Being a practice manager means the responsibility of a practice lies in your hands, along with the tasks of picking up the work of others, whilst keeping your patients and doctors happy. Lesley Beale, practice manager of Blackwater Medical Centre in Maldon, Essex deals with issues such as these and many more in her day to day routine

Blackwater Medical Centre is situated in the centre of Maldon and is a dispensing practice serving Maldon and the surrounding villages.  The practice currently has seven partners and two salaried GP’s working a total of sixty sessions.   There are five part time nurses and one nurse practitioner.  The reception is manned by five part time receptionists and there are four part time admin staff, one full time secretary and a full time manager.

Blackwater is a dispensing practice and currently has two full time dispensers and two part time dispensers (job share).  The practice is open from 8 am to 6.30 pm Monday to Friday and provides extended hours from 7 am to 8 am on four mornings a week, these being Monday, Tuesday, Wednesday and Friday.  The practice has an attached 100 hour Pharmacy which, although owned by the partners, is a stand-alone business.

The practice is divided into three main areas, Nursing, Reception and Admin.  Each of these areas has a line manager responsible to Lesley. There responsibilities are ensuring there is cover when staff are either on holiday or on sick leave.

The practice population currently stands at 14195 patients.  These are divided into age groups of 11024 aged between 0 and 64,   1774 aged between 65 and 77 and 1397 over the age of 78.  The practice is responsible for nine residential homes and provides all GMS services.

The Role of the Practice Manager

The practice manager is responsible for the smooth running of all aspects of the practice. This includes finance, HR, payroll, meetings, education, complaints and maintaining the premises.  Liaison between the practice and the patients, the Clinical Commissioning Group (CCG), the local area team of NHS England (LAT), Local Medical Committee (LMC), Locality Group (BLT) and other attached staff and organisations also goes through the Practice Manager.  A key responsibility is to ensure that the practice achieves the highest levels in the Quality Framework Assessments (QOF).  A more recent task that has been added is to ensure that the Friends and Family Test is distributed properly whilst being responsible for logging the responses onto a spread sheet which has been supplied by NHS England.

Lesley Beale has a number of daily duties which include opening up the surgery premises, unlocking all the inner doors and turning on the computer systems in each room ready for the day ahead.

Her own daily commitments include dealing with any tasks that have appeared overnight or weekend. These could include NHS 111 reports,  Walk in Centre reports, New Registrations, GP to GP transfers, Deducted Patient Requests,  Ultrasound Reports and Tasks of any other nature.

Lesley uses EDI which is a facility on the clinical system linked to the national spine and the Exeter System, whilst also using SCR. Here is where she finds tasks relating to registration details of patients and includes changes to patient details, deductions, amendments and registrations.  Amendments and registrations are easy tasks which only require authorisation.  Deductions are a little bit more complicated in that the medical record has be to pulled from reception and then the whole electronic record of the patient has to be printed out.  She feels it has become easier with Systemone practices not requiring this and hopefully with GP2GP which is a facility which allows different clinical systems to transfer patient records.  If the transfer has worked the patient notes have to be integrated into their clinical system, but this is when it is fully up and running.  This task is shared with two other members of staff, who all work together to get this done.

Lesly also manages the Privacy File. This is a file on the computer that alerts her to staff going into the records of deducted patients which have to be justified.  Usually it is to find out information regarding the patient’s deduction details. The pathology is sent electronically, sometimes there are differences in names and these have to be matched to patients.  Also the results sometimes come through without a designated clinician name this means Lesly and her team have to check the patient record to see who needs to read the report and then assign the report to the clinician.

Dealing with the NHS 111 reports which come through electronically, have to be matched to the relevant patient. This is done through the scanning process and on a weekend or over a Bank Holiday where there can be a vast number of them to do.

Lesley deals with emails on both the NHS system and practice system on a daily basis.  This is more problematic following a holiday when there can be anything up to 400 e-mails waiting to be dealt with.

Lesley has a number of designated tasks on a monthly basis which include the recall of patients for Mental Health Reviews, Learning Disability Annual Checks, Rheumatoid Arthritis Annual Checks and Pertussis recall for pregnant ladies.

