Part 1 of this series looked at delegating minute-taking, reports and internal and external communication. These will have given your APM a good insight into the basics of what the practice does and how things work.
There are many other day-to-day practice management issues that you will want your APM to become involved with. Some of these are listed below, along with advice on how to help them get up to speed and tasks within each area that can be delegated to them.
There may be other issues in your practice that you feel need to be covered as part of this.
Health and safety
Have the APM to shadow you while you carry out risk assessments and ask for their input. Once they are used to the risk assessment process, ask them to run risk assessments solo and to update the health and safety policy based on latest guidance, you will need to show them where to find this information and get them to ask for help if they need it.
You could also train them in fire safety and ask them to ensure that practice is compliant and that all regular annual checks are carried out and that staff are trained appropriately.
- Health and Safety Executive (HSE) short guide to Workplace health, safety and welfare
- HSE FAQs on risk assessment
- HSE guidance on fire safety
- CQC Essentials: Health and safety issues in GP practices
Significant event analysis
This is an area that could be delegated to the APM, ask them to set dates for quarterly meetings with clinical and non-clinical staff and encourage staff to record significant events. You will need to train them up so that they understand the rationale for SEA reporting and how it improves quality.
Ask them to champion SEA reporting in meetings – it can sometimes be difficult to instil a culture of reporting as everyone is busy and may not always see the event as "significant" They can also take the minutes of the meetings, write up the forms and follow up on action points.
Ask the APM to review the disaster recovery plan once a year and make sure that all the contacts are up to date.
It is good practice to go over the plan at least annually with both clinical and non-clinical staff so that they understand what to do if you need to put the plan into action. Encourage the APM to come up with disaster scenarios and run through these with staff.
Ask the APM to work with the clinical lead for infection control to ensure that regular checks are in place.
It is good practice to do a full audit once a year of all of the rooms to ensure that there is no out of date stock, that any minor damage (cracks, peeling paint etc) is noted and rectified. Ask the APM to follow up on any actions identified and cost up any repairs or improvements that are needed.
Ensure that the APM is fully conversant with information governance (IG) – the full training on the IG toolkit is helpful for this. Let them work with you to complete the annual IG toolkit and perhaps ask them to work on some of the areas of compliance over the year to ensure that all policies and procedures are up to date and that everyone is compliant with the policies.
With the recent introduction of Patient Online, are policies for allowing patients access to records being followed? Do receptionists understand and use the policies? Encourage the APM to monitor the effectiveness of procedures and report any potential for breaches, so that practice can learn from these and ensure confidentiality policies are followed carefully.
- Data protection in GP practices
- Providing online access to patient records
- Proxy access to online patient records
- RCGP’s Patient Online Practice Toolkit
Your practice should have an IT asset register. Ask the APM to ensure that the network of computers, printers and any other IT equipment is logged. Ask them to manage any log of problems that are reported to the appropriate service desk and followed up if they are not fixed.
Training the APM is a good time to review systems across the practice. While you are explaining each of the areas below, you could ask your APM to consider any improvements that could be made. There are suggestions for what you and the APM could think about as you run through these.
Explain to the APM how your registration process for new patient works. Does the registration form capture all the necessary information? If you do registration health checks does everyone turn up for them, do you have a high number of registrations rejected?
It is worth asking the APM to become familiar with your contract and any enhanced or local services and to do a compliance review. This will allow them to understand the contract and what the requirements are but also to look at the contracts with fresh eyes and see where there are gaps or improvements could be made.
You may also want to give them responsibility for one clinical area, for example childhood vaccination recall, making sure that the process is in place for calling in patients and ensuring that maximum targets are reached
Annual audit is a requirement for CQC, you could ask the APM to assist in the data collection phase of clinical audit.
You could also look at carrying out a non-clinical audit, for example of the appointment system, referrals system or registrations process. Things to think about include: what is the current system, what is working well and what isn’t working well? Is there a protocol, is everyone following the protocol? What changes could be implemented to improve the system? Review changes after a suitable time period and repeat the cycle.
Ask the APM to look at current recall processes, are they working the way they are supposed to, is the practice meeting its targets, if not why? Which process works the best and can this be replicated for other targets?
Many APMs are responsible for organising the rotas so this is a good area to train them up in. They will need to be able to understand what staff are available when, how many hours/days people work, be able to plan for annual leave, make suggestions for how the rota needs to be adapted and when locums should be considered.
As they become more experienced with dealing with the staff rota, ask them to have a system for monitoring locum use, ensuring that this resource is maximised and that all of their appointments are booked.
You could also ask them to review the locum induction system and locum pack, and making sure it is up to date. Some things to consider while doing this:
- Are there often teething problems with new locums as they are not used to the system or can’t find patient leaflets or their printer doesn’t work?
- Is there a way of improving the system so that the induction is smoother and less time is wasted?
- Is there any scope for interviewing regular locums to find out what they think works best and worst about the practice and feeding this back?
- Equipping a GP locum to do their job safely and effectively
- Preparing GP locums to make effective home visits
- CQC Essentials: GP locums
The APM could review the policy and complaints leaflet, ensuring that it complies with current guidance and that it is publicised to staff, in the waiting room and on the website. They could also be first point of contact for complaints to try to resolve them informally and to draft responses to formal complaints.
Assistant practice manager training plan
- Assistant practice manager training plan 1: Admin, reports and communications
- Assistant practice manager training plan 3: Practice finance
- Assistant practice manager training plan 4: HR and staff management
Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member.