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Redesigning general practice

29 March 2012

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There are times when change can be difficult to notice, and only unsubtle hints or sudden announcements can shake us from our reverie and make us realise that something is different: a passing colleague’s new haircut, for instance, or the precise distinction between the current government’s enthusiasm to open up the health service to the private sector and that of the last government.

Then there are occasions when change is sudden and unmistakable: our own haircuts and the adoption of the word ‘outcomes’ instead of ‘targets’ being examples.

Regular readers will know what I’m getting at, having noticed that this issue of Management in Practice is looking fresher, smarter and altogether updated. We have a new logo and a new look across the entire brand of magazine, website and events. I hope you like it.

I might forgive the busy practice manager for not noticing, however. After all, change is something you’re more than used to. In general practice, change is as constant as the northern star, whether it be new Quality and Outcomes Framework indicators, Care Quality Commission registration requirements in England or new complaints-handling processes, all of which we look at this issue.

Apart from government policies and the usual demands, though, a more longstanding and subtle shift seems to be occurring: the ‘upsizing’ of general practice. I don’t just mean extending premises or increasing list size, but the drive to a more interconnected primary care in which individual surgeries work together as a larger organisation.

The idea of ‘federated practices’ – more or less what I’ve described – is nothing new, and has been championed by the Royal College of GPs for years. But the idea seems to be gathering pace. In January, the NHS Future Forum published a second report in which it recommended that practices form federations serving between 40,000 to 70,000 patients.

Some may instinctively feel that a more ‘corporate’ model of general practice could threaten their independence or continuity of care. But there’s no reason it should. Geraldine Taggart-Jeewa, a leading practice manager and senior representative of the Family Doctor Association, told me she welcomed such a move as it could mean practice managers sharing their skills across a wider network, and even specialising in certain disciplines in the manner of GPs with a Special Interest.

This issue, Russell Vine, the new national Practice Management Network Chair, talks of the move to more “strategic”, long-sighted practice management, supported by networks of managers sharing their insights across associations. Dr Phil Hammond puts aside the comedy when he says: “If general practices are to survive, they’ve got to coalesce into larger management groups”.

Valerie Denton, our Practice Manager of the Year 2011, writes of the integrated work her practice undertook with the local hospital to drive down referrals and improve patient care – a theme of a major European report outlined elsewhere this issue. In all, general practice seems to be reaching out at a difficult time and finding the benefits of collective working as never before – and this time it’s a change that practice managers can drive forward, rather than be subjected to.

Finally, there’s one more change to announce, albeit one of the distant-colleague’s-haircut variety: this is my final issue as the editor of Management in Practice. It has been an enormous privilege to meet practice managers across the UK and to learn more about your vital profession over the last seven years. As the engines at the heart of the health service, practice managers are too-often overlooked, and I know this publication will continue to inform, support and champion those who keep patients’ first port-of-call running smoothly.

Thank you all for reading.

Stuart Gidden is the editor of Management in Practice.