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We paid to appoint new practice manager

Realising the vital importance of the manager in today's practices, Dr Peter Moore and his partners were happy to pay a recruitment agent to fill the post

Realising the vital importance of the manager in today's practices, Dr Peter Moore and his partners were happy to pay a recruitment agent to fill the post

It must be the most important appointment GPs ever make.

Large practices can cope with an ineffective receptionist, nurse or even partner because numbers dilute the problem. But the manager is always crucial. A good manager runs the team smoothly, keeps the patients happy and maximises income. A bad manager creates havoc, upsets people and loses money. If you're really unlucky you might even hire a crook.

And so, when our manager left, we knew we had to make the right decision. A local practice we were friendly with had recently appointed a new manager. They were delighted with their choice and their advice to us was to use a recruitment agency. It would cost 10 per cent of our new manager's first year salary, but if we failed to appoint, or if the manager left within a year, we could repeat the exercise at no extra cost. We agreed that specialist help was essential and also cheaper in the long run.

We agreed terms with the agency, and it delegated one of its consultants to work with us. He arranged a meeting with the partners to run through the process and to get a feel for our practice. He needed to know the size, number of staff and even our GMS2 points. We also discussed our specific needs for the post, and the salary and hours.

The hunt begins

Having agreed details, the consultant advertised in a regional newspaper and the Practice Manager website. All the applications went to the agency but we received regular feedback. There were 48 expressions of interest which were translated into 20 formal applications.

After the deadline for applications had passed the agency sent us a spreadsheet listing all the applicants with their ages and qualifications. The agency also sent us its opinions, including comments such as 'good applicant' or 'worth interviewing'. We were then given the pile of CVs. I spent an interesting evening wading through the details. I tried to avoid looking at the agency's opinion and graded each candidate from A to D.

The partners then met and, surprisingly, we all had a similar shortlist. There was some vacillation over borderline candidates, but the best and worst were easily agreed. Eight candidates were shortlisted with two more as reserves. We then set aside two afternoons during which we employed locums. We used a branch surgery that was closed to patients for the afternoon.

All partners were to spend 15 minutes with each candidate and we each had one area to look at. I chose strategic planning. Other partners covered staff, finance and personal plans. We were asked to prepare questions in advance. This ensured we asked all the candidates the same questions and that questions could be vetted by our consultant.

It was important to make sure the unsuccessful candidate could not accuse us of sexism, racism or any other 'ism'. I sought advice from my son who works for a large American bank. I was told the bank used 'behavioural interviewing' as a technique. This involved NOT asking the candidate what they will be doing in five years' time (which leads to bullshit) but instead asking them about specific projects they had already done.

Thus armed, I chose the question 'tell me about the last project you worked on that challenged you to go that extra mile'. The answers needed to be in three stages ­ the situation, action and results. Using open questions I needed to encourage the candidate to use 'I' and probe with questions such as 'what specifically did you do?'

Assessing group dynamics

The afternoon started with a 'question time'. One shortlisted candidate did not turn up. The partners and the chair of the recruitment agency sat in a semicircle facing the seven candidates. Between us we explained the history of the practice, the problems we were facing, and our future plans.

Those candidates who were already in the NHS dominated this session and some threw questions at us that must have frightened other candidates. They certainly frightened us ­ for instance, what is a Section 108 order?

But some of the candidates lacked vision. I do not think the most important and exciting project facing health care in the 21st century is implementing Choose and Book. After question time the candidates were given the 'desert survival' task. They discussed which items they would rescue from a crashed plane in the desert. This gave us an idea of how each would work in a group. During the tea break the partners disappeared to another room, giving our practice staff a chance to meet the candidates.

For the final session each partner was in a room and the candidates moved around between them all. It gave me the chance to try out the American bank interview technique. It worked. Some candidates were honest and discussed difficult projects they had eventually managed to complete. Others had not done a project for years. One person had done a wonderful NHS project a few years previously. It had been beautifully presented but had never been implemented. (Mind you, this probably said more about the NHS than the candidate.)

Another had implemented projects when told by her line manager exactly what was needed but had never had an original idea. Someone else, when asked about a project where they had to go the extra mile, replied 'I always go the extra mile'. This could have been a short interview. After the gruelling afternoon we met to draw up the final shortlist of three. We had allowed plenty of time for this but we did not need it. There was a bit of discussion about a few borderline people, but the top three candidates were agreed in about five minutes. With three excellent candidates left we expected the next day to be harder.

The final choice

The following afternoon we heard that one of our final three had turned us down. This made things easier in two ways; although she was one of the best applicants, I had been concerned about her. The job was for 35 hours a week and she had already asked whether she could do 30 hours. Another of the three was very experienced and was already a practice manager but appeared curiously lukewarm.

Did she really want to move here? The final candidate was superb. She had no NHS experience, but I saw this as an advantage ­ we wanted some fresh thinking. Her experience was in a bank and she also had a business degree. She was asked to give a presentation on why she should have the job. Clearly the bank had sent her on a presentation skills course ­ and she had the ability to use it.

She likened our practice to a cruise liner: I wondered whether moving from the bank to us would be like leaving the QE2 for a cross-Channel ferry. When asked why she thought she had been shortlisted she gave an astute description of her strengths what we were looking for ­ more clearly than we did ourselves, it seemed. She was not certain whether to accept. She had the choice of a secure job in the bank or taking a risk and changing career. Luckily for us she chose to change career.

Why did she change? A colleague had left the bank and was now a practice manager. He was enjoying his new job and had encouraged her. Funnily enough, he is the manager of the nearby practice who advised us on how to appoint a manager.

Peter Moore is a GP in Torquay, Devon. The recruitment agency he used was First Practice Management

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