50% of Practice Managers new to the job
Some 50% of GP Practice Managers have taken up their posts in the last five years. There are many I am sure enjoy their job thoroughly, whilst there are others who are not so happy. The pay and working conditions vary significantly from practice to practice due to the independent nature of general practice. Added to that practice budgets have become tighter and tighter, but I also have to say that the nature of GPs working in general practice has changed too!
How has it Changed?
Since 2004 GP Practices arguably have become more independent with their own budgets and the right to decide how to man their practices with GPs or other health professionals and how many days and sessions each GP works each week. There are no longer any controls on how many GPs are allowed to work in one practice. The Medical Practices Committee, which decided who could work where was abolished. There are fewer singlehanded practices, around 800, and fewer GPs working full time.(around 15%). Added to that female GPs now work in greater numbers than male GPs, but part time working has now overtaken full time working as the predominant feature of a modern partnerships or practices. The question arises as to whether the commitment to general practice is as strong as was say 20 or 30 years ago. Do part time GPs really want to own premises?
Uncrowned but not deterred
For the Practice Manager, the role of leader and manager is uncertain. The expertise and skills required of a “manager” have increased over the years from being a good secretary able to type and work with a spreadsheet, yet the modern manager is normally not part of the ‘ownership’ of the practice and is just an employee just like all the other practice staff. A well managed practice will have a “chain of command”. The staff will be led by the Practice Manager and the GPs will only become involved when there are disputes, disciplinary and grievance issues to deal with and their are plans and policies to decide. The Manager may be a signatory to bank accounts, not quite so rare these days, and be able to manage the finances of the practice, but I suspect it is more common place for at least one GP to be in charge of the money. Acmanager able to and allowed to manage the GP Team I still think is unusual.
Middle of the Pack
The Manager, therefore, has a role that is in the middle of the practice between the staff and the doctors. In fact, the manager may have no management control over the Nursing Team. The Practice Manager May look after the premises, changing light bulbs and counting toilet rolls. There is often a balancing act going on in practices whereby for instance the manager sets up the appointments system, but then finds it has been tinkered with by the doctors. Staff may also have access to the doctors on a whole range of issues bypassing the manager. Its like shifting sands and the poor manager never knows whether he or she is heading for the quicksand and ends up swimming against the tide. I found the most enjoyable times were when I was left with the responsibility to get on with something with minimal interference. For me, this involved developing a major extension, including a new pharmacy, which I was very proud of. I also enjoyed developing the computer systems from one PC in 1997 to more than 40 in 2010.
Equal Status Quo
To me the solution lies in appointing a practice manager who has equal status with the team of doctors and is able to work with them and agree issues without constantly being overruled. The Managers pay should reflect the GPs pay, along with the same terms and conditions. This does not mean that the Manager should be a partner but of course this is happening in practices up and down the country. During the last decade, many Practice Manager Groups have been established supplemented by web sites that concentrate on providing positive support and information for Practice Managers. Being a Practice Manager can be a lonely affair and with Forums such as that provided by Practice Index Practice Managers can keep in touch with each other through a national network of like minded managers.
I always enjoyed my work but I did not enjoy the conflict and the pressures. I was concerned that new technology was not being taken on-board by all members of my practice. I was also concerned about the loss of expertise in local NHS bodies only to be replaced by inexperience and yet more and more paperwork. How many experts can you find on NHS Pensions. I often wonder whether GPs understand how much ‘practice management’ has developed and changed particularly with the advent of the Care Quality Commission. Who did GPs think we’re going to write literally scores of Policies, now expected by the Care Quality Commission.
The work levels have become ridiculous………