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by Rebecca Gilroy
11 October 2019
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Jo Wadey is chair of the West Sussex Practice Managers Association and was shortlisted for practice manager of the year by the National Association of Primary Care. She spoke to Management in Practice about some of the key challenges facing practice management today, and what can be done to boost the profession.
The West Sussex Practice Managers Association, chaired by Ms Wadey, has been growing in leaps and bounds over the past few years. As a local support network, it offers help and encouragement to 92 practice managers in West Sussex during a time of immense pressure on NHS services.
‘It’s very unique. The CCG in West Sussex contribute towards the cost of running it because they’ve seen the real benefit of it,’ says Ms Wadey.
‘We have a practice manager “bank”, so that all practice managers who work within west Sussex can put themselves on this spreadsheet where, say, if they’re part-time or full-time, they can [offer to] help out. When new practice managers come in, if there’s a gap in practice management between recruitment or a practice is struggling, we can get another practice manager in there.’
As the association has been such a successful model, Ms Wadey, who has previously worked for the Care Quality Commission (CQC), hopes that it will be rolled out nationwide. Practice mangers are under as much strain as any other primary care professional, therefore offering support and boosting resilience are necessary to keep the community motivated and the quality of care they offer high.
‘What I’m really passionate about is ensuring that there are high standards in all practices and I can see from working for the CQC that there are variances at the moment. What I would really like to see is practice managers supported, when they’re new or when they’re struggling or coming through, that they’re doing continual professional development and they’re being mentored and coached,’ says Ms Wadey.
‘It’s such an important job and we just cover so many areas, there are not many professions where you have to do everything, from HR to finance situations to strategy. It’s everything and it’s getting bigger and bigger with primary care networks (PCNs). I think practice managers feel quite unsupported sometimes.’
Without connections, and in a role that can quickly become isolated, resilience is a key part of maintaining the number of practice managers in the profession. Alongside major structural changes and working in diverse practices, across localities with varying sizes and demographics, it makes sense that practice managers have a place to go to share concerns, experiences and ideas.
‘I think resilience is huge. I think that lots of practice managers are saying ‘I just can’t do this anymore’. I think that we are struggling to keep our expertise up. [With PCNs], we’re going to another level where we’re working with patients in sizes of 30-50,000 and working across different practices,’ explained Ms Wadey.
‘There’s a lot of upskilling that’s needed because the average size of a practice is much bigger than it used to be, and we need to become even more business-like and understand the legal and financial side of things. But trying to do that, as well as the operational [side], is a struggle.’
Bringing in allied professionals
When staff needs are met and they feel both motivated and able to fulfil their role, then the quality of service is lifted. Non-clinical staff can have a significant impact of health outcomes, Ms Wadey points out. They play a crucial role in patient education, and as practices gain more allied health professionals, practice managers will become a part of the process of signposting patients to different care pathways. Recognising the value of taking on new staff is one thing, but considering the amount of work this might require is another – and it is often a task that falls to practice managers.
‘It is difficult to recruit but I think we also need to remember that [allied professionals] are not a replacement for GPs. They come with a different skillset and they need close supervision,’ explains Ms Wadey.
‘The practice pharmacist helps out with medication reviews for our 15,500 patients, they do face-to-face consultation medication reviews with our patients who are on statins or hypertensives, they keep audits going to ensure that we’re safe with what we’re prescribing, that antibiotics have been prescribed appropriately and they feedback to the GPs. It’s made our medication process so much safer. I think practice pharmacists are excellent.’
From paramedics to physician’s associates, once patients know what care they need and who they can get it from, the overall practice experience is improved. However, it has always been the case that practice managers are expected to support everyone else, with this often meaning there is no one there to support them. It’s important to make sure staff feel valued, and one way of doing that is through consistent appraisals, Ms Wadey has found.
‘Using a 360 appraisal through the NHS Leadership website, you can ask your partners, your colleagues and your patients how they see you as a leader. From that you can build on where you think you’re doing really well and where you can develop. I’d quite like to see practice managers encouraged to do that as well. It helps us continually look at ourselves and find out where our gaps are and build a good portfolio.’
Recognising practice managers for their work they do
Taking on these challenges can be something practice managers can do on an individual level. But, as Ms Wadey points out, there is something that our leaders, and the wider NHS, can do to help.
‘I think the most important thing, and what I would really like to see in my vision of the future, is to see all practice managers accredited. That they can be recognised for the really difficult job that they do, and have support nationally,’ says Ms Wadey.
‘I think the only way we can do that is by ensuring that we move forward, make it mandatory and ensure that practice managers choose to actually say yes, I’m doing a really important job here. I do keep up with my continuous professional development. I do have my regular appraisals. I do feed things back and I deserve to be accredited in a profession and recognized for the work I do.’
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