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Practice management – change, challenge and opportunity

1 December 2005

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Elaine Guy
AMSPAR Vice President

Doesn’t the media love the word “bureaucrat”? Any shortage in the NHS, any problem with patient care, and out comes that B word. If we believed everything we read in the press then we could blame all the problems in the world – global warming, hurricanes, earthquakes, dictators – on NHS managers. But the truth is out there, and it’s this. Without managers and, of course, the other nonclinical professionals who work alongside them every day, the NHS would, without doubt, grind to a halt.

But that’s not just my opinion. Remember John Hutton? In an article last year, for the AMSPAR Professional Magazine, the then health minister said: “It is absurd that practice managers are often described as bureaucrats. Quite the opposite is true. These professionals are crucial and, without their expertise, patient treatment would grind to a halt. That is why we are committed to recognising their important work. We are determined to expand their roles, improve their training and introduce appropriate pay rewards. Practice managers are an essential ingredient in any smooth running practice.”
And jolly good too. I meet many GPs in my work, and all of them have nothing but praise for their practice manager. Typical comments include, “My practice manager has taken a load off my shoulders” and “I have an excellent manager who has been invaluable in developing the practice.” I could go on, but repetition gets boring after a while.

Constant change can be said to be the only constant feature of the modern NHS, and one of the biggest changes in recent years was the introduction of the new GMS contract last year. This has meant an even greater workload for practice managers, and together with the latest government initiatives – PbC and EPR to spout but two acronyms – it has put practice managers firmly at the head of the queue for professionals who need to keep up to date with the latest information to help them in their challenging and everyday task of managing 21st century primary healthcare.
There seems to have been raft loads of workshops and conferences designed to help with QOF, the patient experience, opting out of Out of Hours, providing Enhanced Services, IT needs, the probity requirements of the accounting system, year-end targets, minimum practice income guarantees … and so on and on and on.
But at the end of the first year of the contract, isn’t it right to give yourselves a pat on the back for all that has been achieved? The average number of points achieved is 950, and there are now the tools to show just how good patient care is. That isn’t to say that it wasn’t just as good before, just that the procedures are in place to prove it. None of this would be possible without the hard work of practice managers and their teams. It’s easy to overlook the little-known fact that in the region of 30% of the points to be gained are in the domain of the practice manager, not the clinician. So, didn’t you do well?

Well, here we are …
I’ve been very interested in the way in which practice management has developed over the years. The traditional route in was, of course, by moving up the ladder from receptionist to senior receptionist to manager. Now we see incomers from banking, the armed forces and many other professional disciplines. I find this a very positive and encouraging move, bringing as it does a wealth of new ideas and experiences into the world of healthcare.
It is encouraging, too, that moving into practice management is seen as a positive career move.
It is very true to say that the role of the practice manager is bound to become even more important as more and more work is put onto the shoulders of the practice team, and fresh ideas and enthusiasm can only be a good thing.

Practice management is one of the most challenging roles that I can think of. How many people do you know, outside of general practice, who have to deal with accountants, bankers, the Inland Revenue, the Police, Primary Care Trusts, Social Services, Health & Safety Executive, roofers and window cleaners? How many have to deal with difficult, even aggressive, patients and then look after their own staff, whilst making sure the working environment is safe and well cared for? Who will have to deal with implementing Agenda for Change in the practice? It’s a huge job, and one that should not be underestimated. Until outsiders know just what is involved, they will never believe exactly how much practice managers have to deal with on a daily basis. We should all seize what opportunities we can to raise the profile of the practice manager. In my role as Vice President of AMSPAR, I am committed to this – as are all my colleagues.

The key to success
I firmly believe that the key to excelling in practice management is good training. Not just because I am a training provider and because AMSPAR is an awarding body. It is only by good training that standards can be raised and that patient care, which is at the heart of what we do, can be improved upon even more than it has been. To those who say that they can’t afford to pay for their staff to go on training courses, I would just say this: what is the cost of training compared with the cost of putting right errors that can be made by untrained staff?
Training should be seen as an investment in the future of the practice and everyone who works in it. Happily, many GPs recognise this, and the take-up rate for AMSPAR’s Diploma in Primary Care Management means that even more managers will be in general practice equipped with the latest information, ready to deal with yet more changes.
And don’t doubt that those changes and challenges will be coming your way soon. The reorganisation of PCTs is likely to be the next big thing.  But, please, see it as an opportunity to excel at what you do, not as a challenge to dread. There is help available to you; all you have to do is access it. Your future development is in your hands, so grasp it firmly.

(Association of Medical Secretaries, Practice Managers, Administrators and Receptionists)
Tavistock House North
Tavistock Square
London WC1H 9LN
T  020 7387 6005
F  020 7388 2648
[email protected]

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