Practice Makes Perfect

by Penny Parkes

  ‘Already on it,’ she called.

  Dan looked up. ‘Tell them I’ve done a light tourniquet to minimise structural damage and we’ve been pressuring the puncture site. Ask them if they’ve an inflatable device?’

  Julia shook her head. ‘That’s military kit, Dan. They’re not going to have one in a local ambulance.’

  He glared at the offending wound in front of him. ‘Well maybe they bloody well should,’ he said grimly, as the paramedics dashed in through the doors and the team began the process of handing over their patient: Holly with relief, Julia with a litany of instructions and Dan with obvious reluctance. True to form, it was Taffy who shepherded Cassie into the ambulance beside her son, all personal acrimony forgotten, in his role as their family GP.

  Chapter 3

  By lunchtime, a sense of unease still spread throughout The Practice. So often the team’s interaction with their patients was limited to the mundane and routine, that this shocking and dramatic turn of events had shaken them all. Even Dan, who had no doubt seen so much worse in his army days, was quietly brooding over a cup of tea. Eric, sensing a need for comfort, was curled up on his feet and, for once, Dan made no complaints about the doctors’ lounge becoming Lizzie’s Doggy Daycare.

  He looked up as Julia leaned against the table beside him, careful to keep any hint of dog-hair away from her tailored trousers. ‘Any news?’

  She shook her head. ‘He’s still in surgery. Looks like there was quite a lot of nerve damage. Cassie’s in pieces apparently.’

  Dan sighed. ‘Can’t help thinking we got lucky, though. All of us here . . . No film crew recording our every move . . .’ He watched Julia’s expression carefully, waiting to see if she would switch into defensive mode, but to his surprise she just nodded.

  ‘I’m trying not to think about what might have been, to be honest. Maybe our film-free Mondays actually were a good idea?’

  Dan tactfully sipped his tea, choosing not to remind Julia that she’d fought them tooth and nail on that very concept. Of course, if it were up to him, then every day would be film-free, Dan thought.

  Holly and Taffy walked into the lounge, chatting easily together and bearing a huge bag of doughnuts from Hartley’s Bakery. ‘Best cure for shock,’ announced Taffy as he tore open the bag on the table and the entire team descended like locusts. Even Jade, of the teeny-tiny uniform, managed to snaffle two before her fellow nurses could stake their claim. Only Julia held back, her lips forming a moue of distaste at the unseemly scrabble for carbs and the ridiculous contest that Holly had immediately instigated, not to lick your lips whilst eating.

  Eric, to give him his due, was working his puppy dog charms on everyone and quickly began to look rather sickly at all the titbits heading his way.

  ‘Why is that dog here again, anyway?’ asked Julia, as Eric brushed past her immaculate trousers leaving a trail of the doughnut sugar caught in his whiskers. ‘Lizzie off on another course to find herself?’

  Dan scowled at her dismissal of his cousin’s attempts to find her new niche in life since quitting her high-powered job as editor of local glossy Larkford Life. It was true, Lizzie had explored a succession of possibilities – a long line of passing fancies – each one begun with utter conviction and an expensive course, only to fade into obscurity as Lizzie continued on her quest for a job that was emotionally rewarding, paid well and meant she could be home in time for the school run. It was no small wonder she was having trouble finding the perfect solution. But then, what did he know? He wasn’t a parent and if Julia had her way, then he probably never would be.

  Holly, ever the peacekeeper despite all Elsie’s efforts, could obviously sense the tension and stepped in. ‘You know, Jules, if you’re stressed, you could always get Lizzie to rub your feet. She’s been on a new reflexology course actually and I’m a rubbish guinea pig because I’m too ticklish,’ she suggested.

  Dan noticed Taffy give her a slow, easy smile from across the room that implied intimate knowledge of her ticklish spots and brought a pink flush to her cheeks.

  Julia just rolled her eyes. ‘Enough with the lovey-dovey crap, you two. You don’t see me and Dan all over each other like a couple of teenagers, do you?’

  ‘No,’ said Taffy, with conviction. ‘We certainly do not.’

  Dan studiously avoided catching his friend’s eye, knowing that Taffy found the constant bickering between them both wearing and bemusing.

