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At the heart of general practice since 1960

Dinah needs a new practice manager, who will have her work cut out

If clinicians are supposed to be leading the NHS, why are there so many barriers in our way? our diarist wonders

If clinicians are supposed to be leading the NHS, why are there so many barriers in our way? our diarist wonders

Monday

Surgery. Another practice manager application in the post. Exciting – although I've had sleepless nights wondering if anyone will want to work with me. Managers – what would we do without them? Old practice manager has become a friend and personal assistant, relied on to tell me where I'm going, where I've been, who I've just been talking to. New practice manager will have job of fighting off Tesco and numerous other dragons on the highway to the future. My little practice has to shape up and get competitive. We already open late two nights a week – it's time we got paid for it. Never mind all that spin about access and GPs getting paid too much. I'll do whatever's asked of me if it's properly funded and commissioned on a level playing field.

Rudely awakened from day dreams by rapping on door – old practice manager – I've got patients waiting, what's happening? Oh dear, global takeover will have to wait.

Wednesday

Visit local tertiary unit to meet nephrologist to sort out CKD guideline. Queue in car park for half an hour, eventually park illegally but scuppered getting ticket as short of cash. Imagine the outcry if we put ticket machines up at the surgery. Saved by cachectic old man who kindly donates 5p, I rush off late for meeting. Needn't have worried – group are waiting outside seminar room, can't get going because some managers are having a look round. Nephrologist is worried – this usually happens when they're planning to convert the room for alternative use. The other day he turned up to find the dialysis prep room had become a diarrhoea room (well, they do sound similar) – on complaining the management said it was okay, dialysis patients could go in too. It was only when the infection control issues were pointed out that the status quo was reinstated. Guideline okay, now need to get it approved, not sure how – more running around…

If clinicians are supposed to be leading the NHS why are there so many barriers?

Friday

PBC – finalising commissioning intentions. Everything to be primary care-based unless unsafe, plus as much Tier 2 as possible.

Discuss programme to develop clinician/manager relationships (The Compact): ‘give and get' – you agree to give up some things in return for others that you receive. Colleagues in private medicine apparently don't have this – the medical bosses decide what happens, the staff do it. Yes, that sounds like Clinical Leadership. Why complicate things?

Old practice manager phones – would I like to meet for a G&T? Why not?

Dinah Roy is a GP in Spennymoor, chair of Sedgefield PBC group and co-PEC chair of County Durham PCT

Dinah

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