A group of practice managers held an online meeting today (25 November) with hundreds of colleagues to discuss ways to amplify their collective voice, and tackle the exhaustion and exasperation faced by the profession during Covid.

Practice managers led organisational changes to keep practices safe and operational at the start of the pandemic, prepared the ‘biggest flu vaccination programme in history’ around unprecedented challenges, and have recently been planning for a Covid-19 vaccination campaign.

Management in Practice spoke to Steve Donlan, co-chair of the Practice Management Network (PMN), about the importance of representation and how a collective voice on the national stage can help improve the situation.

This year has felt like ‘Armageddon’ for practice managers, Mr Donlan explains. On top of the regular workload, they have been responsible for finding logistical answers to a series of pandemic-related issues, such as organising car parks and transportation for the flu vaccination programme. 

‘Ten years ago, we would do our longer-term development work in July and August, as that’s when it was quiet. Now, it’s non-stop and we are exhausted,’ says Mr Donlan, who is also management partner at the Ironopolis Medical Group in Middlesbrough.  

Practice managers are having to constantly put out fires, including tasks such as finding laptops for staff who need to self-isolate, or arranging appointments in the evenings when there’s no cover for them, he adds.

‘I’m sure practice managers up and down the country are doing loads of hours, very often unpaid – because that’s how you sleep at night – knowing that you’re not going to walk into a crisis the following day.’

‘Mass exodus of staff’

A recent survey suggested that 55% of practice managers are considering leaving the profession in the next 12 months – and Mr Donlan says he’s worried the extra pressures will lead to an ‘exodus’.  

‘There are seven surgeries in my primary care network (PCN), and three practice managers have left since the summer, with two retiring.

‘So if the survey and my local experience is anything to go by, then we’re going to have a mass exodus of practice managers. We were all very worried and concerned a year or two ago about the mass exodus of GPs – well this would be equally catastrophic.’

The sector would also struggle to replace those practice managers, Mr Donlan adds. He joined his practice in 2006 from a non-healthcare background but learned the ropes with the support of other managers and GPs – something he says there is little capacity for these days.

‘Joining in these circumstances would be just horrendous, absolutely horrendous – it’s like a war zone [in primary care] at the moment,’ he says. 

Representative organisation

Mr Donlan says he and his colleagues are now campaigning for a dedicated organisation for practice managers because while the British Medical Association (BMA) does a great job of representing GPs – and the National Association of Primary Care (NAPC) does the same for the wider primary care community – there needs to be a body focusing on tackling these key issues. 

‘I think that needs to be more than seven or eight volunteers who get together once every three or four months – which is what the PMN is. It needs to be a recognised organisation.

‘Having that single voice representing practice managers nationally would mean they could have input before things are put on the table.’

Mr Donlan, who has been a partner since 2008, says he was shocked by the ‘bizarre’ decision to exclude practice managers from the £20,000 ‘new to partnership’ scheme, which opened to applications from clinical staff in July. 

He says practices need a healthy number of partners, and practice managers would help ‘steady the ship’ – but the decision to exclude them sent a ‘terrible message’.

The decision prompted practice managers to write an open letter to the health secretary calling for their immediate inclusion in the scheme. NHS England has since said it will be extended to include them – but has yet to release further details on how and when this might be. 

The scheme also requires that applicants be registered with a ‘professional body’. The answer is therefore not to deprive practice managers of the opportunity, Mr Donlan says, but to instead set up an organisation that mirrors what pharmacists, nurses and other professions have.

He firmly believes that practice management is a career and a profession – and says it has always been the PMN’s aspiration to help practice managers become a recognised, accredited role. 

‘The last thing we need is to go away and do a qualification, which involves exams or study, at a time when we’re going under. There are an awful lot of people who have been practice managers for many years, who should just be given an accreditation on the basis of what they’ve done.’

However, he says: ‘If that is what is required to get our profession recognised properly, then that’s what we need to do.’