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by Valeria Fiore
19 December 2018

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The PM edit: Gareth Thomas in his own words

Management in Practice is speaking to a series of PMs on the front-line about what being a practice manager means to them.
Reporter Valeria Fiore talks to Gareth Thomas, business manager at Risca Surgery and North Celynen Practice in Newport about the challenges practice management poses and the future of the profession.
Q. How has being a practice manager changed since you first started out in the profession?
I have been working within NHS Wales for over 18 years and have been a business manager at Risca Surgery and North Celynen Practice for four years. A lot has changed since I started and practices are having to quickly adapt to new ways of working due to a lack of salaried GPs.
We are seeing a number of practices in the Gwent area not surviving and becoming Local Health Board (LHB) managed, while others are merging. A greater focus is also given to employing key allied health professionals – such as advanced nurse practitioners, clinical pharmacists and paramedics – as part of the practice team.
This forms part of the primary care transformation model [that aims] to redesign services provided in primary and community care in NHS Wales, and of the Government’s plan for health and social care published in June –A Healthier Wales: our Plan for Health and Social Care.
Greater emphasis is also being placed on cluster working. There are 64 cluster networks across Wales, serving populations of between 30,000 and 50,000 patients.
They are groups of GPs working with other health and care professionals to plan and provide services locally, but they are all at different levels of maturity and some are unfortunately predominately LHB driven.
I have an MSc in Health IT, so I am really keen to see new technologies help the challenges faced by general practice and help patients.
We have implemented Skype in our practices – at the moment reserved for staff members – to help us improve staff communication. We also offer My Health Online for patients to book and order repeat medication, and My Health Text for two-way text messaging.
Q. When did you begin as a practice manager and how did you get into the role?
I was previously employed by Aneurin Bevan University Local Health Board’s primary care department, so I was aware of how general practice worked from planning, developing, implementing and monitoring primary care general medical services. You could say I am poacher turned gamekeeper.
Q. What are the biggest challenges of being a practice manager today?
The biggest challenge most practice managers face today is managing patient demand with [a limited] practice capacity. We recently changed our appointment system to an open access clinic model [same-day access] in Risca Surgery and are monitoring its progress.
We will also implement eConsult next year to allow patients to consult with our doctors online, with the hope that this will allow us to manage our demand more effectively and provide patients with a better service.
There are a number of other challenges for practice managers nowadays, including the constant changes in legislation, such as GDPR.
Q. What do practice managers need most in terms of support and resources?
Practice management is an isolated profession and everyone comes to you for the answers. I am part of the National Welsh Practice Managers Committee, which organises a conference each year.
I have also recently established the Gwent Practice Manager Forum to allow for local peer-support in Gwent. I have been actively raising my concerns nationally about the lack of support and training opportunities for practice managers across Wales.
Q. What do you find most rewarding about being a practice manager? 
I think the most rewarding part is the variety of the job; one day is always different to the next. The other rewarding element is the flexibility to make changes and see them through from beginning to end.
Q. How do you see the future of practice management?
It is difficult to say, but I would say the current practice manager model is not suitable anymore as there is so much to manage. I can see that there will be more practices merging into super partnerships or federations and that the role will need to become more specialised and much more business-oriented, with a proper management structure in place.
Q. What do you think you would be doing today if you were not a practice manager?
I would probably be in IT. I am a member of the GMS Primary Care Information Management and Technology (IM&T) Board, which forms part of the National Wales Informatics Service (NWIS) and I chair the GP Clinical Systems Quarterly Review Panel.
Q. The practice manager role is forever evolving. If you could choose your dream team, what would it look like?
Our practices are dynamic, innovative and very forward thinking. We previously ran a six month pilot with an MSK practitioner and this has been taken forward in our cluster as a model for all practices.
We have also recently appointed a clinical pharmacist and I would like to think we could embed a paramedic and possibly other allied health professionals, which we are now considering.
Gareth Thomasis is business manager at Risca Surgery and North Celynen Practice in Newport, Wales