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Better together

27 June 2011

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Right now, I’d imagine that Andrew Lansley is probably not a fan of health conferences. The secretary of state for health recently suffered a demoralising vote of no confidence from 99% of delegates at the Royal College of Nursing’s (RCN) annual conference in Liverpool.

Despite his recent Commons statement that the government is to use a pause in the passage of the Health and Social Care Bill through parliament to “listen and reflect” on “genuine concerns” from the public and health professionals, Mr Lansley did not address the RCN conference. Perhaps that’s just as well.

On the other hand, he might have gained from delivering a speech. This is the first time that the RCN has passed a motion of no confidence in a health secretary, and it’s arguable that his keynote silence fuelled the wrath of nurses like Zeba Arif, a mental health nurse from London, who told the BBC: “Reform means making it better. Is this making it better? No, it is not.”

But I can’t help feeling some sympathy for the health secretary, who did attend the conference but stated: “I’m here to listen, not to lecture”. When politicians present themselves in public to deliver passionate speeches, they are often derided as being arrogant, even didactic. They are frequently blamed – sometimes with good cause – for ‘not listening’ to the professionals’ experienced views.

But now that the government has made a pledge to sit back and listen, ministers are accused of avoiding the issues and seeking a hideout. Worse, the media and political opponents clamour to announce a potential ‘U-turn’, even if they should be supporting a reconsideration of a policy they’ve consistently been arguing against.

If the commitment to a ‘listening exercise’ over the coming weeks is genuinely meant, I believe that this should be embraced as a positive step for those who may support the broad thrust of the move to GP-led commissioning, but have concerns over certain aspects, such as the role of the private sector and potential loss of skilled commissioning talent from primary care trusts.

True, the listening programme may be more about an appearance of engagement, rather than actually engaging. Nevertheless policymakers, like practice managers, shouldn’t need to apologise for taking the time to meet people on the frontline and to exchange ideas – even to hold vehement arguments if necessary.

Whatever Mr Lansley’s current view of conferences, practice managers will appreciate their importance. You know the value of getting out there and meeting your peers more than most. ‘Networking’ – despite sounding like something only shoulder-padded yuppies from the 1980s would want to do – is of prime importance to this profession, as we hear in this issue.

Caroline Kerby, Joint Lead of the NHS Alliance Practice Managers’ Network, believes networking is “essential” to her work (see our interview this issue). “I don’t see how you can lead your own organisation if you’re not trying to see what’s happening in the external environment and doing some horizon scanning,” she told me.

Practice management can be an isolated role, as Caroline acknowledged. While you may have several GPs and nurses in your practice who can garner support and advice from each other on a daily basis, there is but one practice manager, and when faced with an unprecedented new challenge there’s nobody else to turn to. And that’s why conferences and support networks are so important.

This issue profiles another well-connected practice manager: Geraldine Taggart-Jeewa, who is not only a member of the Royal College of GPs’ Practice Management Network Steering Group, but is also a senior member of the Family Doctor Association. As she tells us elsewhere this issue: “I recommend that any practice manager, new or old, should make contact with their local colleagues.” It was precisely the early support of her local colleagues that helped make Geraldine the successful manager she is today.

In Wales, practice manager networks are alive and kicking, and are really putting their heads together. Liz Saunders, a practice manager from Rhondda Cynon Taf, explains in this issue how members of the All Wales Practice Managers’ Conference Committee are sharing views on the challenges currently affecting Welsh general practice and opening up “many avenues of learning and creative thinking for primary care managers”.

In Scotland, a practice in Dundee is really going the extra mile – or an extra few thousand miles to be more accurate – to form new and productive links. Practice Director Sam Riddell shares his experiences of an inspiring international project in which his medical centre was ‘twinned’ with an equivalent primary care clinic in Malawi.

This involved reciprocal visits to and from Malawi, with both parties gaining insights into their new partners’ approach to managing care in very different climates. I cannot think of a better example of the “horizon scanning” that Caroline Kerby advocates. As Sam suggests, looking outside your practice in this manner gives a whole new perspective on healthcare services.

This wider outlook may prove useful in the years ahead. Published in March, the King’s Fund’s Inquiry into the Quality of Care in General Practice report concluded that general practice needs to move “from a cottage industry to post-industrial care … there is an urgent need to accelerate the work to establish practice federations, and to bring isolated practices more formally into larger provider organisations or networks.”

Isolation, it would seem, is not an option. Even outside networking events, practice managers may well be working together in a cluster of practices, and ‘collaboration’ could just be the central ethos in a new primary care structure. In such an environment, shared approaches and solutions will be vital. This will go far beyond looking across the road to see what your neighbour is up to.

Indeed, as we report this issue, the disintegration of practice boundaries will be a literal occurrence. The government may be pausing and reflecting on the Health Bill, but completely free registration is still planned to be a reality from April 2012. This opens up general practice to an entirely new era of shared medical records, inter-regional co-operation and patient empowerment. Many practice managers have huge concerns over this issue, but once again you will need each others’ support to find a way to deliver this effectively.

I hope that Management in Practice – across our national events, website forums and this publication – has been, and will continue to be, an important source of support and a means for you to network and share best practice with your peers. With this in mind, I would like to end by paying tribute to Cathryn Bateman, who this issue steps down as our Consultant Editor having been our key adviser since the launch of Management in Practice back in 2005. 

The fulltime manager of a large urban practice, Cathryn nonetheless always found the time to offer crucial advice, expertise and information on all issues affecting this most diverse profession. Her contribution to the success of Management in Practice cannot be overstated and she will be sorely missed. As Cathryn continues in her ‘day job’ as practice manager – her other vital role, and one that Management in Practice will continue to support as general practice develops across the UK – we wish her the very best.