Making management work in practice

Name a reason primary care is seen to be in crisis. Struggling to cope with an increasing workload due to an aging and sicker population. Agree. High political expectations such as seven day services at a time of intense financial constraint. Agree again. GP recruitment and retention issues. Absolutely, as shown in our recent publication Under Pressure.

But none of these reasons adequately reflect what I’m thinking. We almost always characterise GP pressures in terms of their effect on the clinical workforce. However, there is a group of professionals who are essential to the future of general practice who are almost entirely overlooked: practice managers.

This is a serious oversight at a time when much of the drive to develop new models of care relies on major changes in the organisation and management of general practice. In many cases, GPs agree the vision, but practical implementation falls to the practice manager.

Currently, practice management appears to be a rather unhappy, unsupported place to be. 61.9% of practice managers surveyed last year by First Practice Management said that they had considered or had looked for another job in the last three months. Many stated that they were looking for ‘something less stressful’. In the same survey nearly half of practice managers said they didn’t feel like they were getting adequate support from their practice partners. Many said that they felt that their partners needed to take more interest in the management side, and they needed more staff to help support them. 

This echoes my experience of talking to practice managers in my role leading primary care transformation in a clinical commissioning group (CCG). Often there is a real lack of appreciation from GPs and others of the breadth of a practice manager’s responsibility and how lonely and unsupported a role it can be. The role requires you to be a Jack of all trades covering topics as diverse as financial control, leading organisational change, personnel management, buildings maintenance, and oversight of IT – and that’s before dealing directly with patient issues and calls from people like me in the CCG!

So what can be done to help? I think there are three priorities for action.

Make general practice more attractive

As the RCGP recognise in their guide to practice management, management in general practice has evolved as the specialty has developed from a cottage industry into a mainstream business. As such, the traditional career path into practice management from reception, whilst still possible, is no longer the only route; it is now more important to have management skills than direct experience of general practice. 

This is particularly the case with federated practices or super partnerships, many looking to directly compete for contracts with NHS trusts, who are likely to need experienced senior management. This is already being seen in a small number of areas such as the appointment of former NHS trust chief executive Dr Mark Newbold as Managing Director of Our Health Partnership, a large ‘super partnership’ in Birmingham. However it is rare to find general practice managers with health care management experience from other sectors with the understanding of how other parts of the NHS work and how best to engage with them.

If we are serious about improving out-of-hospital care (the first objective in the Department of Health’s shared delivery plan), then we need to enable general practice to attract the best leadership talent, and enable existing practice managers to gain the skills required to create a more sustainable future for primary care. A helpful place to start would be for practice partners to recognise the value of investing in a proper training programme for practice managers such as the AMSPAR diploma in Practice Management and the extension of the NHS Graduate Management training scheme into general practice. 

Make general practice more manageable

Practice managers have been clear that the increasing number of bureaucratic processes is making their role less satisfying and reducing their headspace to engage in change or improvement activity; the NHS Alliance have recently called for the reduction of unnecessary bureaucracy to be a ‘national priority’. Simplifying areas such as the large number of individual local services commissioned from CCGs and local authorities and having more consistent systems for reporting and payments would make a huge difference.

Provide better support for practice managers

At present we don’t know how much capacity and capability is currently available to support quality improvement and transformational change within primary care and there is not a national representative body with the profile to push for the development of bespoke training, development and support programmes for practice managers. It’s this topic that we are keen to explore over the next year. Our aim is to gain a better understanding of how fit the current improvement infrastructure within primary care is to bear the expectations others have for it, and what a focused strategy to support change should cover.

Action across these three areas can help start make a different. While we rarely talk about it, the role practice managers play is vital. Put simply, without an effective management infrastructure within primary care, the hopes of the Five Year Forward View risk never being realised.

Clare Allcock is Head of Primary Care & Community Development at Horsham and Mid Sussex and Crawley CCGs, and a Senior Policy Fellow at the Health Foundation.