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Should practice managers be offered partnerships?

1 September 2006

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Simon Carvell
General Practitioner

Simon qualified from Birmingham University in 1994 and has been a Member of the Royal College of General Practitioners (MRCGP) since 1999. He is currently a GP partner working in the West Midlands. Simon is an honorary lecturer at the University of Birmingham and an editorial board member for Emma’s Diary. He has three children, with another on the way – in what remains of his spare time he likes to play sports

When I reflected upon the arguments for and against practice managers becoming partners in practice, l imagined the potential wrath I could expect from my partners and colleagues at the possibility of change to the inner sanctum of general practice! I do, however, believe that a change in the composition of the traditional general practice partnership is inevitable as the nature of primary care evolves.

I became a GP partner in 2000. It was a goal I’d had from the first moments I considered a career as a GP. I had a fairly traditional idea of general practice at this time. This was in 2000, but even as recently as six years ago the face of general practice was still quite traditional.

I had always considered becoming a profit-sharing partner, as opposed to a salaried, retained, personal medical services (PMS), or associate partner – these positions were all new, or were in evolution at that time. I had many questions when I considered joining a partnership, and I’m sure these questions were not unique to me as a GP and are still relevant today. But before considering the pros and cons of the practice manager joining the partnership, I’d like to consider two fundamental commitments that one has to make when joining a partnership.

The commitments
Joining a partnership in general practice necessitates financial commitment. Buying into the equity of a building and the contents was a complete puzzle to me when first calculating the costs. Buying in can also appear daunting when one already has other financial responsibilities: domestic commitment to the home, a mortgage, a car, etc.

However, securing enough finances to buy-in is not as difficult as it sounds, as there are plenty of options. Business loans from finance houses that may have a particular interest in financing general practice are competitive with the more traditional bank business loan. The short-term pain of considering that you’re mortgaged to the hilt must be tempered by the long-term thought that property tends to go up in value!

This leads to the other fundamental commitment. When buying-in, it is important to regard joining a partnership as a long-term obligation. One must consider the stability of the partners and their long-term commitment. Like a marriage, there will be good times and bad times. A mutual assessment period was useful for me as a new partner, before buying-in. Even for a practice manager, already in position, a mutual assessment period before the buy-in will allow the individual to discover, in their new role, how their opinions are received as a partner rather than as an employee.

Benefits of managers as partners
One view is that clinically related factors, which are beyond the competence of the practice manager, are at the core of the business of general practice and therefore exclude nonclinical staff from becoming partners. In the pre-NHS days of AJ Cronin’s famous book The Citadel – a novel first published in 1937, which reflects the “doctor knows best” attitude of the day – this view was true. Now, whether for better or for worse, this is no longer true.

For partnerships to survive in this new era of commissioning and enhanced services, the traditional general practice faces competition from a new rival. A general practice partnership must become sufficiently resourceful and ambitious to compete with private healthcare companies for traditional and new patient services.

Here, the importance of the practice manager can be pivotal. The traditionally uneasy relationship between health service managers and clinical staff may be tempered and smoothed by the new face of negotiation; but only, perhaps, if that new face has the authority to make decisions. However, that new face – the practice manager partner – may cause confusion.

Confusion? Borne of the new position, the practice manager partner may perhaps feel misunderstood and that others are not taking them seriously. With some difficulty, l managed to locate just one practice manager partner, local to my practice (not our own!). The paucity of manager partners may create a measure of suspicion among clinicians at present, perhaps until the situation is more common.

Levelling the field
Some – probably only clinicians – may argue that, with the advent of Agenda for Change (AfC), there is an adequate pay scale with an appropriate job description to reward the practice manager to the correct level. Some managers, however, will exceed expectations; perhaps these managers require and deserve appropriate recognition and reward.

But to become a partner, perhaps the practice manager should be expected to have attained a similar level of qualifications as a GP partner?

As a GP, in general, undergraduate training lasts for five years (excepting graduate entry, which lasts for four years), to the attainment of a degree in medicine. Typically, a GP then spends three years in hospital specialties, with a further year as a GP registrar, usually obtaining membership of the Royal College of General Practitioners (RCGP) at the end (this will become compulsory in the near future).

Should a practice manager then, desiring to or invited to become a partner, be expected to gain similar levels of experience and accreditation? Should an MBA be minimally desirable?

Not all practice managers, and not all GPs, desire partnership. The future is uncertain in general practice, but I think we will see more manager partners and more practice nurse partners. It will certainly be interesting to see the profile of the new general practice partnership in this country in the next five years.