Conference split on charging patients
Three GPs share their approach to a practice dilemma
Practice manager isn't committed
One morning, during a gap in surgery, you pop into your practice manager's office and discover he has nipped out. You are looking for some papers and accidentally knock the mouse and the screen saver disappears to reveal the sports page of the BBC website. Curious to see what stories your practice manager is reading, you press the back button of the browser and end up in a number of leisure sites. This is not the first time this has happened and many of the partners have been complaining that the practice manager's contribution to the running of the practice is not what it should be. What do you do?
Dr Ian Mclean
'You must marshal all the salient facts and consider the options'
Quite obviously this manager isn't fully committed. So what should you do? You must marshal the salient facts, consider the options and implement the decision.
First, what are his internet activities? Is he bidding for a practice kettle on ebay or flogging the practice spirometer?
How much time is spent surfing? Our health board recently broke down use of the net and found 0.5 per cent of peoples' time was spent at gambling sites. It should be easy enough to establish your manager's net use history.
Second, is he doing his job? Do staff work well with him. Is his area of responsibility clear? Is he up to date with his work? Is the practice running well?
Third, how easy would it be to replace him? If the answers are that the practice is running well, the partners and staff happy with the way things are going, and no replacement could easily be found for this manager, then I would let things ride.
If the answers reveal that all is not well, its time to put heads together. An informal meeting after close of business is appropriate. If problems are identified, it is the responsibility of the partners to discuss these honestly with the manager.
One option is a private meeting with the manager setting out the practice's concerns and seeking his views. Are there training issues? Or personality issues? Or support issues? If the outcome is constructive and the manager seems engaged, give him encouragement. A bonus linked to contract achievements could be offered.
If the meeting is confrontational and negative, have a reaction planned in advance. Follow the discipline protocol.
Give a written warning and set out clear goals and expectations in writing. The meltdown scenario is where the practice manager is failing with poor performance linked to staff and partner upset and dislike. In this case, let him know the police might be interested and his best plan is to quit while he's ahead.
Ian Mclean is a GP in Wigtownshire, Scotland
'The partners should list and record their doubts'
If the practice was running smoothly, the practice manager was efficient and the work was getting done, then this would not be an issue. But this seems not to be the case, and so the manager should be confronted tactfully. As the partner who made this discovery of inappropriate use of the internet during office hours, I would fully document the incident.
I would not discuss the issue with the manager upon his return, but would raise the issue at the next available partners' meeting. This would be an opportunity for the partners to list their doubts and record areas where the manager's running of the practice was falling short.
A time should then be made for one of the partners to meet with the manager and say that there are some management issues that the partners wish to discuss and could the manager air any concerns that he may have. A meeting with all the partners would be too threatening.
The meeting should be seen as an opportunity for the manager to redeem himself, rather than one that is destructive and critical. Similar to the appraisal situation, it is important to praise what is going well and see if the manager is able to identify the areas of possible improvement.
It is at this point concerns could be raised if the manager has not been able to identify areas of improvement. Now would be the time to raise the internet incident example. Changes should be mutually agreed and summarised in writing, and a progress meeting arranged in four weeks.
If an improvement is not made, then it may be necessary to log this first meeting as a written warning in relation to his employment contract. This is not an easy situation, but one that could be detrimental to the practice if it is not addressed and a good working atmosphere and respect for the manager restored.
Rodger Charlton, a principal since 1987, is director of GP undergraduate medical education at Warwick Medical School
'A warning to us all to review management procedures for staff'
This is a scenario that should get all practices reviewing their staff management procedures (contracts, appraisal system, etc).
Is there a clause in the contract to cover the use of the computer for private business? Can the partner be sure the manager was not on practice business, for example buying and selling books to update the library?
While it is unacceptable to spend work time on private business, the important issue here is the fact that there have been complaints about the manager's contribution to the running of the practice.
The partners have to put aside emotions about his internet activities as long as they do not involve illegal activities such as visiting pornographic sites. The difficulty appears to be that his under-performance has not been dealt with earlier. This must now be addressed.
The partners need to follow the procedure laid out in the manager's contract. If there is no contract I would seek advice from the BMA. In my view its advice in this area is one of the most useful benefits of membership. I would then proceed with caution.
Either way the manager has to be made aware of the concerns about his work.
A meeting should be arranged with him and with one or two partners, depending on what usually happens in the practice. A clearly documented record of the discussion signed by both parties must be kept.
The meeting should set out what the partners are unhappy about, the practice manager's response and a plan of action that sets out tasks and dates by which these tasks need to be completed. The degree of dissatisfaction needs to be made clear and no mixed messages should to be given.
A date for the next meeting should be set and the practice manager must be clear of the outcome if he does not keep his side of the agreement.
Inappropriate use of the internet could be brought up at a team meeting. A culture should be fostered within the practice so that only necessary private use of the telephone and internet is acceptable.
Yomi McEwen is a GP in Buckhurst Hill, Essex