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Does the private sector’s shadow loom over the event horizon?

1 December 2006

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Cathryn Bateman
Consultant Editor
E [email protected]

My opening comment must be: “Wow!” I am, of course, referring to the inaugural Management in Practice Event in October (see page 54). I have to say, I was astounded by the turnout and the quality of speakers at the event. I really do hope you enjoyed it. Thanks to those who completed the feedback forms – the information collected will certainly help when planning the next event in Manchester in May 2007.

Feedback is very much the order of the day, as we have received quite a few comments relating to the previous issue of Management in Practice (see page 12). We always welcome your responses. Not everyone’s opinions are the same, and it’s useful to debate issues when they arise.

Agenda for rage?
One bone of contention was Allan Hildon’s discussion on the merits of the Agenda for Change (AfC) grading for practice managers (“Qualified for practice – is this the ‘Cinderella profession’?”). Allan mentioned that the AfC job evaluation scheme places practice managers in the same banding as practice nurses – levels 4 and 5. Some of you commented that most managers are doing jobs far above this level. I too held similar concerns, but once I accepted that Allan wasn’t condoning this, I realised the content was actually quite supportive of practice managers. The article highlighted some important issues relevant to the challenge of identifying appropriate qualifications for the rapidly evolving role of the practice manager.

One reader also commented on the wide variations in workload, responsibility, authority and remuneration in the job of practice management, feeling that such variety cannot be encapsulated in a single generic job specification or qualification. As a fellow practice manager, I can very much understand this sentiment. However, I also think there are potentially many advantages to having an agreed framework of competencies and qualifications to support the negotiation of the terms and conditions of employment between the manager and their practice – particularly as less fortunate managers may not be in a position to negotiate. A point worth considering, but, as Allan said in his article, no one size can fit all.

Dr Simon Carvell’s article on practice managers as partners also attracted comment. Although old hat to some of you, for others this may be a daunting venture – daunting too for many practices, even those that profess to be forward- thinking. One reader said Simon’s article addressed two separate issues (training for the job in hand and the eligibility criteria for becoming a partner), and questioned the qualities that prepare a GP for becoming a partner. I think it’s fair to say Simon’s main objective here was to provoke thought, so it was pleasing to get this response.

I think it’s also fair to say that many new GP partners have enough on their plates adapting to the responsibilities of practice life and their new businesses, and would no doubt be very happy to hand over the management of the practice so they can develop their clinical interests. However, while clinicians can transfer their skills across to management (although they may lack formal qualifications here), practice managers have only one angle to come from. So we have to give it our best shot if we see ourselves offering a different dimension to the traditional partnership. I think the debate is more about how practice managers make that transition, rather than whether they are able to.

Independent thought
Anyway, onto this issue, which features several articles on the subject of private providers to general practice. This is certainly a subject that’s got us all talking – and perhaps a little bit twitchy. With reason?

Perhaps we should invite debate from those who have been affected by working with the independent sector. If we did, would we get feedback from thousands of GPs – after all, aren’t most GPs independent contractors? And aren’t many of them developing other areas of expertise and becoming providers in their own right? Could it be that we’re scared of our own shadow – just one with deeper pockets?