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The shock of the new: views from a first-time practice manager

1 March 2006

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Christine Ranson

I have come to general practice management after a career in further education, initially as a lecturer, and eventually as an assistant principal. I have 17 years of management experience and have a master’s degree in business administration. The four-partner practice where I work is based on the edges of a Midlands conurbation. It has a list size of 8,200 and operates out of a PCT-owned health centre premises

My background is originally from lecturing in secretarial and business studies at a further education college during the 1980s. After a couple of years I was asked to lead the development of a Certificate in Reception course, which then led me to realise that there was a demand for medical receptionist training. I got in touch with AMSPAR and started to make contact with a whole world of professionals and organisations that I didn’t know existed.

First meeting with practice managers
I was fortunate enough to be supported by the college to spend some time in the “medical world” as a preparation for offering the Medical Receptionist course for the first time in 1984. Little did I realise, as I sat with a practice manager hearing all about her job, that 20 years later I would be doing that very job myself!

The Medical Receptionist course was a success, and this put me in touch with many practice managers in the area, as we sought out work experience placements for our students. The practice managers told me that they wanted to do a course as well. Many of them had worked their way up to the role of manager and had no formal training for the job. They ached to put their knowledge into a professional context and to gain some accreditation and status for their experience. So, the college Management Studies Division offered the first AMSPAR practice management course in 1985.

It was like putting a flame to a touch paper: these managers were so keen to get involved in learning and development, and so enthused by the opportunity to “network” with each other. The practice managers who took part in that first AMSPAR Diploma in Practice Management course went on to continue to work together, promoting training and development for all practice staff, and pursuing their own personal development at the same time.

Career change
Anyway, back to me. After starting off those courses I was asked by the college to lead another project, which took me out of teaching – initially for two years, but as it turned out, pretty much forever. One project led to another, and I gained qualifications and experience that took me up the career ladder of college management.
These days, we are all told that we need to view our careers as a “portfolio” rather than as a single-track road. But when I found myself unemployed after 24 years in further education, I did not at first see it as a wonderful opportunity to broaden my horizons. However, now that I am a practice manager, I am told that I am one of a “new breed” who come into the role from a management position elsewhere.

I have met practice managers from army, teaching, banking, human resources and retail management backgrounds who are all very successfully incorporating their own knowledge and experience into their new careers.

Possibly, that is one of my first observations about the role of practice manager. It is a very individual one. The character, background, skills, experience and knowledge of the individual manager very much shape the role that they take in the practice and, to some extent, the “character” of the practice as well. Each practice I have visited reflects its manager.

For instance, one manager may be very comfortable with the human resources side of the job, but uncomfortable with finance. Such a practice would have very well-developed policies, procedures and staff support mechanisms. Staff would feel valued and be well resourced and well developed. Yet the finance side might be subcontracted to an accountant or another organisation, and a partner may take a strong lead in monitoring the monthly income and expenditure.

Practice managers have to be able to cope with such a wide range of activities that it is impossible for them to be good at all of it. But there is more than one way to skin a cat, and practice managers are canny enough to be able to play to their strengths and find other support mechanisms for the things they do not like, or do not feel competent, to do.

Unlike most “small businesses”, general practices do have a “big brother”, in the form of the primary care trust (PCT), looking after them (although I am sure it does not always feel like that).

The relationship with PCTs
The duality of the relationship between general practices and their PCTs is my second observation. It is a relationship of joint dependency, but of obvious tensions and power struggles. Some days the PCT is a best friend, helping the practice out of a difficulty. Sometimes it is a parent, providing cash to support a brilliant idea that a practice has had. Other times it is a frustrating, doddering old aunt who cannot make her mind up, or a stern, critical grandparent who insists on things being done “by the book”.

There are many small businesses that would give their eye teeth to be paid monthly, not have any chasing of invoices, have all their computers provided and maintained for them, and always have someone at the end of a phone to ask for help. Those same businesses, however, would tear their hair out at having their entrepreneurship stifled and having to provide meaningless statistics at seemingly random intervals, while being told to operate in ways that do not make any commercial sense.

Final thoughts
My third and final observation is really a comparison between the world of the big corporations and the world of the practice manager. Even after 18 years of managing in a big organisation, I was amazed at how long things could be talked about before any action was taken. Now as a practice manager I can agree a decision with partners in one minute, and it is in place and known by all by the next day.

The large corporation does give its managers the support and confidence of having professional specialists, HR, finance, marketing, quality and so on. This support comes at the price, however, of the bureaucracy that surrounds it. In primary care, we have to be able to access this professional advice and support when we need it, in a more creative way. The internet is a wonderful tool, but so too is the support networks that practice managers have created for themselves. There is always someone “in the patch” who either knows what you need, or “knows a man” who knows.

I conclude, really, by thanking all the practice managers who have helped – and are helping – me to learn this new job, and by giving a plug to the AMSPAR Diploma in Primary Care Management course, which has brilliantly provided me with the theoretical background and context in which to place my practical learning.

My induction has been by listening, observing, doing, doing wrong and sorting out what I have done wrong. My learning goes on, and I hope that it will go on forever, with each day bringing something new. This is really the best job in the world if you thrive on variety, challenge and change.