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Understanding how to be a leader not just a manager

17 February 2023

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What does leadership mean for practice managers and what responsibilities does it involve that is different to managing? How do PMs know when to be a leader and when to be a manager? Former practice business manager and leadership expert Gary Hughes explains more

What is leadership? NHS England answers by referencing the Chartered Institute of Personnel and Development (the UK body for HR professionals) defines it as, the ability and capacity to lead and influence others, by means of personal attributes and/or behaviours, to achieve a common goal’.

This definitely aligns to the role of a practice manager. But if you want a better understanding of what leadership is you need to dig deeper than the definition and look at what a leader does. There are millions of opinions but there are always common themes.

Arguably most relevant to practice managers, is what the NHS Healthcare Leadership Model says. According to this, there are the nine leadership dimensions:

  1. Inspiring shared purpose
  2. Leading with care
  3. Evaluating information
  4. Connecting our service
  5. Sharing the vision
  6. Engaging the team
  7. Holding to account
  8. Developing capacity
  9. Influencing for results

These can describe leadership in any organisation, but connecting our service’ and ‘developing capacity’ are possibly more fitting to general practice than other sectors.

However, I would argue there is one important characteristic of leadership missing from the list above. That is ‘challenging, developing and progressing’. This ensures the organisation is continually moving forward by:

  • Asking questions to disrupt the status quo
  • Challenging tradition and conventions
  • Seeking and encouraging change
  • Gaining insight from the diverse and unusual.
What’s the difference between leadership and management?

Whenever you’re considering leadership it’s helpful to compare it with management to show how it differs. They are completely different but closely connected activities, and a practice manager will certainly be both a manager and a leader. However, being good at one does not necessarily mean you will be good at the other.

A manager will make sure everything needed to keep the organisation running is available. They set objectives, direct, create procedures and need to be goal-orientated without losing sight of the need to look after their team. Their focus is to:

  • Administer
  • Maintain
  • Rely on control
  • Have a short-range view
  • Ask how and when
  • React to change.

A leader will inspire and set the right example. They focus on the vision, keep the practice moving forward, and connect with the people and teams. A leader’s focus is to:

  • Innovate
  • Develop
  • Inspire trust
  • Take a long-range perspective
  • Ask what and why
  • Create change.

When workload and pressures are high, as they are in the NHS right now, there is a greater need for the activities of leadership. Yet the demands can pull practice managers towards the activities of management.

So, what does leadership mean for a practice manager?

For greater clarity, it can help to break leadership down as an internal activity (inside the practice) and an external activity (outside the practice).

Internal leadership – downwards

It’s worth saying that ‘downwards’ is not the best term, as no leader should be looking down on their team, but it’s reflective of a typical hierarchy in a practice. This downwards leadership is the one that is most readily recognised and is about leading the practice team – typically the non-clinical roles such as reception, administration, secretarial etc, but possibly clinical roles too. This leadership role is one that every practice manager has and involves the activities listed above.

Internal leadership – upwards

Most, if not all, practice managers have to lead, to some degree, in an upwards direction, leading GP partners. This can be a more challenging test of leadership skills but there’s no doubt that the more effective you are at it, the easier everything is for you and the team. Your job can also be more satisfying, and your practice more successful.

Leading those you report to is complex and difficult, but there are some simple rules that will help:

  • Know what they want. Find out what’s important and what stresses them. The easier you make their job, the easier your own will be.
  • Communicate effectively. Everyone communicates differently, so use their preferred method, is it talking, email or written reports?
  • Show your skills. You’ll be better than they are at some things. Make it clear by sharing your skills and knowledge.
  • Give solutions. You’ll be viewed more positively if you suggest solutions rather than continually highlighting problems.
  • Keep them informed. Let them know what progress is being made, and flag issues before it’s too late.
  • Share bad news. Share problems straight away, even your mistakes.
  • Stay neutral. Multiple bosses means multiple relationships. Always be professional, fair and avoid showing favouritism.
  • Don’t blame them. You’ll gain nothing.

External leadership

Leading externally, as opposed to within the practice, is something many practice managers now have opportunities to do, with leadership roles available, for example, in a primary care network, GP Federation or practice manager group.

Leading externally is different to leading internally. You’re not the manager and you’re leading those who don’t report to you. They may have different expectations of a leader and to be successful you may need to adopt a different leadership style. This will include:

  • Flexible leadership. Those you’re leading will have different needs, fears, priorities and levels of power and influence. Understanding these and the ability to adjust your approach is key.
  • Communicate clearly. Keep communicating, constantly. If there is something to say then say it, and clearly so you can’t be misunderstood.
  • Involve everyone. Good ideas don’t only come from those with the most to say. Avoid divisions and look to involve everyone, so no one feels excluded.
  • Resolve issues. If there’s an elephant in the room get it in the open. Not everyone can agree all the time but resolve problems before they become serious.
  • Be diplomatic. It’s not your place to judge but guide without pressure. Truthful and tactful is more likely to get you respect.
  • Build trust. Do all of this and be reliable and consistent, making sure you deal with what’s important.
How do I know if I am leading or managing?

Despite having the title of practice manager, you are in a leadership role. And it’s perfectly natural to feel like you aren’t fulfilling on your leadership responsibilities sometimes, particularly during difficult or pressurised times as we are experiencing now. Yet, these are the situations in which effective leadership is even more important.

To help refocus it can be useful to pause every once in a while to reflect on how much you are actively leading. A good way of doing this is to consider the activities of a leader versus those of a manager (see below) and decide which you are doing more of.

For example, is more of your time spent on administering or innovating, maintaining or developing, and so on? Look at the two lists below and tick which apply. If you are focused on leadership you should end up with a greater number of ticks on the leadership side.

I am leading through:  I am managing, by:
Innovating   Administering
Developing Maintaining
Inspiring trust     Relying on control
Taking a long-range perspective Having a short-range view
Asking what and why Asking how and when
Creating change Reacting to change

Gary Hughes is a director at Venn Health providing support to primary care. He has been a Practice Business Manager and Federation Director and has an MBA and a Post Graduate Certificate in Medical Education. He has also published a book Leadership in Practice.