  Julia raised one eyebrow but beat a tactful retreat. ‘Anyway, I thought Lizzie was studying floristry, wasn’t she, Dan?’

  Dan shrugged, seemingly un-fazed by his cousin’s career carousel. ‘She was. But with the early starts and the hay fever . . .’

  ‘And the crapness,’ interrupted Taffy. ‘Don’t forget the crapness. I’ve never seen anyone make pink roses look quite so bloody miserable before.’

  Holly laughed guiltily, as she snaffled the last of the doughnuts; Taffy’s comment, as always, was particularly astute.

  Julia was laughing too, clearly amused by the notion, but there was no affection there. The undercurrents of rivalry between Lizzie and Julia were always just the right side of civil, but everybody knew that they were only really friends for Holly’s sake.

  But then maybe that was okay, Dan reasoned. You couldn’t be best friends with everyone all the time. Even here at work, the petty disagreements could quickly escalate when essentially living and working in the Larkford bubble.

  It was obviously challenging at times, and certainly a little unconventional, having the four managing partners at The Practice neatly coupled up, but mostly the four friends worked together extremely well.

  Mostly.

  Even if Julia’s ability to micromanage did drive them all insane from time to time. As if to prove his point, she raised an eyebrow at Taffy’s second doughnut, quietly pointing out the fat to sugar ratio in each delicious jammy mouthful.

  But then, Dan thought, nobody ever said their plan was perfect.

  He watched Julia pause mid-sentence and look at Taffy in confusion. ‘Since when do you wear glasses?’

  Taffy silently passed a crisp ten-pound note across to Dan, who pocketed it with a nod and a smile. ‘Buckaroo,’ he said.

  His afternoon having passed without incident, trauma or blood loss, Dan was finally starting to relax. He’d followed up with the ICU in Bath, where young Tarquin was now stable and there was every chance he’d retain full use of the damaged hand with some fairly intensive physiotherapy. He couldn’t deny that the poor boy had been on his mind pretty much constantly all day, and the relief he felt at hearing that news made him physically sag back in his chair.

  His pulse leapt, automatically on high alert, as Taffy burst through the doorway, his laptop balanced precariously in one hand as he shoved the door open with the other. ‘You’re going to want to see this!’ he said.

  Dan pushed his paperwork to one side, fully expecting to see some outlandish video of a cat on a surfboard or a water-skiing piglet. It wasn’t until he saw that it was the conference feed from last night’s National Healthcare Symposium that he belatedly registered the lack of humour in Taffy’s tone. If anything, all he heard was concern and confusion.

  ‘Just watch,’ Taffy insisted, clicking on the pause button to unfreeze the video.

  ‘That’s Harry Grant,’ said Dan, recognising the small bespectacled man who had been so influential in helping them save The Practice the year before. He was their go-to guy in the bureaucracy of the NHS machine and it never hurt that he had such a soft spot for Holly when it came to calling in the occasional favour. Even now, a year later, Harry still referenced her selfless offer to step aside, in order to let The Practice continue.

  Harry was standing on a podium in a large auditorium, his hair smoothed down and a striped tie making him look incredibly uncomfortable and buttoned up. The banner across the bottom of the screen scrolled slowly, forcing Dan to read aloud in instalments, ‘Harry Grant – NHS South West – The Importance of
Evolving and Symbiotic Relationships in Primary Care.’ Dan looked up at his friend. ‘Well, what the hell does that mean?’

  Taffy shrugged. ‘Damned if I know, but here, this is the bit you need to see . . .’ He clicked on the little icon to increase the volume and held up his hand to stay Dan’s questions. ‘Just listen.’

  ‘Well, to answer your question, Derek,’ Harry Grant said in his nasal voice, the distortion from the microphone making it hard to make out his exact words, ‘I do believe there is a better way. A hierarchy in General Practice creates division – by necessity, there have to be leaders and followers. In my experience, some of the best ideas and input don’t always come from CEOs, Senior Partners or indeed the GPs themselves. I would like to encourage a wider forum – a more collaborative style of management.’

  The camera panned around to where ‘Derek’ – whoever he may be – looked flushed and well-fed in an expensive suit that strained to accommodate his bulk. He had senior management written all over him.

