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Vine time

29 March 2012

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Russell Vine is the new chair of the national Practice Management Network, which brings together key associations to support the profession. He combines a very connected approach with a pragmatism that ensures he remains his own man…

The steady demeanour and the 20-year former career in banking are false signifiers: Russell Vine is, as he admits, someone who is “used to flying by the seat of my pants”. His approach to practice management is involved and unafraid; he clearly immerses himself in all aspects of the job and likes to take on more work, not less.

Recently elected as the new chair of the national Practice Management Network (PMN), Vine aligns with the British Medical Association (BMA) on the PMN’s steering group, has a prominent role on his clinical commissioning group (CCG) board and, unusually for a practice manager, is also one of the Royal College of GPs’ clinical commissioning champions (although he admits this network has “died a death” since the RCGP came out in formal opposition to England’s Health and Social Care Bill in February).

Now a partner in his 12,000-patient GMS practice in Essex, Vine joined his practice as manager in 1993, responding to an advert for a “quiet, part-time local job”. He soon realised the description was not quite correct. “Well, it’s local,” he jokes. “But it’s certainly not part-time, and it’s chaotic. And getting more so.”

Banking background
When he joined the practice it was significantly smaller (with around 5,000 patients) but has since been growing steadily. For a time, patients even queued outside the surgery every week for almost two hours before it opened to try and register. Things have calmed down since but Vine finds it “quite scary that level of demand is out there.”

He “came in cold” to general practice following a career at Barclays, and the culture shock proved an “eye opener”. He realised how informal general practice could be early on, when an attempt to formalise the appraisal system revealed the nurses had not only shared the results of their appraisals with each other, but also the neighbouring practice, who to his surprise informed Vine one of his nurses was upset at receiving less favourable feedback than her colleague.

Vine’s background has given him a more business-like view of general practice, which he says it is moving towards.  “Over the years staff have become more aware that it’s a business, not a service,” he says.

Joining the partnership in 2005 reinforced the financial responsibilities of running a practice. He admits he took this decision “just after all the money flooded into general practice; it seemed like a good idea then. It doesn’t feel so good at the moment with all the money flowing out.”

Partnership hasn’t changed his attitude to the job, he says, but “the perception others have of me has changed dramatically. When I first became a partner the primary care trust (PCT) started talking to me; before they only wanted to talk to the GPs.”

Practice Management Network
For Vine, the need to assert the authority of practice management and to work in a more integrated and structured way seem key drivers for his membership – and now stewardship of – the PMN.

The Department of Health (DH) established the network, which champions and supports practice managers, in 2009 when it collaborated on guidance to increase access. For a time the DH continued to fund the PMN, but Vine is candid about their “bizarre” decision to then “totally cut off from it and ignore us”. It is now hosted by the RCGP but is currently seeking independent sponsorship for funding.

The PMN’s steering group, which Vine has chaired since September 2011, brings together leading representatives of seven primary care associations with practice management links: the RCGP, the NHS Alliance, AMSPAR, the Family Doctor Association, the National Association of Primary Care, the Institute of Healthcare Management and the BMA. The representatives meet on a quarterly basis.

For their part, the BMA – despite having bidded to host the PMN at one point – seem to have a vaguely defined relationship with practice managers; Vine admits his link to the doctors’ union is merely “tenuous”. The BMA sought practice management links via local medical committees (LMC), which have more established links to the profession. However, interest has waned, says Vine, as a result of focus on England’s controversial Health Bill and pensions issues.

“You get the feeling that perhaps you’re more of a nuisance than a benefit to them,” he says of the BMA. “Trying to get guidance on what they want us to highlight via the PMN is like trying to get blood out of a stone.”

Vine is clearly a pragmatist, seeking links to bolster networking and collaboration, but with his own independent views. He sees the PMN as an apolitical force for good. “I don’t think practice managers need a union, but I think we need to be more high profile,” he says. “That’s why the PMN plan to raise the image and standards of practice managers, alongside the other member organisations, is useful.”

Information sharing is, he says, the network’s key role, since practice managers can be “isolated” within their own surgeries. “Most of what we need day to day is out there. The difficulty is we don’t know where to find it, and we don’t know what the issues are until they come and kick us in the teeth. But through the PMN we’re hoping we can keep things fresh and in front of people.”

The ethos behind the PMN is that it is “run by practice managers, for practice managers” and its constitution outlines that its aims are to champion the profession, to share best practice and to influence policy.

Vine’s objective – again practical rather than political – is for the PMN potentially to “shoot down poor policies at the start, before we all waste our time trying to do things that are nonsense. But equally, if it’s a good idea let’s make sure it gets out there and works for everybody, and isn’t just something that individual areas tweak to make it work for their own circumstances.”

He would like to see the PMN double in size over the course of his one-year tenure; an ambitious aim given that it currently has between 3,500-4,000 members; around half the practice managers in England. But Vine wants to cast the net wide: “We’re looking to get past 50% and get proper representation into the other three countries, plus the peripheries like the armed forces,” he says. “We want to keep on raising our profile and helping each other out.”

CCGs and future development
Indicative of Vine’s immersive approach is his willingness to grasp the nettle of England’s move to clinical commissioning groups (CCG). He is on the board of his local CCG: at the time of writing as Interim Accountable Officer, and will take up a full-time role as Governance Chair in April.

He remains cautious about CCGs but sees the importance of involvement. “I’m hoping it will allow practices to gain more influence and actually start doing things that make sense to us, as opposed to someone sitting in number 10,” he says. “It means practices should have an easy route in to say, ‘This isn’t working for us, what can we do?’ As opposed to a PCT that says: ‘This is what we’ve been told you have to do.'”

Practice managers working in CCGs will inevitably need training and upskilling, he says (just as GPs and nurses will) because surgeries have never before worked on this scale. “We are taking on a job that’s unfamiliar to us. I’m used to running my small business. I’m not used to running a business of 100-fold income, staff-wise and all the rest of it.” Without training, he says, this would create the “nightmare scenario of the corner-shop taking over Tesco”.

CCGs offer a great potential to enhance practice managers’ role, Vine believes. “If we can grab this and take it forward, we can show our worth to a wider audience and those who wonder, ‘What’s the point of the manager? He/she just does what they’re told’ will see we bring other skills to the table.”

Again, his pragmatism is apparent: “The bill is going to happen. There will be GPs and managers who will avoid it, pay lip service or do the minimum they can get away with until it’s part of the contract. Until then, some will continue to duck and dive as much as they can. But others, and I suppose I must be one, know it’s already happened, and say: ‘Let’s make it work rather than sit on the sidelines.'”

Over the years, practice managers’ workloads have become “immensely more complex”, says Vine, and this requires reinforcing the networks to which he is committed. Central to the changes and the variation in practice management is the need for unity, he believes.

“Practice management will continue to develop, and I think we’ll end up with two styles of practice managers: the ‘strategic’ manager who works with lots of practices and the more ‘basic’ manager doing the traditional role of running a surgery,” he says. “The challenge ahead will be how to make sure they all work together.”

Practice Management Network