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The Business of Healthcare: An interview with David James

David James has worked in healthcare for nearly 15 years. After becoming a Practice Manager in 2005, he has gone on to become Chief Operating Officer at Greenwich Health, a GP Federation in South East London.

With 35 practices in his federation, David’s role involves managing the conflicting needs of lots of stakeholders.

Here’s what David had to say when I asked him about the complex dynamics of his role.

How did you become a Practice Manager?

David: I have an undergraduate degree in Business and IT. My first proper job was with a major IT provider in primary care at the time. After a couple of years, I took a job as an IT Manager in a general practice. I went on to become the Facilities Manager and then a Practice Manager over a period of about eight years.

Was it a big jump from Practice Manager to COO of a GP Federation?

David: Even though the jobs are very different, it wasn’t such a big jump because I had a period of overlap. At one point I was simultaneously working for the CCG, a general practice, the locality network and Greenwich Health.

Tell me about your average week?

David: I’m based at the Greenwich Health offices. There are eight of us there, but the whole Greenwich Health team is between around 80 to 90 people, including GPs, nurses, HCAs and receptionists.

We have a team huddle every week and I’ll tend to have a few one-to-ones with other members of team as needed through the week. I spend a fair amount of time with external stakeholders in meetings for contract monitoring and development, and usually try and find one day a week to work at home to allow me to concentrate on any larger, more detailed pieces of work.

My role is largely strategic and financed-based. I set the direction, prioritise and make sure the team are working on the right projects. I also liaise with the clinical directors who represent our four localities and talk to CCG staff on at least a weekly basis. In addition to this, I often attend South East London STP meetings. We try to ensure we only attend external meetings we know are going to have the biggest impact upon us as an organisation and those that we feel that we can have an influence over.

How many people do you manage? How does that work day-to-day?

David: The office can be quite a lively place, particularly on a Tuesday when we have all our Clinical Directors in. I directly manage the eight people in our head office. It’s a really good team and we’ve grown quickly this year. We held an AGM in November and focused on celebrating our success, which gave the newer members a really clear understanding of everything we do as a company.

They in turn look after the wider teams, made up from receptionists, HCAs, nurses, GPs and others, including a number of sub-contractors we work with. They report back on any issues and where necessary I’ll provide support and suggestions to help them manage those services or projects.

Is your job stressful?

David: It can be. CQC inspections can definitely add a new level of stress.

I find that people feel stressed when they don’t feel in control, or when things are just building up. I find the best way to deal with it is to know what’s going on and what needs to be done. Getting things ticked off that task list is always a good de-stressor.

What surprises people about what you do?

David: I think, for most people, it’s the variation, which is one of the things I love.

I can go from doing some detailed design work to strategy, to finance, to interviewing in the space of a week. A lot of people don’t understand the NHS and how it works. Once you’ve been in it long enough, you start to get the intricacies, understand how the commissioning works and particularly the way CCGs are forced to commission competitively. I think this surprises a lot of people.

How do you help new recruits to understand the world of the NHS?

David: We just try to immerse people. We had a new starter in November, and we didn’t ask him to do an awful lot for the first month. It was primarily a case of ‘come to this meeting’ or ‘go to that meeting’ and build a picture of how the parts of the system work together. Allowing someone to get their head round the intricacies of primary care before throwing them in is really valuable.

You have a fantastic team, do you think good people are hard to find?

David: I don’t know if we’ve been lucky, but everyone’s been a success. We tend to recruit through NHS jobs, and I guess we recruit in the same way as everyone else: we screen, we go through CVs, we interview. But, actually, we’re not afraid to cut the cord if it doesn’t feel right.

What are the main challenges or pressures you face?

David: A lot of people have a stake in what we do. The CCG and the local authority want us to be doing something, and the practices might want us to do something else. Even within our membership practices, different practices can want different things. Piloting our way through that is a challenge.

Staying on top of the shifting landscape of the NHS is also a challenge, particularly with the perpetual reorganisation with things like the 5-Year Forward View, the 10-Year Plan and the new GP Contract.

What training and education have you had to support you in your role?

David: I did the MSc in Healthcare Leadership through the NHS Leadership Academy. And I’ve done lots of role-specific training over the years about things like putting bids together, giving effective presentations, managing meetings and how to deliver training. So it’s lots of different strings I’ve added to the bow over the years. I feel it’s important to keep active and keep training on any areas you identify as a weakness.

Do you network with leaders from other federations? Is there competition?

David: I’m a bit of an introvert. I’m generally not the loudest person in the room, but it’s certainly something I recognise as a need. The final project of the Masters was really self-reflective. What I hadn’t really recognised as a strength previously was the relationships and the network I’ve built up. I take time to try and catch up with some of the other federation leads on a regular basis.

There’s an element of competition in as much as often the STP will have a pot of funding, and that funding will come down to the bids you write. I think there’s a recognition that, if your federation or your localities are not performing, there’s a chance that someone else could be waiting to take over.

Are there any skills you feel you need to improve on?

David: I’m constantly looking to build. My finance skills are something I’m concentrating on presently so am working with a senior CFO who is providing some mentoring and recently completed a module on financial management and planning with CASS Business School.

Tara Humphrey is the founder of THC Primary Care, a leading healthcare consultancy specialising in workforce transformation and the only consultancy to have worked with 11 Training Hubs across South London, Kent, Surrey and Sussex.

Tara and her team also work with GP federations supporting the implementation of clinical services.

Tara has over 20 years of project management and business development experience across the private and public sector and has an MBA in Leadership and Management in Healthcare, is published in the London Journal of Primary Care and is the author of over 100 blogs. 

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