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by Tracy Dell
4 November 2022

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Why leadership planning in practice management can’t be ignored

Leadership planning is crucial for both the individual and the practice. Yet in practice management, it is often overlooked.  Practice business manager Tracy Dell explains why and how to change that.

Do you have a leadership plan in place at your practice?  Over half of those who responded to a poll at the Management in Practice conference in Newcastle this month said they did not. Yet leadership plans play a huge part in succession planning and business continuity.

General practices are small businesses. So, unlike the NHS, the Knowledge and Skills Framework does not apply, and for most some nor does Agenda for Change. Practice managers, therefore, need to drive their own development and evidence the benefits so that GP partners engage with it.

Leadership planning is crucial for both the individual and the practice. It facilitates continuity planning and embeds a contingency plan for the organisation. Yet it is often neglected and usually relies on a staff member being proactive to make it happen for themselves.

A resilient practice

There are plenty of reasons why practices must take leadership planning seriously. Numerous studies link leadership development to employee engagement and retention. When there is investment in staff, employees feel valued and stay to contribute to the organisation.

More than that, though, the business depends on leadership planning. The practice must ensure capable future leaders are waiting in the wings and those shining stars are recognised. It is especially important during times of crisis and in competitive markets. 

And that’s the market we’re in right now.

Practice management vacancies have increased significantly since the pandemic. Many factors are driving this, and practice managers leave for many reasons. These include: burnout, early retirement, moving to PCN or ICS roles, and specialising in specific management areas. And some are stepping down to less demanding roles now that changes to NHS Pension rules enable them to do so.

A changing general practice

General practice management has changed enormously over the last few years.

Historically, it would not be uncommon for practice staff to climb the ladder, progressing from reception and admin roles to the position of practice manager. Often staff were appointed merely on a time-served basis. And, as practice managers would usually remain in post for many years, it could be a long wait! Usually, there would only be one management or senior staff position in the practice with a very simple structure. But that’s all changed.

Thankfully, we have moved on from the ‘dead man’s shoes’ situation in which people cannot progress in their careers until the practice manager retires or dies. And we now operate in an environment that offers a wide range of development and employment opportunities for staff.


New roles have emerged in primary care. These include managing partner, business manager, practice manager, operations manager, deputy manager, finance, HR, IT and PCN managers.  The various roles enable development inside and outside the practice, bringing benefits as we move towards more collaborative and at-scale primary care delivery.

As well as considering these new roles in primary care, a leadership plan should incorporate leadership styles. This is a vital component that needs to be understood for the smooth running of the practice. Leaders can adopt different styles depending on the circumstances and learn to adapt to meet changing needs.

So, how do you go about creating a leadership plan?  Leadership plans need not be complex to achieve the result you need. A simple approach can often work just as well.

Leadership planning

A starting point is a focus on the key areas of priority. This ensures that the practice manager’s ambitions align with the practice plan and those of colleagues.  To do that, explore the various options and routes to development.

Think about existing knowledge, skills and experience in the practice. How do you build on them? Are there gaps?  Those keen to develop should be encouraged to seek new and emerging opportunities outside the practice and PCN to complement their role in the practice and help to horizon scan. This will ensure the practice benefits from areas of development and they can engage with ICB, LMC, GP Federations and NHS England.

Within the practice, consider areas of responsibility and whether there is scope to develop lead roles in certain aspects.  It might be HR, finance, IT, patient services or something else.   Include additional functions and skills in this exercise.  These might include roles such as being an advocate for different groups, for example, dementia champion or carers’ champion. Or it could be knowledge of BSL or other languages.

Consider training and development opportunities. Accreditation is how practice managers validate their role and endorse their professional status, so that’s an obvious place to start. Options to consider include IGPM, PMA and CMI accreditation programmes and courses of study with career pathways.   

But training and development go beyond that. Opportunities can be informal, internal, external, mandatory and supplementary. There are many options, such as bitesize sessions, peer-to-peer shadowing, role swaps, and classroom and online learning.  And existing supervision and line management can be used to their best advantage if you consider adding a mentoring or coaching element. Could those in the practice provide it or receive it for one another? Equally, there is value in seeking it outside the practice.

In summary, practice partners who want to recruit and retain fit-for-purpose managers should embrace the opportunities available to their leaders. A leadership plan is a smart way to do that while ensuring business continuity for the practice.

How to create a leadership plan for yourself as a practice manager

A starting point is thinking about your current role and what you’d like to do in the future. Here are a few questions to consider:

  • Where are you now? Plot your position and evidence your strengths
  • Assess your role and ask yourself if you are happy with where you are. Do you have an ambition to develop? If so, consider how you will do this
  • What opportunities can you explore within the practice and externally? Explore the opportunity to step up, introduce new projects, and work with or for ICB, LMC, PCN, and GP Federation in additional roles
  • Could you do more networking? Strengthen the connections you have already and add to your network whenever you can. Participate in manager groups, seminars, conferences, and online groups such as the Management in Practice LinkedIn group or Facebook’s General Practice Managers UK.
  • Can you take on more responsibilities or tasks within your role to make improvements? Share ideas and demonstrate how they will positively impact the practice
  • Where are you going? Is an opening likely? Is there a plan to expand the practice/increase staff? Interrogate the practice business plan and see which areas relate to your role or one you can progress to
  • Where do you want to be? Is there scope within the practice for you to move quickly enough, or do you need to consider roles outside the practice/PCN? Do not allow yourself to stagnate and dull your sparkle!

Once you’ve decided how you’d like to develop, take steps to make it happen.  Appraisals and role reviews offer the opportunity for discussions, but you don’t need to wait for this to start the process.

Tracy Dell is Practice Business Manager at Cleckheaton Group Practice, West Yorkshire and a primary care management consultant