Practice Manager (PMgr) duties and responsibilities are quite substantial and their attitude, rather than their aptitude, dictates the effective performance of the surgery.
The blogs list varies aspects of surgery management and it is implied that the PMgr duties and responsibilities can be culled from the various sections. PMgr is the administrative ‘supremo’ and should make sure even inadvertently areas into clinical fields are not encroached, leaving to GPs, Nurses and Healthcare professionals.
In some larger practices this role may be split across the two roles of a business manager and an administrative manager:
- The business manager is often responsible for providing financial and business advice to the partners for the development and implementation of the practice corporate strategy.
- The practice (administration) manager’s role in such surgeries can include a wide variety of functions depending on the staffing structure of the practice. This role will be responsible for the management of practice staff, patient liaison and daily operations within the practice. They are usually the first point of contact on anything relating to the management of the GP contract and QOF, prescription management and IT functionality for the practice.
2.9.1 Daily Tasks
The PMgr’s role is one of planning, problem solving, decision making, coordinating, organising, controlling, measuring, researching (of information on all aspects of Surgery operation – patient records, training notes, statutory information e.g. health and safety, personnel records, clinical, prescribing, equipment, PCT financing, GP contracts, patient literature and advice, disciplinary and complaints procedures, statistical information on patients etc.
It is better to break this down into components as laid out in sections below:
List of areas to cover for Practice Manager Training:
These would be the entire details in the book but for initial exposure only the headings are give:
Reception Registration Prescriptions Telephones/Communications
Appointments Staff Rota GP Rota Computer System /IMT
Claims Protocols Immunisations Medical Secretary
Scanner Complaints Discipline Medicines
Forms PBC Payroll etc. Report Generation
Audits Referrals Practice Booklet Data storage/Security
Job Appraisals Accounts Recruitment Insurance
GPs Nurses PCT/Others Healthcare Specialists
All the above areas have been covered in the book/blogs.
Usually a surgery would expect a trained person, now a days suitably qualified person in surgery management, to become a PMgr. However, people from other industries have entered the profession due to their skills in man-management, HR, Finance etc.
In most cases, the actual training of a PMgr in the surgery is non-existent as GPs are too busy to do any structured training. There are courses offered by PCT from time to time but the surgery would expect PMgr to perform ‘from the date of joining’. Hence, PMgr should be a self-motivated person and able to grasp things by observation, previous notes, talking to the nurses, HCA, SR and others in PCT about various issues. He must also search the web for information on various issues and become aware of the various aspects of surgery management. He should aim to be the right-hand person for the partners within 2-3 months of joining the surgery.
2.9.3 Care Quality Commission (CQC) (see Section 20.2)
From July this year the race begins for practices to register with the Care Quality Commission (CQC), the independent regulator of all health and adult social care in England.
This registration should have been completed by 1 April 2013, when new legislation will come into force requiring providers, whose sole or main purpose is, for NHS primary medical services to register with the CQC.
This includes those providers of General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS). Regulations require practices to register as an individual, a partnership or an organisation.
As part of the process practices will also be required to adhere to a set of essential quality standards, which will be continuously monitored.
It seems very likely that the CQC will consider a well-documented programme of mandatory training to be a basic requirement for practices. To demonstrate compliance with CQC Outcome 14, Regulation 23, practices would need to demonstrate that staff is competent to carry out their work and are properly trained, supervised and appraised.
Practices may wish to keep a simple spreadsheet record of staff training – where the cells in the spreadsheet contain the date on which each named employee last had training in a particular mandatory topic.
2.9.4 Rota – GP’s, Receptionists
PMgr should aim to give a monthly rota, of GPs, Nurses, HCA, Clinics and Receptionists, at least one week prior to the beginning of the following month. PMgr should have in the Annual Planner the holidays and special days booked by GPs, Nurses and other staff.
The rota should indicate all the morning and evening surgeries, clinics and any late evening meetings for the patients e.g. Patient Participation Group, is formed to discuss issues with the patients.
