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by Nora Elias
23 April 2019

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Editor’s blog: let’s resource practice managers properly

Data reveal that many practice managers are considering leaving the profession because of rising pressure, thinning resources and growing demand. We must stop this before it’s too late, says editor Nora Elias
Management in Practice (MiP) publisher Cogora recently published a new report: Primary Concerns 2018 – The State of Primary Care , which paints a worrying picture of a sector under severe pressure and struggling to cope. 
Admittedly, this is unlikely to come as a surprise to practice managers, but the report nevertheless provides fresh data confirming that primary care is sorely underfunded, with a workforce that is stressed, overworked, lacking a work-life balance and battling to keep up with an intense workload and high patient demand.
When we asked practice managers how they would describe the current state of primary care, comments included ‘a big bloody mess’, ‘broken, overworked, understaffed’, ‘deteriorating rapidly: we can’t keep providing more and more for less money’, and ‘teetering on the brink of collapse’.
The picture emerging from the report, which surveyed more than 2,300 primary care professionals, is how committed practice managers are to their jobs – yet how tired, disillusioned and concerned about the future.
What was most indicative of a profession in dire straits is that of the more than 400 practice manager respondents, nearly half, 47%, said they may leave the profession within a year for reasons including unrealistic demands from patients, mounting bureaucracy and increasing workload from other NHS sectors.
It’s little wonder that the report also revealed that practice managers are struggling with low work morale. It’s no secret that practice managers and their teams often feel undervalued and overlooked. In an NHS where attention and resources are overwhelmingly reserved for secondary care, primary care tends to be left lagging.
When it does get the spotlight, the focus is typically on clinicians, not on administrative members of the workforce. Although this year has seen the publication of two key healthcare documents – the long-term plan and the new five-year GP contract – neither of these contained a mention of the words ‘practice manager’.
That’s not to say they feature nothing of possible benefit to practice managers. The long-term plan pledge of an additional £4.5bn a year for primary and community care by 2023/24 is intended to alleviate pressure across the sector, which of course includes practice managers.
The primary care networks (PCNs) that are a focus both of the long-term plan and the GP contract also bring potential advantages for practice managers.

For professionals who can be quite isolated – since a GP surgery typically has just one practice manager there are rarely peers with whom to exchange advice and experiences – the PCN development could be positive.
Offering the potential of collaborating with practice managers at other surgeries in the network, they may provide a new level of peer support. And while PCNs are to be clinically led, the debate on this has served to highlight the crucial role of the practice manager.
Many are now asking if a practice manager could be at the helm. After all, practice managers, with their valuable experience of running a practice, are perfectly placed to transfer that knowledge onto the larger canvas of PCN leadership. 
Nevertheless, there is quite a difference between measures that aim to help general practice as a sector, and initiatives specifically designed to support practice managers. The Cogora report draws attention to the fact that a significant proportion of practice managers are unhappy in their roles and considering leaving the profession.
If something is not done to address this, we could soon be facing a dearth of practice managers, just as we are with GPs. We all know that practice managers are vital to general practice functioning. Yet, how much attention does a potential shortage of practice managers get? Not much.

What we need are more initiatives like the Practice Manager Development Programme, for which £6m over three years was set aside in 2016/17, to support practice managers in finding ways to balance their workload.

In outlining the initiative, NHS England recognised that: ‘Practice managers are a vital resource in the NHS, playing a key role in maintaining a quality service. Yet they are also one of the most neglected parts of the workforce, receiving relatively little formal training or ongoing development.’
We need more programmes, strategies and, crucially, funding to support and develop practice managers if we are to prevent an exodus of these talented professionals.