Thornfield's Charan Sarai recently met with a former PM and friend who had left general practice and was now returning. in this first part of our 3-part series, we learn how she is getting on, and what her main hopes and fears are for the future.

“I need 6 months and a very large bin!”

The idea that a messy desk is a sign of genius is a popular saying, often attributed to famous thinkers like Albert Einstein and Mark Twain (though there isn’t any scientific evidence to support this claim…)

I recently met a PM for coffee (who wishes to be known as Miss X) and she relayed her recent experience when going back into a role she did for many years. She has had a break in between and tried other things which she did very successfully, but felt now was the time to go back and make a difference in GP land.

We got together in week three and I asked her about how things were going. She said that Rome wasn’t built in a day, but has gone in with a heart to get things sorted but states she needs to get rid of a lot of old paperwork!

Q:  What was your first day like?

I was given an Induction check list and names of people that I was to meet that day. I was shown round. While the meet and greets were planned they never happened. The check list was good but it’s at the bottom of the in tray presently with just my name on it.

We are not supposed to use “post it notes” for safety/security reasons, but they are all over the place. My office is quite a long way from the main reception and admin areas, and is packed with old files. I was given a laptop, access to several important systems including the clinical system and I was reminded not to write my password down. Subsequently, I have a list hidden somewhere secret of all the different passwords!

I was to carry out my mandatory training but found that some questions were harder than I expected. I think I was being a bit of a clever-clogs, thinking that I knew more than I actually do. I am still making my way through the list.

I literally landed in the practice running; I even came in before I started officially. There was so much to do, piles of papers including invoices waiting to be paid and nothing reconciled.

Urgent and necessary things had not been seen to, especially infection control and estates management. I don’t feel stressed though, as the signs are good that I can settle and make a difference. I met with the doctors at 10.30 to have a coffee and let them share their morning. This happens every day and is useful.

But remembering everybody’s name is a major challenge! So many people, and they all know my name.

Day 2

Oh, dear I have been noticed! They have seen me and suddenly I start receiving annual leave requests, getting their favourite dates in, even one requesting dates for next year. Meetings, meetings, meetings including one with the ICB, not too bad, interestingly faces I know. Good to know what’s going on behind the scenes.

Day 3

I have no recollection what happened on this day! I vaguely remember having a ham and cheese sandwich.

Day 4

A nice day, letters to all the staff saying they have been awarded a pay rise in line with the uplift. I dealt with a complaint and the experience I have gained really helped here. When the phone went to say that a patient was complaining I went straight away to deal with it. The staff and the patients haven’t been used to this level of attention. 

Day 5

I am exhausted, physically, and mentally. The pressure has started to build, tired and so looking forward to the weekend. I likened this day to the Johari window model and its 3 main goals, building self-awareness, improving communication, and improving teamwork.

I can see that there are things to be done and it’s scary!

It will take a good 6 months in to be able to just do what needs to be done. Right now, I am working on establishing a realistic and useable baseline.

Summary

It’s a hell of a job, more complex than it ever was. I certainly have more to think about and more balls to keep in the air at the same time. Once upon a time it was just you, heading up your little silo, with your doctors and nurses and the support team. Then change happened, ARR’s Roles etc. I am so mindful of CQC and their expectations and the fact that they are getting back to onsite inspections. We’ve had recent partnership changes, so it’s inevitable that we’ll get a visit some time soon. I have the relevant training and know how to run a practice and know I have done the right thing going back into GP land. I am enjoying it.

There have been times when it’s been overwhelming, but I keep reminding myself about eating that elephant … a bite at a time!

Emails from the Federation can be a bit self-absorbed and always seem to read as “We Want, We Want.” I have started discussions with them and have invited them to talk with me. I still have the same frustrations as always with commissioners but realise that I do have to make time for them.

Training is very much needed, and I have already identified some key training needs.  We have a training matrix, but it has gaps and I want to get to grips with that asap. The practice is in the very early days of transformation. With help from my colleagues, I’m pulling together an assets register and do feel that we will get there. I have the desire to make inroads.

Yes, there is self-questioning going on, and self-doubting. The new terminology, acronyms and jargon used in the NHS are much more daunting than ever, but I'm optimistic. 

Thornfields Manager and mindfulness expert Charan Sarai is running some Touch Base sessions where Practice Managers can have a confidential chat with her to find a listening ear, get support, and be signposted to useful resources and information. Email her now at charan@firstpracticemanagement.co.uk  to book your session.