is advisable to try for consensus if at all possible. It can be very difficult if the candidate chosen only by a majority of the partners is selected and the other doctors may not feel supportive of the newly appointed partner. It is preferable to choose the partners’ second choice, rather than a candidate favoured by some but fiercely objected to by others.

Once the appointment is made, the partners and manager together should devise a suitable induction programme. One of the partners will need to act as mentor for the new doctor during the probationary period. If they are not familiar with the medical software, at some time prior to their starting they will need to be taken through the various protocols. One of the partners will have to tell them just what information needs to be entered on the system during consultations, and in what format. The new doctor will also need help in accessing patient data and prescribing history and will need to feel confident in their ability to print acute prescriptions during surgery.

It can also be helpful if, in addition to a GP mentor, the new partner has a member of the reception staff allocated to them who will answer any queries in the first weeks about local arrangements regarding hospital admissions, patient transport, availability of appointments and so on.

Question 4: Partners at parity

I understand from a discussion the doctors had recently in a meeting, that one of the partners has not yet reached parity. What exactly does this mean?

When a new doctor joins a practice, he may or may not be invited or expected to ‘buy into’ the practice. If he is, he will only be asked to buy his share of the premises and any equipment used to run the business: in law he cannot, as in most other businesses, be asked to buy a share of the ‘goodwill’ of the practice. The goodwill is the customer loyalty, i.e. the patient list, that has been built up over time by the previous partnership.

In recognition of this, it has been the practice of GPs taking on a new partner to offer him a reduced share of the profits for a few years, the surplus then being shared among the others. For instance, if there are five partners in the practice and they receive equal profit shares, they will be receiving 20% of the profits under normal circumstances. If one of them retires and a new partner is brought in, he may be offered 80% of his anticipated one-fifth share for the first year or two. This would mean that he receives 16/100ths, and the other four will receive 21/100ths of the profits. In this way the four original partners will receive an additional 1% of profits each until the new partner is established and moves to parity, ...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• About the author
• Acknowledgements
• Abbreviations
• Introduction
• 1 The Primary Healthcare Team
• 2 Managing
• 3 Communicating
• References
• Further reading
• Useful addresses
• Index