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by Our manager in practice
22 August 2011

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Should practice management be regulated?

The latest candid thoughts from our undercover practice manager…

Last time I tried to get you all thinking about CQC and what you were doing towards it – or not! But what about your own compliance?

Tricky one this, isn’t it? What is it that you have to show compliance against? Your job description? Practice Manager Competencies, as in the 2004 GMS contract (yes, they are there!)? Membership of a professional body? Or do you measure yourself against something else entirely?

How do you record your CPD? Do you have a programme for developing yourself? How do you choose what courses to do or what you need to develop?

Should there be a mandatory standard for GP practice managers to achieve?

Okay, that’s enough of the questions, I’m getting a headache. And I’m afraid I haven’t got all the answers, but I would like to prod you into thinking about the whole subject.

Central to the whole question is the annual review and appraisal process. This is another minefield for practice managers.

It would seem perfectly sensible for the practice partners to carry out a performance review of their manager – but do they really know what you do? (Back to the job description!)

Even more important: do they understand what competencies you need to perform your role? Which takes us to appraisal, which, in my view, partners are generally not equipped to carry out!

GPs undergo peer appraisal – they have to show various achievements and evidence of CPD, all appraised by a peer. Is this not what practice managers should be aspiring to?

There is a multiplicity of organisations to ‘represent’ practice managers, various ways of recording your CPD and many different systems for performance review and appraisal.

Isn’t it about time we had one lead organisation, setting clear standards for practice managers, so that all practices would know what they should be looking for in a performance review? A system of offering peer appraisal could then be set up.

I know this is all going to cost money. But if we are really serious about standards in primary care – and we should be – practices need to take this forward. Of course, were it a mandatory requirement in some way, via CQC or QOF, for example, a way would be found!

What do you think? I would really like to hear your views on this one. Do you think practice management should be regulated?

Should practice management be regulated? Your comments (terms and conditions apply):

“I think it will happen either voluntary or not, some requirement for accreditation/validation will come out of the Mid Staffs report as long as it is done in a constructive and developmental way it should not be a problem” – John Noton – NE Lincs

“We are already regulated as a proxy of regulations for gps and practices; compliance of these mountains of regulations is enough, thank you very much, and more are coming. Add to that practice manager’s regulations will take our eyes off the ball, our current priorities will take 2nd place, the 1st being to concentrate on our own regulatory requirments. continue with running all our practices successfully in compliance with the current and forthcoming regulations in a perpetually changing NHS landscapes coupled with an array of audits and performance indicators, all these will judge each practice manager whether we are professional or not” – Mohammad Rafiq, Newham

“Another set of boxes to tick? I have a masters in both law and management specialising in employment law. I keep myself up to date as a matter of professional conduct and no one can regulate for that. There is enough to do in practice management (which I love and fell into when my firm was restructured and I just could not commute 100 miles each way every day with young children to care for) as is. One set of criteria will not suit every practice I work in one of the 10 most deprived practices in the country I use a practice (rarely) in the leafy suburbs, they are very different entities the skills base and approach needed for each is different. This is why micro management does not work it fails to recognise diversity. It is ironic patients are to be afforded choice at every opportunity while GPs are given almost none” – Name and address withheld

“I wonder how many of us PMs will become the Responsible Managers under CQC? I know that the suggestion is that GPs should be nominated but I don`t think it will happen, do you?  So, many of us will be regulated by the need for self-preservation anyway! Joining a nationally accredited body such as the Chartered Management Institute and taking their Chartered Manager qualification route at least would enable you to defend your competence if ever it was needed?” – Alan Moore, Cheshire

“No, no, no. It would be a disaster. It would bring in a new layer of bureaucracy. It would undoubtedly have to be accompanied by an expensive leadership and mentoring programme to support managers to demonstrate their skills against an elaborate competency framework. Those competencies will take no account of the context in which Practice Managers operate. We have more important things to do, this is a red herring invented by someone who simply cannot understand the nature of general practice management” – David McBride, Poulton le Fylde

“Absolutely not! For two important reasons. The first reason is that we are already regulated enough. The second reason is that it would be pointless: PMs are (with few exceptions) answerable to the GPs that employ them. GPs choose their PM, the role they want them to perform, and hold them to account for their performance of that role. In this context there is very little room for external regulation. If regulation is imposed, this will force GPs to employ a qualified PM – meaning a one-size-fits-all approach. For smaller practices this could force an unwarranted increase in costs and force out many PMs that currently do their job perfectly well” – SB, Northwest

“Yes, I think there should be some basic business and management skills that all practice managers should be able to demonstrate based as a starting point perhaps on the core competencies of the 2004 GMS contract. As PMs we will never gain any form of recognition as a body unless we allow ourselves to be regulated with a core skills framework, stating minimum responsibilities. Other titles such as Administrator, Surgery Manager etc could be used instead of PM to differentiate the various levels of involvement or otherwise with the strategic development and operation of the practice, and this can apply to small and large practices” – Paula Salerno, West Sussex

