Denise Smith is practice manager at Merepark Medical Centre, in Alsager, Cheshire.
She is also practice manager lead for the SMASH Primary Care Network (PCN), which covers the areas of Sandbach, Middlewich, Alsager, Scholar Green and Haslington. The network is made up of seven GP practices and around 50,000 patients.
Q. How did you become practice manager lead for a PCN?
A. I was approached and given the opportunity by the clinical director for the PCN, Dr Neil Paul. He’s based at Ashfields Primary Care Centre, one of the surgeries in our network.
Q. What have you done in the role so far?
A. It’s quite an exciting role. I believe communication is key to making PCNs work, because change is happening at a rapid pace and everybody needs to be on board.
So, one of the first things I did was to set up what I call our SMASH PCN meeting for the network’s practice managers to attend every six weeks. Our advanced nurse practitioners and nurses are invited to attend too, and we’re having our third meeting this month.
I chair the meetings and we invite lots of different people in to do presentations to give us ideas, which we can share across the practices to improve communication. For example, it might be on a particular tool we’re looking to use within the network, like GP TeamNet.
The network’s clinical director came to the first meeting and did a presentation on PCNs, because we actually realised that lots of people didn’t even know what one was. It’s been a great success so far and we’ve had lots of positive feedback.
We’re also running a number of pilot schemes and working together with the Alliance, our GP Federation, and Howbeck Healthcare IT consultancy to get our ideas off the ground.
One of these pilots is looking at whether we can use a web chat platform for our staff to communicate with each other. We’ve also just done our first newsletter, which details where we are and what our vision is as a PCN. This will be uploaded to a new website.
Q. What have you enjoyed most about the role so far?
A. Networking and seeing it all start to come together.
I’m actually excited about it all and very enthusiastic. I spoke to the CQC a couple of days ago and they ended the call by saying ‘keep up the enthusiasm’. For a long time, practice managers have known that even though we’re all doing the same thing, with the same deadlines, we haven’t been in a position to share staff or resources. But hopefully with PCNs we’ll be able to do that – if someone is off sick then straight away you’ve got cover.
The early stages have been networking and meeting lots of different people, attending meetings and interviewing [for new staff]. I feel I’m in a good position because I’m hands on and we know what we need as practice managers.
Networks will give us the opportunity to share staff and work collaboratively, while maintaining the independence of individual practices – but we’ll also need to make sure resources are distributed equitably.
Q. What do you think PCNs will mean for the future of practice management?
A. I think if we work together and support each other within the PCN then there’s a role for all of us, but we do need to make sure everybody is on board.
At the moment, practice managers deal with all HR issues, payroll, and accounts, but I think that could change in the future. If PCN hubs are going to support us with HR and share that across the practices, then it will relieve the pressure on practice managers. We can focus on setting up other hubs or initiatives that will benefit the patients instead.
I also think as practice managers, we will share the workload. This will relieve pressure on the GPs and the practice and will improve recruitment and retention. Not just of doctors, but of practice managers and other staff. There will be more career opportunities too.
Q. What are some of the challenges that lie ahead?
A. I think for practice managers it’s time really – those attending the meetings I’ve set up need their practices to release them so they can attend or be able to send someone else from within their team if they can’t get there. I’m very fortunate that our GPs are very forward-thinking and support me in this role, but it’s important that other practice managers have that same structure and support back at base, which enables them to be released.
More widely, the challenge is funding – what we should spend the money on and what we can invest in now that will reap benefits later on – and geography. When we’re looking at setting up joint clinics or services, it’s not always easy to figure out how we should locate it or who will host it.
Similarly, with the physician associate or any of the clinical pharmacists who will be coming on board in the future, do we share that person around, have them based in-house, or set up a new hub at one of the practices? We also need to make sure our patients can travel to where we locate those hubs, because otherwise they won’t go.
But I think PCNs will be very positive for primary care and will relieve some of the pressures because we are going to share the workload. Also, lots of practices are running out of building space, so if we have a room set up in one particular practice as a hub, then patients can be seen there, don’t have to wait for a referral and it’ll be like a one stop shop.
