Practice Managers Manual in around 1000 words?…….

This is a suggested ‘content’ guide to a manual that all practice managers usefully prepare for their Practices and their successor(s). As I have found from experience it is never certain that you will turn up for work tomorrow. One of my colleagues died suddenly on holiday. Likewise there is never a guararntee that when you resign or retire, hopefully gracefully, that you will meet the new manager for a formal handover of duties. These days too with the threat hovering overd all practices of an inspection, even when you are on holiday, from the Care Quality Commission it is also a wise move to document your ‘fountain of knowledge’ about the Practice. So what should you include?

Who’s who and who’s in charge?

A good starting point might be a basic list of the names and personnel details of all doctors, nurses and staff making up the Practice Team. In one practice I worked at recently I had to set up a computer payroll immediately so finding out about everyone very quickly was essential. I ended up asking each individual for their personal details. I even had to ask for copies of recent payslips. Added to that once produced the ‘list’ formed part of a Disaster Recovery Plan just in case the surgery burnt down. An organisation chart setting out the staffing structure and job titles would be helpful as would an indication as to what the ‘pecking order’ is. In other words ‘who is in charge?’ and who is the Registered Manager for Care Quality Commission (CQC) purposes.

Who does what?

Hopefully there is a decent up to date set of personal files for all members of the practice team along with signed copies of contracts of employment, and a full set of Personnel Policies. Again I have found such files incomplete, moth eaten and dog eared or even non-existent. I also found no ‘Word’ file copies of personnel documents. Training Records were also sparse or non-existent. The manual might need to provide a set of Job Descriptions and a description of the management structure. The CQC has been ‘touchy’ about the need for Criminal Records Checks for all staff before employment starts and they also liked to see training records and references where and if they exist. Who carries out the annual Staff Appraisals and is there a record of them? The manual should provide an outline all of the processes involved.

Who gets paid and how?

A short guide on how to run the Payroll each month (Iris or Sage Payroll software) and what actions need to be taken at the end of the tax year. The guide should also set out the arrangements for drawings for the principals, and payments for salaried doctors and practice staff. Has the Practice adopted Agenda for Change and how is the annual cost of living pay increase applied if at all? Inland Revenue notifications are now sent online so a record of the Gateway registration should be available. In addition the user name and password for the NHS Business Agency for the NHS Pension Scheme should also be apparent.

How are payments made?

The manual should show how and when payments to ‘suppliers’ and creditors are made. This might include a list of suppliers and their banking details. It should also be possible to find copies of any ‘lease’ agreements that have been entered into often for switchboard systems and telephone services. The Manual should describe the practice Bank Accounts and explain who is or are the signatories to the account(s). What are the arrangements for dealing with cash – how and where is it banked? Are there still cheque books or is banking on line in use? Who is authorised to make payments on line or sign cheques. Is the Practice Value Added Tax registered and when are returns due?

What Income is received and how to claim?

There will be both NHS Income and Private Income but the type of income received will vary from practice to practice so a new manager will need to know what to claim and what to monitor. A description of all income sources would therefore be invaluable along with a note of who to submit quarterly claims to and when. Whilst the CQRS (QOF) payments are claimed via the practice computer some claims need to be submitted via Open Exeter and other needs to be sent to the Clinical Commissioning Group or the Local Government Authority. Some require an invoice and others require a form to be completed. Life is complicated and payment is not always consistent and therefore difficult to monitor. What happens to the private income received and is there a scale of fees that is revised annually?

How is income and expenditure recorded?

There are a number of accounts packages, such as Iris Accounts or Sage Accounts, available to use and a description of the package used and how it is used would be ideal. What headings, category or classes of income and expenditure are used? In addition, as a guide a copy of a recent annual accounts document should be appended to the manual. Some practices still use spreadsheets. One area that I have experienced not being recorded adequately was NHS Income as shown on the monthly statements that can now be downloaded from the Open Exeter site directly into accounts software. The manual should list what documents the Accountants will need to prepare the Annual Accounts. It should include banks statements, cheque book stubs, invoices, receipts, NHS statements and remittances, and backs up of the payroll and accounts or printed versions.

Where do you work – all about the premises?

The workload for the practice manager is significantly affected where premises are leased as there may well be a requirement to contract for the maintenance of the building. The practice manager may need to deal with a variety of maintenance agreements covering a lift, fire prevention, fire alarms, burglar alarms, cleaning and CCTV security. The strangest contract I have come across is for a man safe. It turned out to be wire on the outside of the building used to hold the window cleaners cradle. The manual should describe how the property is looked after. The manager will need to know what the arrangements are for notional rent review by the District Valuation Service. It goes without saying that life is far more complicated if there are ‘branch surgeries’.

What computer systems are in place?

There seem to be two distinct GP practices at large these days – the EMIS practice and the Systm One practice. A new manager not familiar with one, the other or either will at least need an introduction as well as an NHS Smart Card and an NHS email address. The manual should explain how to obtain an email address and a smart card. Instructions will need to be available on how to access all the computer systems – is a list of passwords kept in the practice safe – that assumes there is one. Are the entries on the Practice web site and NHS Choices up to date? The practice may use My Surgery Web Site or Neighbourhood Direct. It may also use the GP Intranet.

Who does the practice work with?

What are the local health organisations? Who are the contacts at the Clinical Commissioning Group, NHS England, and is there a local ‘federation’? What are the issues the practice is involved with. Does the Practice share premises with another practice(s)? Do any of the Team members have ‘roles’ outside the practice such as member of the Local Medical Committee or ‘police surgeon’?

What services does the practice provide?

What services are provided for patients. Are they described in a practice leaflet and is there a patient participation group? Describe the appointments system and what the oncall and overnight and weekend arrangements are. How is the telephone system operated? Is it a training practice? Does the practice use Choose and Book?

How often does the Practice meet?

The manual should describe what the arrangements are for regular meetings in the practice with the doctors and with the practice staff. There may also be a monthly protected afternoon when members of the practice attend CCG meetings or staff training sessions.

Finishing off and wrapping up!

Finally, the Practice Manager should have a record of the General Medical Council registrations of all doctors and membership of the Royal College of Nurses. There should be a record of all medical indemnity and surgery content and buildings insurances. The Manager will need to know how to deal with an application to join the Professional List.

Robert Campbell – December 2014 (Copyright)

All in all the document needs to be informative and thorough. This is just a short guide to the content. You may have much more you can or should include? Just live in hope that ‘someone’ will read it. Make sure you have given a copy to the doctors.

The author has also prepared for Handbook for Practice Nanagers and a Practice Managers Dictionary which can be found elsewhere on the web site. You can also visit

Robert Campbell – Revised  2016

1201 words


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