Management in Practice is speaking to a series of PMs on the front-line about what being a practice manager means to them.

Editor Nora Elias talks to Martin Bell, business manager at the Sacriston Surgery in County Durham, 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 don’t think the essence of the job has changed that much over the 10 years I’ve been doing it. At its heart, it’s about keeping staff and patients happy, keeping the money coming in, and keeping the place running.
 
However, the breadth and depth of the role is far greater today, with more stakeholders, both people and organisations, that we seem accountable to – such as NHS England, CCGs, and the CQC.
 
Which means more complex relationships, with a lot more bureaucracy. Working with secondary care and voluntary and community sector colleagues, which is the right thing to do, also takes time and effort. There is a real sense of having to be ‘game savvy’ in a way that we maybe didn’t need to be before.
 
Q. When did you begin working as a practice manager and how did you get into the role?
About 10 years ago. I’m at my third practice now, the biggest so far. I left my first practice manager role as an impending budget cut meant either I or a clinical staff member would have had to go, and I’m too squeamish to stick a needle in anyone. With the second position, a change in personal circumstances gave rise to a job shift. I love where I am now, in a modern building with a patient list of just over 10,000.
 
Q. What are the biggest challenges of being a practice manager today?
Keeping a handle on the changing environment is hard work. Structures and people seem to change with alarming frequency in the NHS. Change is good, but change needs to be given time to see if it works, and to be allowed to bed down. Change for the sake of change is not good leadership.

Keeping the money coming in is also becoming more challenging. Receiving a significantly smaller slice of the cake than secondary care, we in primary care represent good value for money. However, with increased cuts to enhanced services and more hoops to jump through to get funding, for example in the shape of CCG incentive schemes, it takes considerable effort to ensure sustainable revenue.

Q. What do practice managers need most in terms of support and resources?
Practice managers need programmes and core skills to ensure they are competent. However, in my view, putting on programme after programme of management and/or leadership development has limited value. A tailored coaching-style support for practice managers, with someone they can talk through the issues of the day with over a prolonged period of time, would be a good investment.

Q. What do you find most rewarding about being a practice manager?
The staff and the patients. Rarely are two days the same. I find it important, absolutely vital in fact, to remember that I manage and lead a service that interacts with people during some of the high and low points of their lives, including times when they may be vulnerable.
 
Q. How do you see the future of practice management?
I would like to see more recognition and acknowledgement for the value managers bring to practices, with salaries that reflect that value. The differentiation between practice managers – operationally focused, and centred on keeping ‘the show on the road’ – and business managers, more strategic and with a longer-term focus, is something I would also like to see develop.
 
Q. What do you think you would be doing today if you were not a practice manager?
I started my career in HR, so it would either be going back to that, or possibly teaching.
 
Q. The practice manager role is forever evolving. If you could choose your dream team, what would it look like?
With the drive for primary care at scale and working collaboratively, I think a good first step would be for practices to consider an ‘administrative merger’. This could see a manager look after one particular functional area across a number of differnet practices. Practice management would then be more operationally focused on the needs of different physical sites.
 
Martin Bell is business manager at the Sacriston Surgery in County Durham