This advance notification is for GPs, Nurses and staff to check their availability and suggest any changes. Once agreed upon, the rota is final for the month and the surgery should operate like clockwork.
In the event of any sudden illness or absenteeism, the Senior Receptionist (SR) should make quick adjustment to the rota, so that the surgery operation and effectiveness is not compromised.
When a GP is unfortunately absent, then the patients booked should be shared with the other GPs in the practice. All patients should be given the option to have late appointment or make new ones, if they want to see that particular GP.
2.9.5 Healthcare professionals
The role of the HCA can vary depending on the number of services provided by practice nurses. They often provide assistance to nurses, as well as undertaking routine tasks such as phlebotomy, chaperoning and taking patient blood pressure and weight measurements for long-term conditions’ clinics. See Section 21 for further details.
The whole write up for these blogs is about the surgery practice and these are laid out several sections. One key issue that would be dealt here is the creation and maintenance of a web site for the surgery. A good IMT specialist should be able to design a web page for the surgery otherwise the designs are available from external specialists at a modest cost. (www.mysurgerywebsite.co.uk/).
The IMT specialist has to maintain it and the site should be most useful for patients and others in the area.
The site should layout the following:
opening hours, appointments, Prescriptions including repeats, clinics & services, Policies, Practice Staff, New Patients, Feedback and Contact details for the surgery, NHS111, walk-in centres, PCT?CCGs, Hospitals etc.
The web site should be regularly updated so that people accessing it would have confidence in the information provided in the site.
If you disagree with the way your GP wants to treat you, or you’re unhappy about the service provided by your GP surgery, tell them openly. However, if you feel unable to do so or you’re unhappy with the response you receive, you may wish to make a complaint.
All GP surgeries should have a written complaints procedure, and you will find this at reception or on the practice website.
As a first step, speak to the practice manager. You can also complain to the practice in writing, or by email.
If this doesn’t resolve the problem, or you’d rather not raise the issue directly with the practice, you can complain to the local primary care trust (PCT).
Find out more about how to complain in the NHS.
The Practice Manager should have, in the surgery folders, one folder for Complaints Procedures – a lengthy documents running to several pages with several forms to be completed in terms of a complaint. A similar copy should also be in the reception area for senior receptionist to refer and advise receptionists. Section 2.3.5 deals with the role of the receptionists and SR regarding complaints.
The practice manager should record the complaint in paper (not the form) and assure the person that his/her comments would be discussed with the GP partners in the next few hours and would try to seek an amicable solution.
If the complaint is of a serious nature involving a Nurse, HCA or GP, then attempts could be made to fix a meeting with them for discussion. Should the person is not satisfied and wants to fill in a complaint form, then the form should be given to the person to fill it. Trying to help in filling the form might go a long way towards toning down the person’s strong wordings in the form. Generally strong wordings would be magnified when PCT Complaints Manager get a copy.
It is prudent of the PMgr to sound the PCT complaints Manager.
Practice Manager has to organise monthly meetings with all GPs, Nurses, HCAs and staff. Usually it should be on the day when surgery has afternoon off e.g. Wednesday or Thursday afternoon when the surgery is closed. If there are two surgeries under on practice, then staff from both surgeries should attend.
Meetings should be reasonably formal and everyone should be allowed to express their opinion. This is a forum for the staff, especially the junior staff, to speak and make their views heard. GPs and Practice Manager (PMgr) should not take over the proceeding and turn it into a ‘Tell’ and not a ‘listening’ meeting. The concept is ‘all points expressed are useful’ and ‘none to be dismissed’. Only then would the staff participate fully and effectively. They must be made to realise that they are also part of the Team and their contribution counts, as they might know more about the ‘pulse of the patients’ and what makes them do certain things.
Understanding these and being sensitive would make the meetings very productive. This should be a forum where the staff could see the GPs close by, talk to them, and listen to GPs views expressed openly to the staff directly.