“I support the idea for the recognisable qualification for Managers. At the moment we are not considered as professionals as everyone of us is playing a very role within each practice. Some are good in finance, some specialise in HR but most of us have to do it all. I think that our career can only be recognised through qualification and individual talent in present and future healthcare world. I fear that without it our role will be always left on side as it was in current health bill” – Sabina Grzeda, Kent

“I agree with lots of the points for and against as given by fellow Practice Managers. I moved into General Practice in 2006 after 28 years in retail management and was able to utilise my transferrable skills to great effect, however, I did also undertake a Certificate in Primary Care Practice Management over 10 months. There are several routes into Practice Management and each of them attracts a range of people with varying skills and knowledge. I do agree that GP’s do not have a complete grasp on the diversity and complexity of the role. Expecting someone to high levels of skills and expertise in Personnel, Finance, I.T and Business Acumen and I would now add Practice branding and marketing!! is a tall order for anyone and yet that is the role. General Practice is not a Multiple organisation like M & S where Managers are recruited under specific criteria” – Lynne Bolton, West Yorkshire

“NO NO NO: Some of the reasons outlined below (varied roles/independent businesses) are sound, but practices are all already so highly regulated to death that adding an additional burden by regulating the PM is pointless. The fact that we succeed in guiding our practices through all these legislative and compliance hoops is (in part) a testament to the abilities (or otherwise) of the PM” – Chris Stead, North West

“Picking up on Alan’s point [see comment below – Ed], other industries – the insurance industry is a good example – set themselves competency exams. AMSPAR/IHSM etc could introduce voluntary multiple choice exams requiring knowledge of HR, accounts, health & safety, the NHS, QoF etc and those who score in the top ten percent get a certificate of achievement and are excused the exam for 5 years…  The others are told how their score compared to the rest and so encouraged to improve. The exact details need more thought but I’m sure something could be worked up – it would be self-financing and help objectively differentiate the various practice managers that exist” – Stephen Humphreys, Hertfordshire

“I can see pro’s and con’s. As already stated we all do vastly different roles. GPs do pretty much the same job wherever they work, but my job is very different from the PM next door.  On the other hand, I am a Partner and not aprraised by the other partners, and therefore can see that it could be beneficial for a peer review, although again would need to be carried out by individual/organisation that understood my role” – Marion Leister, Essex

“Yes but how would it be enforced? Useless unless mandatory by QOF points” – Katrina Collins, London

“How far would you take it? I manage a 7 GP 11,000 patient practice. A colleague at a nearby practice has 11 GPs and 19,000 patients. My brief covers the whole business/practice management role whereas he is practice business manager and has an assistant who encompasses the “pure” PM role. Would she need to be regulated as well? And how about those practices where much of the “routine” running of the practice is through a reception manager? The roles are too varied for a “one size fits all” approach” – Mike Carey, Derby

“We as practice managers should be keeping personal CPD records and logs that could be called upon to show learning and knowledge of current issues as in any professional occupation, also paying professional subscriptions will also allow for tighter control of those that say they practice managers” J Bowman, North West

“I don’t believe we should be regulated. General Practices are individual businesses and therefore the job of ‘Practice Manager’ is as varied across practices as the salary. What fits one practice may be totally unsuitable for another practice. In some we have to be predominantly rota-makers, HR people and extra hands when staff are on leave. In others we run a business, sit in front of PCs and discuss contracts. neither is right, neither is wrong, but you would be struggling to regulate such variety without a lot of pointless bureaucracy. Mind you that may be the norm unless CQC becomes more appropriate for General Practice” – Nigel Kenward, Lincolnshire

“Just what we need – more regulation – at this rate there won’t be any time left to do any WORK!” – Fraser Cherry, Stockport

“I am not sure about regulation as the roles vary so much across areas, different support etc a training/achievement structure self managed would be welcome and also perhaps a code of practice? This has been developed for HCA why not for us” – Jane, Wales

“The biggest challenge as I see it is that there is no standard Practice Manager Job, some are Partners, some are Business Managers, all dependent on what the GP Partners want or allow the PM to do. We do need some form of funded accreditation other than the current Amspar provision that provides some form of certification for PM’s achieving basic competencies. I believe that MIP did try to get a national PM’s group set up some time ago but this failed to get off the ground. Maybe it’s time to try again?” – Alan Morton, Oldham

“Yes, I believe that these days we should be regulated like GPs. Most managers have an important part to play in general practice these days as we should seek (if not already there), to show that we are competent for the job and support we give to our employers” – Frank Hunter, Leicester