I came into practice management almost by accident. About ten years ago I was working as a senior nurse in a struggling Dorset practice which was lacking organisation. Seeing that things needed to be done I began to put little changes in place, and when the practice manager left I was offered the job. I didn’t want it at first, but I’m glad I changed my mind. I enjoyed bringing the practice back to a good level and seeing happy staff and patients.
I’ve since moved to Chichester Smiles to work for a friend, where I’m part of a lovely team that feels like a big family. We have four surgeries (three dentists and one hygienist), one receptionist, and five other staff who help to run the desk and work in the surgeries. Most staff work from 08:00 to 17:00, with a 13:00 finish on Fridays.
My day at work
I arrive at work just before 08:00 and start with a walk around the practice to make sure everyone is in. I have a brief chat with staff about the day to come, and then I check that the emergency drugs are in place and have not been tampered with. Next I catch up on emails over a cuppa; with a toddler at home this is precious quiet time that helps me get into work mode!
- 08:00 Arrive about 7.45am and put Wave 105 on the radio (I like listening to Steve Power in the morning); check all staff are in. I check the emergency drugs are in place and I also give out the surgery keys to their filing cupboards. The girls make tea for everyone, and I then sit at my desk with my cuppa and some breakfast and look through the appointment book to see which patients are in. I then print a day list for fire reasons and check my emails and voicemail.
- 09:00 I have lists of things to do each day, so I go through my diary and also have a look to see if I have any pending appointments with patients or company representatives.
- 10:00 I also have lists of daily, weekly, monthly and yearly things to check, and I go through those so I don’t forget anything.
- 11:00 By now I would have put the coffee pot on and I take a break for about 15 minutes. During coffee breaks I often do CPD (continual professional development) and catch up with reading or webinars. Then I get on with jobs which could range from stock ordering, to an ‘open courses of treatment’ report, talking with NHS Services, other reports etc.
- 11.30 is the morning cut-off for filling gaps for the afternoon.
- 12:00 During the day, other things may crop up like equipment failure, staff being unwell, or staff/patients may want to speak to me etc.
- 13:00 Lunch.
- 14:00 I finish off the morning jobs I haven’t finished – if there are any. Sometimes I have phone calls to make; today I had to speak to a tutor for one of our new nurses, because I’m about to start mentoring her on a training programme which will continue over almost a year. I will have to assess her in the surgery and do an ‘online assessment’ form for each module.
- I also check the appointment book, because we have a cut-off period at 2.30: if we haven’t filled the gaps in the book for the next day, the staff put new patients in.
- 15:00 I’m usually ready for another cuppa by now! I often do filing, tidy up, re-organise my in-tray ready for the next day and move anything in my diary which doesn’t get done to the following day.
- 16:00 There are times during the day when I’m out and about in the practice, but often during the late afternoon I’ll be in reception making sure the staff are okay and checking that the surgeries will finish on time. If there’s time, and reception or the surgeries are quiet, it’s nice to have a chat and a catch up with the staff; I like to be sociable, but also to ensure that they’re okay.
- 17:00 Usually, at this point I’m finished for the day. Sometimes I stay late to chat to the cleaner, archive papers (located in the surgery), or for some other reason (an electrician might be coming in to fix the wiring, for example).
- 18:00 At home by now, playing with my daughter and chatting to my husband!
To help me keep on top of my work I have checklists on the wall. I tick my tasks off daily, weekly, monthly and yearly. This is especially helpful for monthly and yearly items that can easily be forgotten about. I also found this system very useful when I had my CQC inspection.
Like most people, I find it very satisfying to tick off my whole to-do list or empty my in-tray, but this is not always possible. At times my to-do list carries over to the next day and my in-tray seems bottomless, but you just have to know what you can achieve and prioritise the things that will make the biggest difference.
Keeping on top of the routine tasks helps me make time for CPD and my own professional development phase (PDP). I hold in-house training and CPD sessions on an as-and-when basis (mainly during lunch breaks); these sessions are usually no longer than 15 minutes and staff don’t have to attend. Those who do come along are given non-verifiable CPD.
Finding the right people
Although most of our staff have been here a long time, occasionally we get in some new blood and I love meeting and interviewing people. Whatever the role, finding the right person is really important; too many similar personalities can cause a lot of challenges for a manager and create havoc among the team. My husband has been a big help with this, passing on useful tips from ‘personalities in the workplace’ courses he’s attended.
Maintaining a positive vibe in the practice is a real priority for me. If I notice staff aren’t happy I let them know and make it clear that I’m more than happy to help them – especially if their concerns are work-related. Those little niggles can fester and quite often they can be resolved relatively quickly.
Anything can happen
Whatever systems we put in place as practice managers, we know that every day is different and adapting to this is part of the job. Equipment could break down; a nurse might fall ill in the middle of the day; a patient could faint in the waiting room… sometimes quick decisions are crucial.
Phone calls and appointments are also difficult to predict. Our principal dentist liaises with me over lots of things and she’ll often ask me to arrange appointments with contractors, business reps or to interview candidates. At other times I’m the one receiving the calls, such as from NHS services who need things doing or checking.
Although anything can happen and no two days are exactly the same, I try to keep to my own working pattern as much as possible so that I know where I am.
Q and A
1. What are the most rewarding aspects of your role?
When I know I have helped make a difference for a patient or member of staff. Sometimes patients want to talk to me about their treatment plan, their dentist, or just whether they can get up the front steps or not!
On other occasions I’ve had staff in the office telling me about personal issues they’ve found difficult to cope with. They know that it won’t go any further, so chatting confidentially usually helps them to come into work and do their job knowing that somebody else is aware of their problems.
2. What are the main challenges you face in your role?
Staff disputes are the biggest challenge, although thankfully I don’t get many nowadays. In my previous practice there was lots of tension, and I once had to separate a dentist and a nurse who were arguing loudly at the front desk, in front of a full waiting room! I asked them both to come into the office and explain the problem, and then had to decide on an immediate solution.
Sickness can be very challenging too, especially long-term sickness. As the employer you cannot put pressure on someone who is sick; you just have to manage the situation and seek legal advice if necessary. You have to ensure your staff rota is covered; you can’t employ someone simply to ‘hang around’ just in case someone’s off sick. Things get even trickier when other staff want to book holiday time. One solution we’ve come up with is training one of our nurses as a treatment coordinator (TCO), which provides essential cover when we need it.
3. What are your professional concerns for the coming year?
Staying on top of Units of Dental Activity (UDAs) is always a top priority. I check that the appointment book is full on a daily basis, and keep an eye on dentists’ annual leave and training courses. Of course they are entitled to this time, but I try to make sure it’s spread out.
The new NHS contract is a concern too, but it’s just one of those things you have to get on with when it arrives.
About the author
Caroline Adair has 25 years’ experience working in dentistry and has spent over ten years as a practice manager, having first qualified as a registered dental nurse. For the past five years she has worked at Chichester Smiles, where she ensures the practice runs smoothly on a daily basis. In her spare time she enjoys spending time with her family, walking, gardening, country living, and bargain hunting.