Two primary care managers talk to Lyn Whitfield about the challenges they face driving forward the IT and clinical governance agendas

Lynn Smith Primary care information projects manager, Stockport health authority.

Stockport HA covers a population of approximately 300,000 people, 59 GP practices and 170 GPs.

Age: 37 Salary: SMP band 5,£21,600 to£25,958 per year.

Describe your current job I am a primary care information projects manager at Stockport health authority. I work as part of a small team overseeing IT purchasing, support and maintenance and offering advice on IT developments.

What was your career path?

From 1997-98 I worked in the evaluation and audit unit of Manchester University's public health department. One of the department's projects concerned clinical guidelines and their use in primary care. I became interested in finding out how a clinician combines what they know from personal experience with formal guidelines and research knowledge: how they end up with 'value added' guidance for practice.

I was then fortunate to be part of a two-year project piloting local multidisciplinary evidence centres (LMECS) in the North West, financed by the non-medical education and training fund.

As project leader for the Warrington LMEC, I was based at Appleton Primary Care, a first-wave personal medical services pilot, which gave me experience of a wide range of systems and IT issues.

When my fixed-term contract finished, I knew I wanted to stay in primary care computing and the Stockport post was advertised at just the right time.

What is the most satisfying part of your work?

It is always satisfying to help any practice with a call for basic IT support, especially if it is something we can deal with immediately.

However, I am most satisfied when we contribute to an increased use of computer systems for clinical purposes. It is always nice to see a practice changing the way it works and beginning to store quality, retrievable, meaningful clinical data, and to know that we have helped staff to 'work smarter and not harder'.

What is the most frustrating aspect of your job?

Much frustration centres on the fault resolution process with clinical system suppliers. Sometimes it can take the best part of a day to register a call for support.

In another vein it can be frustrating to see IT solutions implemented as a 'tick box' approach. I believe we need to make a distinction between IT (a technical solution) and informatics (the intelligent use of information). Once the infrastructure programme (Project Connect) is completed, informatics will become a bigger issue.

What are the main challenges ahead?

Having ensured each practice in Stockport is connected to NHSnet, we need to make sure that every clinical desktop has access.

We are also engaged on a project to help practices change how they send information to the HA. At the moment, messages come across a network called Healthlink. We need to transfer them to NHSnet, which is run by the NHS itself. We also need to alter the way messages are structured.

These tasks will take a lot of project management.

And national infrastructure programmes being developed by the NHS Information Authority will overlap with our work programme.

What has been the high point of your career?

Very difficult to answer. But if I had to choose, it would be some of the work I did at Appleton. It was established as a paperless practice, but after each visit, patients would be given a printout of their consultation notes, plus a list of medication.

We wrote up what we did after I moved to the HA and had an article published in the Journal of Integrated Care.

At Appleton, we also encouraged patients to come and see me if they had information needs.

For example, I would help someone search quality-reviewed websites or suggest ways of appraising the information they found elsewhere.

It was very satisfying to help a patient find information that allowed them to take part in the decision-making process. It is their health, after all.

What has been the low point of your career?

Also difficult to answer, but I was disappointed when the LMEC project came to a close. We were making progress with drawing on clinicians' knowledge and experiences to enrich the service to make it a truly local resource with value for local practices.

How do you relax?

I am a season ticket holder at Manchester City, although I doubt I could describe supporting City as relaxing. I also play drums for a local, unsigned band.

If you were to choose an alternative career, what would it be?

I would have liked to be a professional musician, preferably a jazz drummer.

Could you imagine tackling clinical governance?

I am not sure where I would start. I would need to have a practical working definition of clinical governance - but I do not think it is something you can 'do'. It is something you have to 'practise'.

Derek Mitchell: Clinical governance manager, East Kent health authority.

East Kent HA covers a population of 600,000, five primary care groups and just over 300 GPs in just over 100 practices. More than 240 GPs in 70 practices are in the PRICCE project, but it should cover 90 per cent of local GPs by next April.

Age: 44 Salary:£39,000 per year,£31,000 prorata.

Describe your current job I am clinical governance manager at East Kent health authority. I work in a team of five, which includes the HA medical adviser, pharmaceutical advisor, a clinical governance nurse and an assistant manager. I am also the project manager for our primary care clinical effectiveness (PRICCE) project, which takes up a lot of my time.

The team is responsible for performance management of primary care group clinical governance. This includes approving primary care group clinical governance plans and supporting PCGs in implementing them.

What was your career path?

I have managed to run two careers in parallel by combining academic philosophy with my NHS work. I started in the NHS in 1986 as a practice manager in a very innovative group practice. I moved to the HA in 1994, first into locality commissioning, then primary care service development, then clinical governance. I work for the HA four days a week and completed a PhD in philosophy in 1997. I am now doing a diploma in healthcare ethics at King's College, London. I chose my current job because, having begun the PRICCE project, I wanted to follow it through. I am also interested in understanding the ways in which clinical behaviour is changed.

What is the most satisfying part of your work?

The best bit of the job is knowing that we are actually doing some good for real patients. With more than three-quarters of the population of East Kent now in our project, the work is touching the lives of thousands. The feeling that people are benefiting directly from the work I do is important to me. I think it comes from my own background and from having worked in general practice where patients are very much seen and heard.

And the most frustrating aspect?

The most frustrating aspect is knowing what needs to be done but finding it difficult to move through the morass of procedures and competing interests that make up a lot of the NHS. I think I share the frustrations that many GPs express when they can see what patients need, but the system is not able to respond quickly enough - or at all, in some cases. We have a very definite implementation culture in our team, which does not always make us popular, but it does get things done.

What are the main challenges ahead?

The main challenge I can see is to keep the good work that we have been doing going when primary care trusts are established next year. Continuity and consistency of approach has been an important part of our success and I would hate to see that diminished. It has taken time to build up the expertise and respect that we need to do our job and it would be a pity if that were to be lost just at the time it is beginning to be needed most, through yet another organisational change. In the longer term, I suppose the challenge is to make the projects that we have been running sustainable and to make clinical governance a part of mainstream culture, supported by mainstream funding.

What has been the high point of your career?

There have been two high points. The first was when it became clear that the PRICCE project was going to be a success, and that was when we visited all 26 first-year practices in the summer of 1999. It was great to hear and feel the enthusiasm of the practices who had worked so hard over the year - and to be able to congratulate them. The second was when I collected my PhD in the cathedral at Canterbury with my parents in the audience.

And the low point?

The worst moment was when I was a service development manager. We thought we had a six-figure sum to share between a group of practices, but it turned out there were a lot of strings attached and we had to disappoint them. It was a difficult period because we had spent a lot of time asking the practices what they wanted - so we got a lot of criticism for giving them something else.

How do you relax?

Apart from the philosophy, I grow flowers and vegetables, and cycle. I also buy 18th-century flatware (spoons, forks and plates, usually in silver or pewter).

If you were to choose an alternative career, what would it be?

Probably academic teaching: although the pay is worse than in the NHS. And the politics are more vicious.

Are you a computer wizard?

No, not really - although some people seem to think so. I once had to negotiate our computer reimbursement policy through the local medical committee, and we computerised the practice where I worked in 1987. I am a firm advocate of the use of computers in all aspects of general practice, but I am only really interested in what computers can do for me - not how they do it.