  ‘It’s all very well speaking in generalities, Harry, but it’s just not practical, is it? You’d be letting the lunatics run the asylum. Let’s be honest, we applaud your ideals, but realities must weigh in. You can’t seriously expect us to fund a research project on a large scale just because you’ve dreamed up a management concept you “think” might work.’ He was patronising in the extreme and Dan, who had never even met the bloke, took an instant dislike to him. He could already see that this was the kind of guy who would loudly endorse cutting costs in community care, whilst happily charging his lobster dinner on expenses.

  ‘Twat!’ said Dan with feeling.

  ‘Keep watching,’ Taffy cautioned.

  As the spotlight returned to Harry Grant, Dan felt a surge of solidarity for the poor bloke on the stage. Obviously he hadn’t heard the full paper that Harry Grant had delivered, but his passion and support of his troops on the ground was enough to have Dan on his side whatever was coming next.

  ‘But, Derek,’ Harry said, his calmness under fire almost unnerving, ‘I can prove to you,’ he swept his arm around the room, ‘that collaborative management does work. In fact I have evidence of it in my own jurisdiction. There’s a town called Larkford—’

  Dan reached out and hit pause almost instinctively. ‘Oh, he didn’t?’

  Taffy just nodded and set the video to run again.

  ‘Some of you may even have seen it in the press last year. The surgery there was blighted by inefficiencies, an unmanageable hierarchy and escalating costs. One year later, it has better doctor:patient ratios, patient satisfaction levels and higher efficiency ratings than any other practice I oversee.’

  Derek butted in from the audience and the camera lagged behind in trying to locate him again, so his voice echoed from off-screen. ‘Well you were obviously right not to close it. So what?’

  Harry smiled, as though he had Derek on the ropes. ‘So, they manage without seniority. There are four equal partners. Each with a vote, each with a say in how their practice is run. In my opinion, The Practice at Larkford is quite literally a model surgery. A model we should all be aspiring to.’

  There was a bark of laughter from Derek and several others in the auditorium. ‘Well, that’s quite a claim to make in a public forum there, Harry. Let’s explore that, shall we?’ He turned to confer with the gentleman sitting beside him, an identikit bureaucrat in an even pricier suit. ‘We’ll give you a budget,’ he said after a few moments of whispering, as he made a show of standing up and striding on to the stage, ‘but there’ll be compliance and evaluation. Considerable oversight. Are you sure you’re ready to take this on?’ He held out his hand as though to shake on a bet. ‘No shame in backing down now.’

  Dan wasn’t even in the room with him, but he could see that this wasn’t really the case. The gauntlet had been laid down and Harry Grant really had no choice but to pick it up and run with it.

  Harry nodded, standing firm as he shook Derek’s hand. ‘I’m ready.’

  Derek smirked slightly. ‘Well, let’s just hope the good doctors of Larkford are too.’

  Taffy clicked on pause, freezing the image of the two men shaking hands and the first glimmer of doubt on Harry’s face.

  ‘Fuck,’ said Dan simply, sinking back in his chair.

  ‘My thoughts exactly,’ said Taffy.

  Dan was frankly relieved to have got through evening surgery without dropping the ball. The sheer effort of concentrating on the job in hand and not having imaginary arguments with Harry Grant was exhausting. Nevertheless, as he waved Emily Frank on her way, clutching a prescription for some mild tranquilisers for panic attacks, he felt hard pushed not to prescribe something similar for himself. He wasn’t entirely sure whether it was fear of the impending scrutiny coming their way, or fear of telling Holly and Julia, but finding a calm equilibrium seemed like a good idea either way.

  Taffy knocked on his door, this time gently, mindful that Dan might be off his game. ‘I’ve told the girls we need to talk. Come on, I’ve even bought chocolate Hobnobs.’

  He pushed open the door to the doctors’ lounge to find Holly and Julia already waiting, bickering – or so it seemed – about biscuits.

  ‘Holly Graham, you evil temptress, get those bloody Hobnobs away from me. You know the camera adds ten pounds and Dan’s already been fattening me up on steak and chips. I basically feel like foie gras at this point.’

