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by Angela Sharda
22 January 2019

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The PM edit: Sheinaz Stansfield in her 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.
Deputy editor Angela Sharda talks to Sheinaz Stansfield 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?
Ten years ago our waiting rooms were full of people with health needs, now our waiting rooms are full of people with social needs that impact their health. As the system becomes harder for them to access and navigate, general practice is always accessible.
As a result we have to work with others in a very complex health and wellbeing system to manage these people proactively with different skills. I feel that our contracts have not evolved to support integrated working and to manage the person rather than the condition.
Therefore, much of my time is spent supporting staff and improving the health and wellbeing system to help us manage needs of the patient differently. I can confidently say that this is no easy task.
Q. When did you begin as a practice manager and how did you get into the role?
I was on my way to university to do a PhD in 2008 and I was invited to apply for the practice manager post at Oxford Terrace Medical Group. What they didn’t tell me was this was in fact a ‘merger manager job.’ I agreed to take the post for 18 months.
Having led that merger, many years ago now, and transformed Oxford Terrace and Rawling Road Medical Group, I have been in the post for nearly 11 years.
Becoming a practice manager was the best career decision I ever made and it has been an awesome journey.
Q.    What are the biggest challenges of being a practice manager today?
With the ever-increasing complexity in the system, rising patient demand and reduced budgets, it is challenging to maintain staff motivation and meet patient expectations.
We have a culture of continuous quality improvement and using quality improvement skills and science enables us to maintain energy survive, thrive and overcome challenges.
Q.    What do practice managers need most in terms of support and resources?
Practice managers need to believe in themselves, and work to a position of influence. We need to do this for ourselves and not wait for others to do it for us.
There are many opportunities available through initiatives such as the NAPC practice manager diploma, NHSE GPFV practice development programme, particularly the general practice improvement leaders programme, NELA practice manager programme and many other local initiatives funded though the £6m GPFV funding for practice manager development.
There needs to be more recognition across the system and if general practice is to transform and survive then practice managers are key to this. As practice managers we need to grab the opportunity with both hands and lead the way.
Q.    What do you find most rewarding about being a practice manager?
There are so many amazing and rewarding things about being a practice manager. The most important aspect for me is the difference we make every day to each individual patient, family or carer when we create an excellent environment in which our staff can deliver safe, high quality services and bring joy both to patients and the team.
During these days of austerity, increasing demand and increased scrutiny of GPs, we are in the privileged position to have autonomy in our practices to design and deliver services to meet population needs.
With a motivated team, engaged patients and a tool kit of quality improvement methods, we have been able to transform this practice into a thriving modern 21st century organisation – what could be more rewarding than that.   
Q.    What is the future of practice management? 
Traditionally, practice managers have had operational roles and although they have been excellent, many have had limited influence or involvement in strategic decision making.
In the next five years we will need leaders who take an active role in transformation and change. In the future we will set strategy, inspire others and act as role models and mentors coaching and supporting others. We will be using a very different skills set, looking for different ways of doing things.
We will become system leaders working with our communities, in a very complex health and wellbeing system to proactively manage population needs. We will lead more complex organisations equal to our secondary care counterparts offering a real voice and influence for general practice at the highest levels in the system.
Q. What do you think you would be doing today if you were not a practice manager?
I would probably be called Dr Stansfield, and be in an academic role.
For my MBA dissertation in 1998, I undertook a triangulated study of the barriers to public participation in general practice.
Q. The practice manager role is forever evolving. If you could choose your dream team, what would it look like?
Population needs are changing and so must the structure, culture, workforce and skills of the GP workforce. We have over 15,000 patients and five partners left the practice following our merger.
All our staff are skilled up to understand and connect patients to health and wellbeing interventions. 
New roles in the practice include: health and wellbeing co-ordinator, care navigators, frailty nurse, older people’s specialist nurse and pharmacists working in care homes and in the practice, all funded through role redesign and reduction of waste in our systems.
Sheinaz Stansfield is practice manager at Oxford Terrace and Rawling Road Medical Group