In the last 15 years we have seen several changes in the National Health Service (NHS) due to political, economic, administration and other factors like demand and accessibility. These changes have been costly, resulted in mergers of General Practitioners (GP) practices, new super Medical Centres and even opened the doors to Private Enterprises seeking Private Financial Incentives (PFI).
These days GP Practices have undergone major changes in the monitoring and delivery of services controlled by Primary Care Trusts (PCT) and each trust may supervise over 60 GP Practices in the area. These PCTs have enormous departments to serve the public but mainly set up to increase employment in NHS.
Presently NHS has over a million personnel on its payroll, mostly in administrative roles swamping the number of Medical Doctors, Nurses and other specialists.
The changes in the Hospital sector has also been significant, often brutal, taking away the power base from the medically qualified and very professional consultants, to the hands of administrative personnel with questionable knowledge in medical field. Changes had been introduced for the Hospitals to rely on GPs for the services they provide to the patients.
GP practices had mostly relied on the spouse of a Partner as Practice Manager (PMgr) and no formal qualification had been specified for the post. Due to diverse and complicated procedures involved in these changes, many practices had to appoint PMgr with Management experience in Industry. Recently, however, due to various courses available and training set up within PCT in early days and outside in Colleges, Practices do specify a formal qualification for considering when choosing a PMgr.
Royal College of General Practitioners (RCGP), British Medical Association (BMA), General Medical Council (GMC) provide, in most cases, a robust support to GPs, highlighting the areas to focus, how to do the jobs and even procedures, instruction leaflets and leaflets for patients to see and take with them, when they come to the surgeries.
Royal College of Nurses (RCN) provides training and support to the nurses for working in the hospital or GP practices and they are very visible in their support for their fraternity. They also provide legal cover in various areas for the members.
Medical Defence Organisations (MDOs) are, mutual non-profit making organisations, owned by their members. All MDOs provide members with 24-hour access to advice and assistance on medico-legal issues arising from clinical practice, which fall outside the scope of indemnity provided by NHS bodies.
There are three MDOs: Medical Defence Union (MDU), Medical Protection Society (MPS) and Medical and Dental Defence Union of Scotland (MDDUS). As the benefits of membership of the MDOs differ, it is important that one considers each society carefully before making a choice.
The help afforded to Reception and administrative staff, in terms of induction and training courses, is minimal both in PCT’s and Practices due to shortage of staff, funds and other factors. They have to rely on the PMgr to help, train and support them. They do not have any legal cover and they are not even recognised to become a member of any institution, which would provide cover. PMgr can become a member of the above MDO’s at a very nominal cost.
The author had been in GP practices, mostly in London area but also for very short periods in Birmingham and Manchester surgeries, as a Practice Manager. Having had a staff of 20 people, in two surgery locations with about 10000 patients, I had witnessed the plight of the reception and other admin staff, in terms of induction, training, salary levels, sickness and other privileges, which employees in other industries seem to enjoy more. Receptionists start usually at a basic minimum salary levels but were expected to do a highly skilled job from the date of taking up appointments and in dealing with patients.
My usual philosophy, which was stated to the practitioners, whom I knew of some years, is that ‘my empathy and loyalty were to the GPs but my sympathy was always with the staff, as they had little protection from external support organisations’. GPs have generally concurred and applauded but, in reality, they have rarely shown any change in their management style and sensitivity to the issues.
The book is written as an aid to any person wanting to join the industry – as a new entrant from school or colleges, or a senior person from another industry with no exposure to NHS previously. This is written as a manual for all admin staff, even for those at present in the NHS. There are several areas which they are aware but do not usually focus due to other commitments; also, unaware in terms of significance when any error occurs and when procedures are not clinically and systematically followed. All the admin staffs has to realise that they are working primarily in support roles to the GPs, nurses and other health care professionals and this principle is crucial for their effective functioning in their roles.
The author was not a staunch practicing Hindu but had stated to all the GPs and other personnel, that a GP Practice clearly elucidates the Hindu caste system.
The GPs are, the ‘Brahmins’, the high priests and they are ‘semi-gods’. Never incur their wrath at any time. Nurses are like ‘Kshatriyas’ – warrior class, in as much they, with their weapon of needles and injections, deal with patients. The reception and other staff are like ‘Vaisyas’ – the traders, dealing with people and in this case the patients. Finally the Practice Manager is like a ‘Sudra’ – the working class, as the Practice Manager has to serve all the people in the surgery.
Even though he may be above the staff administratively the onus on the PM is to provide support, training and other crucial help for them to provide an effective service to the surgery and the community. As long as the Practice Manager realises and performs on this basis, the surgery would end up with a very effective team keeping the GPs, Nurses and other Healthcare professionals happy.