Nicola Davies describes how she proactively addressed concerns about a shortage of future practice managers in her area
Four years ago, after 41 years in general practice, I began to think seriously about stepping down as practice manager. I had spent the last eight years at a rural three-site dispensing practice in Cornwall and I was concerned that we might struggle to recruit my replacement.
Cornwall faces a particular workforce challenge because our geography means we don’t benefit from the same level of workforce movement seen elsewhere. My assistant had already indicated that she did not want the practice manager job so I was worried about how I could leave without putting the practice at risk.
Those concerns led me to a conversation with my colleague Liz Symons at the Cornwall Training Hub and together, we began exploring the idea of a practice manager ‘apprenticeship’-style scheme.
The attraction was clear. It would help address the challenge of relying on external recruitment by a focus on ‘growing our own’. We could create a pipeline of managers ready to step into senior roles in the future. An apprenticeship scheme would also allow people to train over a longer period of time, giving them the opportunity to step up into management without the pressure of a short, intense handover.
First steps – designing a bespoke course
Turning the idea into reality took time. We initially approached apprenticeship providers, but we couldn’t get the course that we needed. Practice management is so niche that I felt a generic management course wouldn’t teach aspiring managers what was required for general practice. In the end, we decided to bite the bullet and design our own bespoke course – called Foundations in Practice Management.
Funding was secured through a combination of non-clinical training funds from the training hub and the ICB, which has been incredibly supportive of the initiative. By outlining to the ICB how critical recruitment is, but also how problematic it was going to become, it was actually not that hard to get them to see our point of view. They understood the landscape and the age profile of the managers in the county. To gain funding, we knew that there was a pot of money we could access via general practice resilience (and this is about making the teams more resilient!). We had to put a business case to the ICB and have an in-depth conversation about the aims of the course and potential outcomes. We were very fortunate that our business case was approved and the ICB provided us with some funding.
The aim of the scheme was to ensure trainees emerge with a solid grounding in all aspects of practice management; that includes finance, HR and complaints handling, as well as leadership skills such as adapting management styles to get the best out of a team. Alongside our training, we brought in an accredited provider so trainees could undertake an ILM Level 5 qualification in Leadership and Management.
Each module focuses on a specific aspect of the practice manager role and is aligned with the accreditation scheme offered by the Institute of General Practice Management (IGPM), meaning trainees can begin building their portfolio of evidence from the outset.
Training days are fortnightly and follow the academic year with surgeries releasing their employees to attend. The training itself is free to practices though we expect them to pay their employee to attend the day.
How the scheme works
The course is open to people already working in general practice who have been identified by their line manager as having both the potential and the desire to move into management.
Trainees typically come from supervisory or junior management roles, such as reception leads, assistant practice managers and operations leads. Regardless of their background, they all share a clear ambition to develop their skills for a move into more senior management positions.
What makes the scheme unique is its local and highly tailored approach. Training is led by an experienced practice manager and supported by guest expert speakers who also work in Cornwall. This gives trainees a very specific understanding of the role and all it entails. For example, there is a session delivered by a business manager colleague on the profitable dispensary – crucial for a rural practice manager.
What is expected of both trainees and practices?
The commitment required from both practices and trainees is significant. Each surgery is expected to fully support their employee, agreeing to release them from their role for one day per fortnight and offer study leave when necessary. Trainees must attend at least 80% of academic sessions, complete two ILM assignments and undertake a quality improvement project for their practice.
In return for that commitment, there is a lot of support. Each trainee has me – an experienced practice manager – for coaching and mentoring. We also create a WhatsApp group for each cohort. This allows trainees to ask questions, share challenges and support one another in a safe and confidential space. This supportive network can move with them through their careers. That kind of support is vital to surviving in what can be an incredibly isolating role.
We are currently on our third cohort. Each cohort starts in September and runs for 16 months, with breaks during school holidays and at Christmas and Easter. There is some overlap between cohorts: cohort two is due to graduate in March 2026, while cohort three began in September 2025 and will run until March 2027.
Benefits
Trainees report increased confidence as their competencies develop, while practices are able to delegate more responsibility and potentially offer promotion in-house. This saves on recruitment time and costs and improves retention for those surgeries.
So far, three trainees have gone on to secure practice manager roles. One of them was my trainee who was recruited specifically with a view to taking over from me. Another, previously a secretarial lead, has had a promotion to Assistant Practice Manager.
Although the model hasn’t yet been formally replicated elsewhere, we have shared our approach with other training hubs and ICBs. Some of them are considering something similar. We are always happy to talk to colleagues interested in developing a scheme in their own area.
Looking ahead, our focus remains on long-term succession planning for practice management in Cornwall. The programme works because it is a genuine partnership between the training hub, the ICB, the LMC and local practice manager colleagues. We review the content to make sure that it continues to be relevant in the ever-changing landscape of primary care.
Nicola Davies is the PM Ambassador for Kernow Health CIC (a GP-owned organisation), offering support to practice managers across the county, in addition to running the Foundations in Practice Management course
