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MiP Birmingham: “soul” responsibility?

1 December 2010

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General practice faces a challenging time ahead, and will need to transform its services and develop robust relationships with other organisations. But practice managers have a key role in the government’s radical NHS reform programme and should not feel excluded.

This was the key message from the final Management in Practice Event of 2010, held at the Birmingham NEC on 20 October. More than 400 practice managers and GPs attended the one-day conference. The atmosphere suggested that the initial reaction of surprise at the far-reaching proposals contained in the government’s health white paper of July has now moved on to an almost-intense speculation as to their practical development.

What role would practice managers have, if any, in the new commissioning consortia? How could managers transfer their existing skills to the structure of the “new” NHS? And whom should we look to for answers, now that centrally led directives appear to have had their day? Such questions permeated speaker presentations at this event.

However, reassuring answers were not always to be found. Speaking of the organisational arrangements for GP-led commissioning consortia, keynote speaker Jill Matthews, Director of Primary Care Improvement at the Department of Health, gave a stark message to delegates. “Lots of the detail is up to you, not us,” she said. “The Department hasn’t got a massive truckload of transaction manuals coming your way anytime soon. We believe this needs to be built and designed by primary care practitioners and managers, not by the centre. I hope that’s empowering, if not a little scary.”

Quoting Dr Donald Berwick’s assertion that primary care is the “soul” of the NHS, Ms Matthews said the sector did not sing its praises enough, and that managers in primary care have not received the same recognition as their counterparts in secondary care. She insisted on the direct link between leadership and effective patient outcomes: “Good management underpins the highest-quality 
clinical care.”

However, this is evidently not recognised by all. In a subsequent question-and-answer session, one delegate criticised the “GP-led white paper” for ignoring the role of practice managers, adding: “The GPs think they’ve got to lead all of this [the commissioning consortia], including the management, and I feel there’s no room for me at all.”

In response, Ms Matthews said: “GPs will be leading the consortia, but we don’t believe they will be doing all the work to establish them. Over the next few months, as we start to develop shadow consortia, more opportunities about the roles of others will emerge.”

Indeed, the selection of expert presentations at MiP Birmingham included two sessions offering guidance on the role that practice managers could play in new commissioning consortia.

Leaders from NHS Primary Care Commissioning urged delegates to ensure their practice has a shared vision for future development, and to develop an operational plan to achieve this. Adviser Sally Simmonds reiterated Jill Matthews’ earlier message. “For the first time in your working lives, you’re not being directed to deliver services – you’re expected to deliver them yourselves,” she said.

This theme of self-sufficiency was continued in a session from Manchester’s Commissioning Business Service, who gave a technical overview of how delegates might improve the efficiency of patient pathways, with a look at strategic procurement.

During this session, one delegate voiced support for the proposals in the government’s July white paper, but also expressed concern at the mounting challenge ahead. “With the level of commissioning knowledge involved, we need to recognise that we can’t do it all ourselves. However, we shouldn’t underestimate the skills we do have as 
practice managers.”

The development of those skills was supported throughout the MiP Event, with specialist training sessions on financial matters, data management and HR issues. In one workshop, primary care trainer Alison Telfer gave valuable insights into a range of employment issues – from handling bullying in the practice and underperforming staff members to contractual agreements and the impact of the new Equality Act.

Other sessions advised on legal considerations, complaints procedures and the future regulation of general practice. A separate exhibition hall featured a host of primary care providers who were available to talk about their products and services. Exhibitors included medicolegal advisers, IT specialists, practice accountants and medical associations. The kind support of these exhibitors ensures that these events are completely free to delegates.

In the afternoon, the NEC played host to the Management in Practice Awards Ceremony 2010, at which this year’s winners were announced. Full details of the winners and their achievements can be found on page 22. As Jane Gamble, a practice manager and award judge for the past three years said: “Each year it seems the leadership skills of practice managers become even greater.” These awards seemed a fitting way to “sing the praises” of primary care, as Jill Matthews had earlier advocated.

Key themes of the Birmingham event were returned to in the closing speech by Dr Beth McCarron-Nash, a negotiator for the British Medical Association’s GPs’ Committee (GPC). Dr McCarron-Nash told delegates that practice managers had a key role to play in the new arrangements, not least by advising consortia who the best performing PCT managers are, so that strong commissioners can be retained in the new structure.

Dr McCarron-Nash echoed the view that the lack of clarity from the centre meant change would need to be led locally. “We’re all on the train, we know where it’s going to stop but we’ve no idea how to get there.” She argued that the GPC and local medical committees had a key role to play in helping to put forward more detail, particularly on governance issues.

Dr McCarron-Nash’s closing thoughts supported one of the key messages of the day: that GPs could not lead consortia alone. “Should we be calling it something else?” she asked. “‘GP commissioning’ makes me feel rather nervous, whereas ‘local commissioning’ reflects the shared responsibility. It’s not just GPs, it’s practice managers, nurses, ancillary staff, managers we employ on our behalf, local authorities and patients.”

The next MiP Event will take place on 14 June 2011, at Manchester’s Bridgewater Hall. Until then, the idea of shared responsibility, with practice manager’s involvement, should be in some way reassuring. After all, it seems that the development of general practice is now down to you.