  Dan watched as Holly obediently slid the packet to the other end of the table, as she tried not to laugh. It was just the tableau of normality that he needed to find his composure. Julia’s protestations were genuine enough – she was becoming paranoid about how she appeared on screen in her new role as TV Doctor. But to Dan’s eye at least, Julia looked just as slender, toned and elegant as she always had. If anything, he was worried that her obsession with her on-screen image was getting a little out of control. Hence the steak, and his recent insistence on Hobnobs (her secret vice) at every meeting. Julia, it seemed, could resist everything except temptation and this tiny foible made Dan love her even more, despite how hard it was sometimes to look beyond her prickly exterior.

  He only hoped her openness to the media might extend to a little scrutiny from the NHS, at least without somehow finding a way to blame him for it.

  ‘Right,’ he said firmly, calling them to order. ‘Grab a seat and watch this.’ He set up the laptop on the table for them. ‘And then we need to have a little chat.’

  There was a groaning creak as the door to the lounge was pushed slowly open and Harry Grant’s myopic face peered in. He clocked the laptop on the table and stepped inside. ‘I had hoped to, ah . . . that is, I was hoping to talk to you before you—’

  ‘Hi, Harry,’ said Taffy, stepping forward to shake his hand. ‘You’re a little late for that, I’m afraid. But since you’re here, maybe you can fill Holly and Julia in on your bet.’

  Harry looked aghast. ‘Is that what you think this is? A bet? Dr Jones, I would never ever play God with your livelihood like that.’ He paused, obviously reflecting on the footage online. ‘Although, to be fair, I can understand why you might feel that way.’

  Julia stood up abruptly. ‘I don’t mean to be rude, but perhaps you’d like to include us in your conversation?’

  Holly had been staring at the paused image on the screen, where the usually scrolling banner flickered unmoving, bearing the title of Harry’s presentation. She looked up at Dan and he nodded. Clicking the mouse, Harry’s voice echoed around the room on high volume and everyone stood in silence as the video scrolled to the end.

  ‘Sounds like a bet to me,’ said Julia coldly.

  It took a little while for the hubbub in the room to calm down to the point where Harry could actually address their individual questions, and he shuffled his feet as he composed himself. ‘The thing is—’ he began.

  ‘The thing is,’ cut in Julia, ‘you’ve committed us to something without even consulting us. And I have to be honest, I don’t even unders
tand why!’ She was clearly baffled as to why anyone would think their chaotic brand of management was something to aspire to. Decisions by committee made Julia incredibly uncomfortable and more than once, Dan had borne the burden of her displeasure once they got home. He only hoped that she went a little easier on Harry, who would be unlikely to view her harsh words through his own filter of being madly in love with her.

  Harry cleared his throat uncomfortably. ‘Sit down, won’t you, and let me explain.’ Nervous he may be, but Harry still took his time for them all to settle before speaking again. ‘You need to be aware of how incredibly impressive the turn-around here has been. You might not even realise how unprecedented it is, to go from imminent closure to the kind of numbers we’re seeing from here.’ He held up a hand to fend off another interruption. ‘And it’s not all about the numbers. The feedback we’re getting is that your team management style is contemporary and accessible and that there is a real community vibe here. It’s something we’d very much like to analyse and emulate elsewhere. And, of course, it means you have an absolute reprieve from closure,’ he paused, ‘so that’s something.’

  ‘Harry?’ Holly said quietly. ‘Is this a foregone conclusion? I mean, could we even say no if we wanted to? The reprieve is fabulous, of course and thank you – but can we consider how all this analysis will affect the patients – they are the priority here, after all.’ Dan could see that the whole notion of oversight and scrutiny would basically be Holly’s worst nightmare. She was all for putting the patients first and anything that interfered with that would struggle to get her blessing; Julia managing to insert her blasted film crew into their lives had only heightened that perspective.

  Harry took off his glasses and polished them with a tea towel. ‘Well, technically you could, I suppose,’ he said. ‘But I’m honestly not sure why you would.’ He looked confident then, for the first time since entering the room. ‘There’s a rather healthy budget, you see. For you to spend as you see fit and another to cover the expenses of oversight. You’ll need some considerable support on the admin side, of course, but the reality is this. You can afford another GP if you’d like, or to modernise some of your systems and equipment—’