In addition to this she may be asked to conduct audits for the partners, CCG, NHS England or Equip.  Annually she is responsible for recalling patients for annual flu, pneumonia, shingles, which include placing an advert in the local paper and local free magazine.  She is also in charge of recalling all new over 65 year olds and new patients meeting the criteria of the shingles programme.

She also has to ensure to keep up to date with Information Governance making sure that the annual return is completed and returned.

Other tasks:

There are also many other tasks that Lesley has to manage. The first is payroll which is run once a month. This involves ensuring that all staff have logged overtime and any other aspects such as maternity or sick pay.  This includes running the payroll, printing off the payslips, putting them into envelopes and printing off all other aspects associated with payroll, including the pension payment sheet.  She also has to complete the fax pay sheet ready for faxing to the bank for payment to the staff to ensure that it is in the bank on the correct day along with completing the Tax and NI form for payment to HMRC and writing the cheque ready for this.

Pensions are looked after by logging into the NHS Pensions online and ensuring that the correct data is sent to them regarding the pension payments. Whilst making sure that real time information is sent to HMRC.

To keep up with Employment Law the practice has purchased the services of Natwest Bank’s Mentor scheme to assist in this matter.

Although Lesley is not the named person for health and Safety, she is heavily involved in it.  Again the practice has purchased the services of NatWest’s Mentor Scheme for this.

Accounts:

Lesley also looks after the accounts side of the practice. Making sure that all invoices are paid in a timely fashion and ensuring that the bank reconciliation is correct alongside banking monies and cheques and keeping an eye on the cash flow status. Banking money from dispensary and private fees are all under taking care of accounts.

She Ensures that all the payments and receipts are in the accounting package ready for auditing by the accountant and making sure that the Partners Tax is paid on time, this happens twice yearly in July and January, whilst liaising with the accountant on any accounting issue.

Her role is to ensure that all claims are made on time to the CCG, NHS England, Essex County Council and ACE. This includes completing forms from CCG, NHS England, ACE and ECC as well as checking the CQRS to ensure that all DES and LES are either accepted or rejected and deal with any task messages that might come through.

HR/Education

In relation to HR and Education Lesley make’s sure that staff are happy in the environment and that they are dealing with the public in an appropriate and efficient manner. She deals with any upsets and liaising with the partners on behalf of the staff. She also looks after the recruiting by advertising and employing staff as and when required whilst helping to keep her team up to date by booking and paying for courses where appropriate and carrying out appraisals.

Patient Representative:

Lesley deals with patient complaints and to help them in any way to ensure that their experience at the practice is good. She hosts and supports the Blackwater Patients’ Participant Group and is the conduit between them and the partners. This involves organising and attending regular patient meetings & forums, producing minutes, resolving issues and considering the group’s suggestions and recommendations.  There is also quite a lot of email communication required, in order to keep the team updated and aware of committee activity.

She attends meetings with the locality group, local practice managers and CCG practice managers meeting on a monthly basis.  Lesley is also a representative for the Maldon and Dengie area on the Local Medical Committee Meeting, which meets monthly. Her role is to attend meetings with the Maldon District Council with regard to the local development plan.  There are also meetings with Longfield Medical Centre to provide information and support in our joint endeavour for a new surgery build in Heybridge. Attending necessary training events is also important, which are of benefit to the practice and can include updates on QOF, CQRS, payroll, etc.

Lesley has a policy of open door which is great for the patients and staff but sometimes the interruptions are at inappropriate times. Lesley sees the practice as a team and she is just the person with the title.  This means that she is happy to assist and cover other members of the team, particularly in the admin area, although she has spent time in dispensary printing off prescriptions.

When Lesley was interviewed, each member of the admin team (including her) were responsible for the summarising of doctor’s incoming mail.  Since the interview this process has changed in that the scanning clerk logs every letter, report, fax, discharge summary etc.  It then goes to the doctors who have the responsibility of highlighting any part they wish added to the patient’s record.  The team members are still responsible for the doctors summarising but only in so much as adding the highlighted parts.  This reduces the time each person spends on doing this and the flow of paperwork is much quicker.