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The Practice Mana THIRD EDITION Edited by Michael Drury AND Lynne Hobden-Clarke RADCLIFFE MEDICAL PRESS OXFORD and NEW YORK © 1994 Radcliffe Medical Press Ltd 15 Kings Meadow, Ferry Hinksey Road, Oxford OX2 ODP 141 Fifth Avenue, New York, NY 10010, USA All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocoping, recording or otherwise without the prior permission of the copyright owner. First Edition 1990 Reprinted 1990 Reprinted 1991 Second Edition 1991 Reprinted 1992 Reprinted 1993 British Library Cataloguing in Publication Data A catalogue record is available from the British Library ISBN 1 85775 050 0 Typeset by AMA Graphics Ltd, Preston Printed and bound in Great Britain by Biddies Ltd, Guildford and King's Lynn Contents Preface to the First Edition v Preface to the Second Edition vii Preface to the Third Edition ix Publisher's Note ix List of Authors xi 1 The Nature and Structure of General Practice 1 Michael Drury 2 The Nature of Management and Administration 10 Roderick Martin 3 The Role of the Practice Manager 26 Ly nne Hob den-Clarke 4 The Personnel Management of the Team 45 Ly nne Hob den-Clarke 5 Training and the Primary Care Team 73 Bernard Baillon 6 Communication 87 Paula Taft 7 Computers and General Practice 101 Angela Scott iv THE PRACTICE MANAGER 8 Managing Audit 128 Michael Drury and Sue Casement 9 Managing Money 136 John Dean 10 Fundholding 183 Lynne Hobden-Clarke Total Fundholding 204 Richard Wilkinson 11 Managing Patients 207 Bernard Baillon 12 Managing Prescribing 220 Christopher Trower 13 Health and Safety 226 Norman Ellis 14 Managing for Quality Care 240 Michael Drury and Lynne Hobden-Clarke Index 248 Preface to the First Edition THIS book is written for the practice managers and senior receptionists. Whilst it will stand on its own, it is designed to accompany Practice Manager Development, a course in which a group of practice managers (and sometimes doctors) learn together and from each other. Whilst nearly all group practices now have a practice manager their experience and skills are very varied. Some, probably the majority, have been promoted within the practice from receptionist and have learnt and developed as time has passed. These have very often had little opportunity to learn outside the practice, little chance to get support and education from their peer group and it has been difficult to introduce modern management skills from different business areas. A few have come from outside with previous management training but have had to learn the medical component of their job the hard way. This book is designed primarily for the former group but we hope that any practice manager would be helped by it. The authors have been drawn from outside disciplines and from the medical world in an attempt to get the balance right; the book therefore covers both concepts and practical issues. Managers are concerned with people, equipment and money and the management of all these aspects of general practice is considered. Not all practice managers are female but for the sake of continuity we have written as if they are and as if the doctors are male. We hope this device will not offend others. We are grateful to Drs Fleming, Oldroyd, Ridsdill-Smith, Taylor, Pike and Steel who, sometimes with their practice managers, advised on the content of the book. We are also grateful to a large number of secretaries who have helped. Finally, our thanks go to Andrew Bax and Kate Martin at Radcliffe Medical Press and to Ciba-Geigy Pharmaceuticals whose financial help made publication possible. Professor Sir Michael Drury Department of General Practice University of Birmingham November 1989 Preface to the Second Edition THE wide acceptance of the first edition of this book has been responsible for the need to reprint it during its first year. Further demand has given an opportunity to produce a Second Edition and to add some new sections, keeping it thoroughly up to date with the rapid changes in the health service. In particular, sections have been added to cover audit, practice prescribing budgets and fund holding. We have also taken the opportunity to make alterations to those sections covering communication, motivation and team work as well as revising most other chapters. All concerned in this new edition recognize the importance of the role of practice managers in today's health service and hope that this book will help them with their tasks and add to the satisfaction they obtain. I would like to acknowledge the help of David Clegg and Michael Hamilton, who have joined our team of contributors for this edition, and of Janice Downing and Pauline Shepherd, who advised in its preparation. Professor Sir Michael Drury Department of General Practice University of Birmingham May 1991 Preface to the Third Edition Despite the popularity of the first two editions of this book the rapidity of change in general practice has meant that a third edition is required, only four years after its first appearance, to ensure that it is thoroughly up-to-date. We have made radical changes, including enlisting more practice managers as contributors, who now provide almost half the content, and sharing the task of editing. Computing now merits a separate chapter and the chapter on fundholding has been revised and expanded. Issues of quality are dealt with in the sections on audit and in the final chapter. We are grateful for the enthusiastic support of contributing authors and to the editorial staff at Radcliffe Medical Press. Finally, we are aware that the pace of change is unlikely to slacken and would therefore welcome any suggestions from our readers on how this book may be further improved. Sir Michael Drury, Emeritus Professor of General Practice, University of Birmingham Mrs Lynne Hobden-Clarke, Practice Manager, Gerrards Cross Publisher's Note Gender is an issue which always provokes controversy and comment, and there is no successful formula which can avoid it. Readers of this book will notice that some chapters are written as if all practice managers are female, and others as if they are male. Although it would normally be part of our editorial process to make the text consistent in such matters, we decided, on this occasion, to leave it according to the contributors' style. This policy will not satisfy the purists, and to them we can only apologize. However, all of us know that practice managers can be of either sex, and we ask those who use this book to read it with this reality in mind. Radcliffe Medical Press July 1994
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