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The practice manager of tomorrow

28 April 2017

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What will your job be like in a decade’s time? Victoria Vaughan asks the experts

If the past year has taught us anything, it is that predicting the future is a fool’s errand. Few people expected Brexit, to see Theresa May moving into Downing Street or Donald Trump waving from the White House.

But, closer to home, there are some clues to how the role of the practice manager is changing – and how it might look 10 years from now. 

Driven by financial constraints, rising demand, an aging population and a workforce shortage, the battle is on to squeeze out inefficiency and drive up quality. The latest vision is one of sustainability and transformation plans (STPs), 44 footprints, hubs, new care models, super practices, and Skype consultations; of focusing on prevention, rather than cure. The same pressures are bearing down across the UK, although the answers are different from country to country.

At the same time, in many places practice numbers are declining as the traditional partnership model goes out of fashion, while smaller practices struggle with workload and recruitment. 

The millennial generation doesn’t want to be tied down to a building and a business and prefers to be salaried. In response, practices have been banding together in federations and networks to help spread the increased workload. And there is the rise of the super-practice with formalised partnerships across a federation. 

A different landscape

Amanda Sayer, managing partner at The Lighthouse Medical Practice in Eastbourne, East Sussex, says: ‘I don’t think my role will exist in 10 years. The STPs suggest GP practices could lose their individual NHS contracts. 

‘If the STP comes into place, it will be a completely different landscape, with great big federated models, where the management functions will be done centrally and be divided into different roles, some covering human resources, health and safety, contracts, Care Quality Commission (CQC), and public and patient involvement,’ adds Sayer.

But in North Wales, practice manager Dwysan Rowena is less radical. ‘I can’t see practice managers going, but the role will depend on the size of practice. There is one in Prestatyn where there are a number of managers with split roles. They are all doing different things and it is more diverse.’

Rowena, chair of the Denbighshire practice managers group, is going to recruit an assistant – as other nearby practices have done – to help with the day-to-day running, so she can focus on business planning. 

Fiona Dalziel, a recently retired practice manager in Aberdeen and adviser to the Royal College of GPs, believes there is a ‘fantastic opportunity to diversify and expand our range of skills’.

‘As practices get bigger and work in federations and super-practices, and across clinical commissioning groups (CCGs), the amount of input and control a practice manager has will have to increase.

‘The more GPs become salaried, the less willing they are to spend time on managing. Practice managers are ideally placed to run with delivering excellent services, as they are the people with the understanding of how a GP practice works.’

She acknowledges that this won’t appeal to all. ‘There will be some who will stay as practice administrators, but there will be opportunities for those with the enterprise, skills, knowledge and drive.’

Clearly not all today’s 7,000 or so practice managers can head up super-practices. But the traditional jack-of-all-trades, cleaning up petrol spills in the car park one minute and presenting business plans the next, is on the way out. Rowena says: ‘The practice manager coming up through reception is not going to exist; it will be a thing of the past.’

Dalziel is adamant that governments must invest in both training and the creation of a professional body.

The practice manager will need

1. Leadership skills

2. The ability to horizon-scan

3. IT skills

4. An understanding of hospital contracts

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5. Management skills, particularly in relation to people

6. Strategic planning

7. An ability to work with a variety of stakeholders

8. Organisational ability to run a small or medium-sized enterprise day to day 

9. An ability to manage a portfolio of properties

10. An ability to handle multi-million-pound budgets

Funding in Scotland

In Scotland, the government is going to invest an additional £71.6m in direct support of surgeries.

A Scottish government spokesperson says: ‘General practice is indispensable to the health service – without effective practice managers, this system can’t work. We value the role of both clinical and non-clinical staff in delivering in the practice setting, including the vital local leadership shown by practice managers. We are committed to reinvigorating general practice so we can attract more people into it, make things better for people already working there, and ensure it has a bright future.’

NHS Education for Scotland runs a practice managers vocational training scheme. The 15-month course, now in its twelfth year, covers subjects such as networking at a local and national level, building workforce capacity and strengthening partnership working.

A spokesman says: ‘We also offer support via The Scottish Practice Management Development Network, which encourages the development of high quality, easily accessible and local networks providing information, support, education and representation.’

Investment in Wales

A spokesperson from the Welsh government says demands on practice managers will grow: ‘The role will increasingly lead on new contractual relationships, such as GP federations and social enterprises and in developing initiatives to address demand. We are working with GPC Wales and NHS Wales to develop this further, as part of the changes to the GP contract for 2017/18.’ However, the Welsh government, the Health and Social Care Board in Northern Ireland and the Department of Health (DH) in England all state that training is the duty of the practice itself.

Resources in England

A DH spokesperson said: ‘Practice managers are a vital resource in the NHS, playing a key role in maintaining a quality GP service. A sum of £6m is being invested in developing practice managers, including a support network to share best practice. As independent contractors, GPs are responsible for ensuring the staff they employ are adequately trained.’

The £6m fund was outlined in the General Practice Forward View, published in April 2016, which also pledged that practice managers would have access to to the national development programme. NHS England is supporting the new Practice Management Network (PMN), run by the National Association for Primary Care (NAPC). 

But funding for the PMN is not guaranteed, admits co-chair, Steve Williams. ‘This funding is non-recurring and is being allocated over three years. We hope there will be continued investment after this time.’

He also agrees the practice manager role will not exist in its current form in the future. ‘Since the 2003/04 contract, requirements have been changing year on year. However, the generic principles of being a good manager and leader will remain.’ He echoes Ms Dalziel’s comments that larger organisations will mean practice managers will need to work at scale. However, he says this will ‘be determined by local demographics’ and ‘greater emphasis will be placed on strategic planning’.

Opportunities to learn

The PMN is starting a training programme this October to prepare practice managers for these bigger roles. It is backed by the Healthcare Financial Management Association (HFMA), the Institute of Healthcare Management (IHM), the Association of Medical Secretaries, Practice Managers, Administrators and Receptionists (AMSPAR), NHS England and law firm Capsticks. It will be modular, by distance learning. ‘We are going through the acceptance criteria, and we are not sure if it will be those who are already practice managers, or whether we will open it to others who want to come into the profession,’ says NAPC president Dr James Kingsland.

The IHM is also developing online training for members. Chief executive Jill DeBene says: ‘There is definitely a future for GP practice managers. The role is becoming larger and more complex. Practice managers who, in the past, may have had a more administrative-type role, are now managing hundreds of members of staff and multi-million pound budgets. 

There is a consensus, both from the front line of the practice, to the upper echelons of policymakers that the role of practice manager is going through a significant change. 

Predicting the future may be a dangerous game, but it seems the job title ‘practice manager’ may be obsolete in a decade’s time. Instead a new breed of ‘business managers’ will be the linchpin of primary care.

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