Everyone should treat the meeting as an important event and they should desist from lengthy explanations and anecdotes. Points should be crisp and succinct. It is better to write down what one wants to say so that errors would be less. All staff should come with a pad and pen and not expect the PMgr to dish out these. It is an in-house meeting and everyone has to do his or her part. It is better to be a bit formal and aim to finish the meeting quickly and effectively than prolong it and waste half day earned-holiday in the week.
The PMgr should circulate an Agenda for the meeting well in advance to all and place a notice in the Reception Hall. The agenda should be specific and list areas to be covered. The start time and date to be given. Any patient(s) invited to the meeting should also be mentioned. This invitation would be a strong PR exercise for the surgery in the ‘eyes’ of the PCT about involvement of patients. It does have to be the same representatives coming for all meetings. PMgr should vary the representation for each meeting.
The format of a succinct report for the monthly meeting is attached.
Previously there used to be Patient Participation Group one evening in 2-3 months but as this involved a willing volunteer from the patient group and active work to arrange the meetings etc., these Groups no longer exist. It would be always preferable to resurrect such Groups, if possible.
These sorts of Group lift the profile of the surgery and would significantly reduce complaints against the surgery. It is also recommended that one person chairs the meeting for that time and even junior can be given opportunity to be the ‘Chair’. Rotation of people to chair the meeting would be good for staff morale and make them think laterally about their jobs and commitments.
A typical agenda to be circulated may be like this, depending on the issues to be important at that time –
Meeting to be held on date, month, year, day and time from and to.
The topics to be covered:
Actions arising from previous meeting.
Computer training and clinical templates
Post and Ante- natal clinics
R/U (returned undelivered) mail and records closed
ANother (any other)
These meetings form the basis for Continuous Practice Development. The purpose of the meeting had to be clearly defined. Meetings should start on time. Introduce Patient representatives, who have been requested to attend the meeting. Deal with each topic effectively. It is preferable for staff to organise and collect their views beforehand and they can nominate within themselves, who would address a particular issue. This prevents lot of people saying the same thing. Also, such organising means it is no longer an individual issue but a collective one. GPs should not ‘bulldoze’ ideas or opinions but give a patient an encouraging hearing. They have to exhibit ‘listening’ side of them when they are normally perceived on ‘telling’ side to them.
Patient representatives should be given a chance to express their opinions and if required actions. Then when those actions are completed later, these representatives should be informed of the results of the actions via mobile phone calls and recorded in the next month’s meeting minutes.
When the meeting is duly finished, the PMgr should do the minutes of the meeting by next day and circulate it. It should be a one-page format, printed laterally, split into sections, for example:
Subject Relevant details Decision Target Date Comments
Action by Initials
CHD Visit by … from PCT. use template from …….;
Monthly JS (for John Smith)
R/U mail 500+ closed fill PCT form from date; JS no back log.
With all the best intentions in the world, a PMgr would periodical find a considerable Backlog of issues that need to be dealt with in the practice and at the same time keep abreast of new developments and increased paper work generated. A good PMgr should identify the priorities for the practice.
A typical list is attached with suggested backlog work.
One of the suggested ways to tackle is to ask 4 questions
(applies to all aspects in life – education, career, job change, place change etc.):
- where am I now? Identify backlogs, shortage of staff and skill levels, finance etc.
- where do I want to be? set a date, say, a month ahead; target reduce backlog by 80%; GPs seeing all patients in clinical list; aim 95%QOF
- what are the ways of getting there? Various but getting funding for increased staff would be difficult in short term.
- what is the best way for me right now? Delegate and also involve yourself to motivate and speed up the work and set a good example for staff.
Most of the surgeries pay scant attention to Copyright Laws. It is common to see in some surgeries either playing music or have TV turned on for waiting patients. These contravene Copyright Laws. The Copyright and Patents Act 1988 outlines the principal legislation covering intellectual property rights in UK and the work to which it applies.
The Law gives the creators of literary, musical, artistic works, sound recordings, broadcasts, films and typographical arrangement of published editions, rights to control the ways in which their material may be used. The details are very clearly stated in the Law and it can be accessed in the web site given. Copyright lasts between 70 to 125 years.
