A day in a life of a Practice Manager

“It was snowing in Gateshead at 9am, Friday before the bank holiday. On leaving the surgery I bumped into Jez, a homeless patient, who has recently been released from prison. The receptionist had sorted his script. I was late for a meeting. He followed me out. Cold wet and hungry, he burst into tears. A 15 minute conversation followed, I gave him some money for breakfast asking him to wait for me in a local café. By this time, I was cold wet and very late, but I had a warm car to escape into.”

Working jointly with the 3rd sector, the practice had just won funding to manage people with complex needs. Those who were too complex for us to manage in primary care, but not complex enough to fit the criteria for other services. The vulnerable, isolated, lonely and dispossessed in society. Those that fall through the net and are lost in the mire of fragmentation in the health and wellbeing system. We have many such patients, who have GP appointments several times a week, because of social issues impacting their health. Those patients cannot possibly be helped through the health system alone.

Filling the gaps with the help of local communities

At Oxford Terrace and Rawling Road Medical Group, our social prescribing is led by two Primary Care Navigators (HCA’S). Without the necessary skills to provide the right support, their biggest frustration is trying to help patients like Jez who are bounced around the system as there is no “Jez shaped hole for him to fit into”. That said, they had identified this need and using the new funding we will be working with a local charity (Fulfilling Lives) to test a new model of care. After an initial meeting a new co-ordinator, Alex, had been appointed. We also agreed broad referral criteria, with specific patients in mind. Those that were too complex for primary care, and did not fit access criteria for other services, but needed support in the community. Jez fitted the bill perfectly. I introduced Alex to him as her first patient.

This approach will help us to manage the population need, beyond the 10 minute GP appointment.”

A core component of this service will be to identify peer mentors as volunteers for befriending and support. Fortuitously, my next engagement was a training session for Practice Health Champions. We have 39, who work with us a volunteers. Leading a range of self-help groups. They also host events for patient engagement such as a flu fair, summer health fair, an annual Christmas dinner. A new event for this year will be a veteran’s event.

This morning we were welcoming 10 new volunteers into the fold. The training was developed and led by other champions, facilitated by the practice, hosted by Bensham Grove, a local charity. Therefore, there was no cost to the health and wellbeing system. We were connecting local resources, building alliances around patient need and supporting each other to help the most vulnerable and deprived people in our community, those who don’t fit into existing systems. Such is the power of unleashed energy when patients connect with staff to share skills, passion and commitment.

Paperwork, patients and positive outlook

My afternoon was spent back at the desk, trying to navigate my way through the transformation fund (GP Premises) and decide how we are going to make up the shortfall form our PMS budget following recent review to fund 33%, and all the exclusions, (including staff toilets and shower), of the premises development. Financial flows have not been right or timely since we went from one pay master to four in the Lansley reforms. At this point I decided to call it a day. At 6pm as I left the practice, reflecting on my day. I smiled at a patient on my way out.

“My day job as a Practice Manager is full of “bad” NHS rules that block and beleaguer most of our attempts to care for people the way they need to be cared for. Today though, I felt privileged to have had the opportunity of making a difference to at least one person, who might have otherwise spent the long weekend on a park bench, tired, cold, hungry and dispossessed.”

That is the value of asset based community engagement, social prescribing and connecting the passion, power and energy of patients and staff in General Practice.

Sheinaz Stansfield is a practice manager with over 30 years’ experience in the NHS. She initially trained as a nurse and health visitor, and then worked in commissioning at PCT and strategic health authority level, concerned mostly with developing services outside hospital, for example, integrated primary and community services, integrated nursing teams and services in GP practices. She has also worked for a Primary Care Group as a primary care development and commissioning/contracting manager and helped set up clinical commissioning in Gateshead. She is an elected locality manager for Gateshead Clinical Commissioning Group, practice representative on the Gateshead Newcastle CCG Governing Body and the practice manager representative on the RCGP Northern Faculty Board.

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