I’ve been looking at my Practice Manager Handover Manual again, having found an example of a practice that’s been going through a succession of managers and three GP retirements in the space of 12 months. I learnt that while there may have been a handover of sorts, the quality of the handovers left much to be desired. I’ve prepared a manual on at least five occasions in differing circumstances.

A manual for all seasons

In recent years, like a number of my colleagues, I’ve been charged with the unenviable task of helping a practice without a manager to get to grips with running a safe practice again. The previous manager might have resigned, walked out, gone off sick or, in one case, sadly died suddenly. As a consequence, I’ve helped to develop an extensive reference manual for practice managers. The handover manual is a made-to-measure document that sets out what a new PM will need to know from day one.

Change and change again

There are of course AMSPAR qualifications and many worthy professional and business qualifications that will stand any budding manager in good stead. But in my opinion a practice that’s suffering from too much change and from too little expertise needs someone with considerable PM experience to sort them out and get them back on the road to recovery. There has been a great deal of change and new ways of working even in the last six months.

Farming out the work

It doesn’t help when major and important business tasks, such as payroll or accounts, are delegated to an agency or accountant and the practice has no clear, identifiable and knowledgeable leader. I’ve found on a number of occasions that practice accounts haven’t been kept up to date, ranging from being a month to six months out of date. I’ve even come across a manual payroll. I’ve discovered that annual pension updates for staff and doctors haven’t been completed. I’ve seen manual accounts with only one signatory to payments. Claims for NHS income have ceased to be made. In one case, the use of a not widely used clinical system hadn’t helped matters, making training difficult. Even worse, a CQC inspection was threatened and there was no current registered manager in post.

Be CQC aware

Do you have a registered manager? Is your website up to date? (If not, remember that internet searches can produce unpleasant reviews.) Are your practice policies up to date? Are there records of significant events and clinical audits? Are personnel files complete with records of the recruitment process, training undertaken and DBS checks? Is there a record of PAT tests, a cleaning regime, and clean curtains? And so it goes on… Would you pass the test of an instant inspection? The answer is simple: all the questions the CQC may ask should be regularly reviewed and updated.

Where the pennies are sparse!

I’ve been to practices that are close to the breadline, yet cheques and cash haven’t been banked. Claims haven’t been submitted and there’s a backlog to catch up on. There are bills not yet paid. Even worse, there are bills showing the wrong amounts which have been paid, or paid twice! No one seems to know what payments are being made to whom and why.

The new PM needs to start by recording all the tasks and systems in place. It might begin with a collection of passwords to be kept under lock and key, but including Open Exeter for payment statements, CQRS for making claims, and access to banking online and the payroll. Then there’s the NHS Pensions website and probably the Government Gateway for the Inland Revenue.

Here’s a short list of the most important areas a handover manual needs to cover:

• Annual accounts (year end)
• Appointments system (structure and organisation)
• Banking arrangements (signatories)
• Clinical computer system – IT support
• Complaints management
• CQC registration
• General management (clinical correspondence, safety alerts, audits)
• Keyholder and estate management
• NHS email and smartcard management
• NHS pensions (staff members and GP superannuation returns)
• NHS management (CCG, PCN, PCSE, NHS England, etc.)
• Passwords
• Payroll management
• Personnel – induction
• Petty cash
• Practice accounts – practice accountant
• Practice policies, protocols, procedures and plans
• Prescribing management (repeat prescriptions)
• Staffing establishment
• Telephone system – call management (triage, text, video, etc.)
• Training
• Website management (surgery, NHS Choices, CQC, Google, etc.)

This list is by no means exhaustive. Each practice will have key features that new staff need to know about.