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Bold, creative and inspired practice management is key to primary care

1 December 2005

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Mayur Lakhani
Chairman, RCGP

I am delighted to welcome this new publication for practice managers. As a practising GP, I know just how important it is to have good practice management. Put it this way: without practice managers it would be impossible to deliver patient care that is safe and of high quality. So, on behalf of GPs up and down the country, I want to say a big thank you to you, particularly for your role in the highly successful implementation of the Quality and Outcomes Framework of the new GP contract. This was a complex policy to implement in a relatively short space of time, and there have been clear benefits for patients: more checkups than ever before and better, evidence-based clinical management.
I am very clear that bold, creative and inspired practice management holds the key to transforming the health service. But the health community needs to do more to support practice managers. Not enough attention has been paid to the professional development needs of practice managers, who sometimes work in an unsupported environment. General practice has become such a complex field that practice managers are entitled to expect more support, particularly for those keen to undertake formal management training and qualification. Effective continuing professional development is a “must do” for all.

In the future, practice managers will have an even bigger role in improving the standard of patient care and expanding the range of services. Sometimes GPs and managers can be so busy with their day-to-day work that they cannot step back and think of the bigger picture. But that is precisely what we have to do! So let us declare our ambition for patient care. Fabulous opportunities exist for improving it by developing primary care through practice-based commissioning and the new policy areas likely to be included in the forthcoming White Paper Health Outside of Hospital.

In my view it will be a landmark document that will affect the future of every practice. I predict its impact will be felt quickly in 2006, and it has the potential to transform primary care. Practice managers need to be aware of the key issues that the White Paper is intended to tackle: improving patient experience and access both in daytime and out-of-hours; improving efficiency and value for money in the NHS; moving activity out of hospitals into the community; personalising services for special groups such as commuters, teenagers and cancer patients; better links with social care and public health issues.

Practices spend a significant proportion of their time dealing with deficits in secondary and social care. The setup of the NHS is clearly not optimal – take, for example, the organisation of community nursing services, focused around the employer rather than the patient. Surely nurses should work and deliver care according to the skills they have, not who they are employed by or their place of work?

Would it not be great to have: longer consultations; more practice-based services; better communication between practices and hospitals; short or no waiting lists; and the ability to order scans?
Practice managers should be aware that enhanced services, chronic disease management, new specialised services akin to ambulatory care in the USA, and the provision of community services such as podiatry and physiotherapy could all be tendered for by a range of providers such as foundation trusts and private companies. Pitched against these professional business organisations with their large staff, resources and expertise in planning, individual GP practices could struggle to be taken seriously.

Can primary care rise to the challenge? I believe that it can, but it will require a step change in strategic thinking. This means developing the infrastructure and strategic capability and capacity in GP practices. GP practices will need to be strong on planning and governance. And there is a continuing need for effective and strong clinician/manager partnerships. With the role of PCTs changing fundamentally, primary care and specifically GP practices will be in the driving seat.
My advice to practice managers is:

  • Unite: appropriate collaboration between GP practices is essential.
  • Develop a local plan for primary care development of services and extended primary care teams. Encourage each practice to develop and realise its full potential.
  • Improve the quality of general practice (in its broadest sense) and services. Ensure the goal is patient-centred care.
  • Develop and support strong local leadership in the health community to fight for increased resources in primary care.

Practice managers have a key role in delivering this new “offer” from primary care. Good practice managers are essential to the delivery of high-quality, accessible and safe patient care. The next time you are asked what you do, don’t just say, I am a practice manager – also say: I am helping to improve patient care!

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