It is recommended that the Practice Manager contact the Copyright Licensing Agency for Music, PRS for Music. It is strongly recommended that the annual fee of around £ 100 – 150 be paid to conform to the laws and the Certificates displayed in Reception area.
2.9.11 Documents in Practice
There are several documents, which should be readily available in the surgery for GPs and everyone to refer. These become more important if due to any inadvertent reasons the GP’s have to follow remedial procedures, when PCT would make a big and pertinent issue of this omission in the surgery Practice.
It is the Practice Manager’s sole and key responsibility to ensure such omissions never occurs.
The surgery should have for all staff including GPs, Nurses, HCP, and Receptionists etc. up-to-date:
- Job Specifications
- Job Descriptions
- Appointment Orders and Contract of Employments
- Personal folders with Job evaluations, salary increases, disciplinary details etc.
- Induction Programmes and Training details for all staff .
- Employment Rules, and Regulations and key Laws.
- Pension plans under NHS schemes.
- HMRC Tax/NI details.
- Complaints Procedures.
- Grievance Procedures.
- Clinical Supervision.
- Clinical Protocol List and individual Folders for ready reference.
- All other day-to-day operational contact details.
2.9.12 Checklist of Policies
- The policies for performance assessment – appraisal or otherwise – are in practice files. The practice manager helps the practitioners in getting any relevant information for such assessment and also does a check list on areas to cover for the practitioner. All documents in forms of reports and results are given to the practitioner well in advance to prepare for such an assessment. Relevant staff knows about the policies. Policies are reviewed yearly.
- Policies regarding confidentiality are in place and are of utmost importance for the practitioner and for the practice. All are made aware of the policy at the time of joining the practice and issued raised periodically at the monthly meetings.
2.9.13 Pandemic situations
an audit regarding surgical masks should be done at the outset of the crisis.
- In the pandemic situation, do you have sufficient surgical masks at you disposal at reception; note down the quantities and order more if needed.
- Secondly, ensure there are facilities for patients to decontaminate their hands at reception/surgery.
There must be a suggestions box for all staff to input their ideas and there must be a monthly review of those suggestions by PMgr, IMT specialist, Senior Receptionist, one receptionist, a nurse and a GP, all selected on rota basis to review the suggestions.
The staff must be encouraged to suggest on all aspects of surgery operations, within and outside the premises, dealing with persons within and outside the premises, any others they think would improve the performance, effectiveness morale, patient satisfaction, reduce complaints, reduce costs etc. No suggestion should be ridiculed and any not followed up must have a valid reason for doing so. The PMgr should thank the staff individually after the review meeting for their input and explain the committee decision in either following their suggestion or not doing so with reasons. Such interactions are a positive ways of improving staff morale and should keep the staff feeling involved as they perceive that GPs and PMgr care.
2.9.15 Psychological issues for PMgr’s to know.
- Eye contact a strong indicator of mood. More eye contact – positive mood; looking down or away from person – bad mood.
- Familiarity breeds’ contempt is not true; breeds’ fondness – just the opposite is true. The greater the exposure the more positive the response.
- May be in magnetism ‘opposites attract’ – in business world similarities seem to attract more.
- Rapport creates a trust allowing one to build a psychological bridge.
- Smile often – it accomplishes confidence, happiness, enthusiasm and most notably acceptance.
- First impressions are no doubt very important; equally with staff that is quite young working in a GP surgery, PMgr should be aware that ‘a book should not be judged by the cover’.
- PMgr should instill in staff that when an error is made, saying ‘I am embarrassed’ achieve three things – self realization that an error was made which was unacceptable, that the person is human and takes responsibility for it and finally the person is honest.
- One should be aware of manipulation by seniors or even peer group – these are guilt, intimidation, appeal to ego, fear, curiosity, and one’s desire to be liked and love.
- Use the Law of Inertia – people in motion, tend to stay in motion; people at rest tend to stay at rest! If PMgr should also be aware that if he gives the staff a small task to complete easily, they are more likely to accept a big task. PMgr should avoid asking staff to do a big job lest personality issues clash and work gets undone.