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Has this profession lost its voice? Chair’s report from MiP Events 2007

1 November 2007

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Wendy Garcarz
MA DipEd DipTM

Managing Director
4 Health Ltd

The Management in Practice Events held in 2007 culminated with the Birmingham NEC conference in October. It was really good to see a mixture of familiar and new faces at the events this year, and hear about developments in general practice.

These events have provided some real food for thought, mixing political contexts, technological developments, leadership research and private sector presentations to challenge the thinking of managers operating in general practice and, more generally, primary care.

At the Birmingham event, practice managers were urged to look to their peers across the broader NHS, and draw some parallels in leadership and management development. Key questions raised by delegates at the event’s panel discussion included:

  • “How can we (practice managers) get our voice heard by policymakers?”
  • “Will there ever be a standardised job description for practice managers?”
  • “What is the biggest risk to general practice from the introduction of a market economy?”

On reflection, however, I began to ask myself: “What has really changed over the 15 years I have been presenting and chairing such events?”

The calibre, maturity and professionalism of practice management has definitely improved over that time, and GPs have recognised the value of an effective manager driving initiatives such as the Quality and Outcomes Framework (QOF), those introduced by Connecting for Health (CfH), and clinical system implementation.

For some, opportunities in education and training have also improved, with a much higher proportion of practice managers holding postgraduate qualifications or management diplomas.

I have supported managers in primary care settings for more than 20 years, and I must admit to feeling somewhat dazed and confused. These events were well planned, well attended, with stimulating content, and yet I am no better informed about what practice managers think about their role.

I couldn’t honestly say that I got a feel for managers’ hopes and aspirations for their profession, what educational opportunities they want, or even what they think the future holds for them. In short, there was no unifying voice from this silent profession!

What disturbs me about that this is that the NHS is about to become a planned market, with real competition for the first time, and no one seems very bothered about it. Having run my own business consultancy for the last 10 years in an environment of contestability and outright competition, I understand the impact that has on how a business is developed and maintained.

It is a whole new ball game. It requires managers to become experts about their own business and others offering similar services. It requires an indepth understanding of client needs and their purchasing power, but most importantly it requires a careful judgment of how to keep a business profitable, sustainable, capable and competent in the eyes of those that fund it.

I didn’t get any sense of how prepared general practice is for that type of environment, and even less of the manager’s view. It is possible that this doesn’t matter, and that the changes will not have a major impact on the majority of practices.

It is also possible that managers will continue to wrestle with the vast quantities of paper, information requests and new schemes to implement that are passed down by the Department of Health, CfH, strategic health authorities (SHAs) and primary care trusts (PCTs). It is of course essential that these things are done in order for practices to keep up with the market, as their targets are linked to financial incentives.

But can you afford to rest your eye on “one ball”? And, while you are looking after your practice’s present, who is considering its future?

At the Birmingham event, I had several conversations with very experienced managers who have worked in general practice for many years – the sort of managers who are good at reinventing themselves to keep pace with the changing requirements of this complex but generalist role.

But one thought struck me: “The fight has gone out of them!” And for the first time ever, I felt fear for this most valuable and undervalued role. If practice managers are not vocal about their contribution, how can others be expected to defend and develop it?

I began to read around on how other professional managers have developed their profile and political position in their fields, and was struck by the similarity between legal and medical practices. Yet legal practice managers have a very different focus, with their responsibilities, including:

  • Maximising chargeable income.
  • Billing and cash flow control.
  • Analysing the profit centre of the business.
  • Developing new income streams.
  • Risk assessment and management (in its broadest terms).
  • Developing online services and marketing the practice.
  • Client relationship management.

Nonetheless, there are strong parallels between the cultures of professional practices (ie, solicitors’, barristers’, and GP practices), and the expertise needed to run a profitable business unit is highly prized by the legal profession.

I also looked back over three years of journal articles, publications and books on practice management to try to gauge how objective my feelings and thoughts were. I found lots of material that talked of the challenges practice managers face; I saw many articles highlighting what is wrong with the role, what was missing, the lack of equitable status with other
professional managers.

Isolated articles and printed letters by managers who felt very passionate about their profession, defended the role and its uniqueness. But what was missing was a unifying vision or voice that raised the profile, issues or aspirations of practice managers.

Some may say, “So what? It’s not important”, or “It doesn’t detract from what we do as managers”, but I would argue differently. You are operating in an environment populated with recognised professionals that have proper career paths, well-established education programmes and opportunities to access these programmes with supported funding.

GPs and other healthcare professionals have written policies that protect continuing professional development and time for reflective learning. They are supported to take on new initiatives, with tailored training programmes, networking, conferences and study days. As recognised professions, they are afforded these things – and yet many practice managers chatted about how difficult it had been to attend one of the Management in Practice Events. One manager even described this as her “annual training session” – her only one.

My aspiration for practice management is that it receives national and governmental recognition of its importance to the continued development of primary care service delivery. I would like the General Medical Council (GMC) to recognise that GP practices are only truly effective with a competent and creative business manager leading it through change.

I want SHAs and PCTs to work in equal partnership with practice managers, recognising their competence, skill and greater knowledge of the general practice business unit.

Most of all, I would like to see conferences – such as those held this year by Management in Practice – that truly reflect the practice manager’s agenda, with presentations that share innovations in practices, complex debates and ways to prepare for the future (whatever this may hold).

Of course, I may be completely wrong. You may be perfectly happy, and the lack of noise in the system is because you have no need to be represented by a national voice or be consulted about the changes to your environment.

Either way, I could not give up without testing my views and assumptions. On Tuesday 29 January, a think tank on the profession of the practice manager will be held in Birmingham. Its purpose is to quantify how practice managers view their profession, and what they are willing and not willing to do to raise it to strategic and national body levels.

If anyone is interested in attending, please contact me on 0121 240 8835 for further details, or write to Management in Practice (at [email protected]), who will put you in touch. My aim is to invite key figures involved in developing professional bodies, brand imaging and marketing to see what can be done. If you have a view that is wider than your own practice, I can promise a stimulating day.