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New vocational training scheme for practice managers

1 March 2006

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Fiona Dalziel
Independent Consultant in Practice Management

Fiona is an experienced primary care trainer and facilitator. She is the national RCGP QPA Adviser and has advised on both the original and the review of the Quality and Outcomes Framework (QOF) of the new GP contract. Fiona is currently working with NHS Education Scotland and IHM on the delivery of the new VTS for primary care managers

Rosey Foster
IHM VTS Project Lead

Rosey was Deputy Chief Executive of the IHM for five years, with responsibilities for the primary care sector, IHM Healthcare Management Code and the Fellowship by Assessment programme. She was also Chairman of Carers UK charity. As well as the VTS project, she now undertakes coaching and mentoring for those in primary care and not-for-profit sectors, and she holds CIPD accreditation as a coach mentor

The model for this groundbreaking scheme is the GP Vocational Training Scheme. This scheme is acknowledged as having been remarkably successful in introducing “standard setting and external performance review” into primary care.(1) Research evidence shows that the VTS for GPs produces GPs who are more confident, have increased knowledge, adhere more to practice guidelines and show an improvement in healthcare.(2) It is anticipated that the VTS initiative by the Institute of Healthcare Management (IHM) will do the same for practice managers.

Continuing professional development
IHM’s purpose is to “enhance and promote high standards of professional healthcare management in order to improve health and healthcare for the benefit of the public”. Box 1 shows how the VTS fits into IHM’s continuing professional development (CPD) progression:


The VTS is an important part of the Institute’s application for chartered status, which is the highest accolade achievable by a professional body and is awarded by the Privy Council on behalf of the Queen. All IHM members are required to demonstrate CPD as a professional obligation.

The Practice Manager VTS (PMVTS) scheme is intended to provide a programme to support new managers entering general practice by placing them with an experienced practice manager. Participating practices are approved GP training practices; practice manager trainers are members of IHM who have a special interest and skill in training and development. Alternatively, practices may be research or teaching practices with a link to a medical school/university. The practice manager trainer may have already achieved IHM Fellowship by Assessment.

In England, funding for the project has come from the NHS Working in Partnership Programme (www.workloadmanage Nine trainers and trainees have already taken posts in separate practices, perhaps at some geographical distance, although one trainer/trainee pairing is in the same practice.

In Scotland, more generous funding for the project, from NHS Education Scotland (NES), has allowed two models to develop, both of which allow the trainer and trainee to work closely together in the same practice. Of nine training posts, six trainees were already working in more junior posts in the training practice but were ready for development as managers, and three trainees are in reimbursed salaried posts in their practices, which allows them additional training for skills and knowledge development. Two of the salaried trainees were recruited to their present practice from elsewhere. All three models will be evaluated as part of the pilot year of the scheme.

Management competencies
During the training year, trainee practice managers are working through the IHM “Developing through Partnership” framework of management competencies, identified as a basic requirement for a competent practice manager. These competencies form the curriculum for the training year.
The six competency areas are:

  • Communication/working with others.
  • Optimising resources.
  • Managing risk.
  • Leading change.
  • Developing oneself and others.
  • Working with people.

Over the course of the training year, both trainer and trainee gather and present evidence in each competency area sufficient to allow the trainer to form a judgement on the trainee’s level of competency. To complete the report successfully, the trainee must meet the competency standard in each of the six areas.

The PMVTS assessment process is mapped against the IHM competency document and approved curriculum. The process involves four components:

  • Trainer’s report.
  • Portfolio.
  • Project.
  • Professional dialogue (oral).

A trainee must pass all four components. IHM is presently working to approve this route to competency as a route to full IHM membership (trainees being associate members during their training year).

Training support
In England and Scotland, considerable support is offered to both trainers and trainees. This takes the form of workshops for trainers and trainees (together and separately), and topic-based training sessions in a central location, together with funding for additional educational activities related to achieving the competencies (Scotland). A web-based chat group and website have been established to share learning and good practice. Both England and Scotland run the schemes through a national steering group.

Benefits of the scheme
The evaluation of the pilot year in England and Scotland is eagerly awaited, but we anticipate the following benefits:

For new managers:

  • A more formal career structure.
  • A strong network.
  • Supported learning development.
  • Demonstrable fitness to practice.
  • Excellent role models.

For GPs:

  • Promotion of a culture of learning and development.
  • Improved quality.
  • Enhanced practice income via the GMS Quality and Outcomes Framework.
  • Effective delivery of practice-based commissioning and payment by results (England and Wales).

Benefits for the profession of practice management:

  • Provision of education and support on a national basis.
  • Dissemination of good practice.
  • Improved knowledge and insight of PCOs.
  • Practice management highlighted as a career choice, with potential for progression to chartered status.

For IHM:

  • Affirmation of IHM’s purpose.
  • Delivery of standard-setting objectives.
  • Support for a move to chartered status.
  • Accountability through IHM registration.
  • Reduction of poor-quality practice.


The future
A business case for the continuation of the pilot scheme, from pilot to established status, is currently being developed by NES. We hope similar continuity for the scheme will be forthcoming in England.

For further information on the IHM VTS for practice managers:
[email protected] (Rosey Foster, England and Wales)
[email protected] (Fiona Dalziel, Scotland)


  1. Irvine D. The doctor’s tale – professionalism and public trust. Oxford: Radcliffe Medical Press; 2003.
  2. Hindmarsh JH, Coster GD, Gilbert C. Are vocationally trained general practitioners better GPs? A review of research designs and outcomes. Med Educ 1998;32:244-54.

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