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18 September 2017
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The primary care landscape is developing at a rapid pace and practice managers are the key to the sustainability of primary care. Jo Wadey discusses why it is an important time to invest in themWith the rapidly changing landscape of primary care, there has never been a more important time to think about our professional development.
In March 2017, the then junior health minister David Mowat told MPs: ‘We are finding that things are working better with GP practices being put into hubs of 35,000 to 40,000 people. They are able to employ pharmacists and physiotherapists and do more things at scale than they could as a single practice or as a practice of two or three GPs, which has historically been the norm.
‘We are changing over time from a position where we have 7,500 GP practices to a smaller number of 1,500 super-hubs.’
I have seen this already starting to happen in my locality. In Worthing, West Sussex, we have seen the closure of three practices and we now have one with over 20,000 patients and another with over 30,000.
The practice manager role will need to change significantly if we are to manage teams of around 100 to 200 people and work in community networks or primary care homes – a model developed by the National Association of Primary Care (NAPC) to form different models of care – or new accountable care systems.
I constantly hear practice managers say they are too busy to take time out to develop. We certainly are busy, but so are practice nurses and receptionists, yet we manage to invest time and money in developing them. So we need to ask our partners to support our own professional development.
How many practice managers have regular appraisals? Anecdotally, I would say that many of us appraise our staff but rarely have an annual appraisal ourselves. Have you considered asking another practice manager to sit in on your appraisal with your GP partner? This can help generate more ideas and give you support to ask for investment into your development.
I asked some experts that work in primary care or educational and training companies for their opinions and to understand what resources are there to help and support us. Everyone agrees; the success of the future of primary care rests with us.
The GP Forward View states that the success of general practice will rely on expanding the wider non-medical workforce, and that this is about the beginning of a journey to support practices to build the capacity and capabilities needed with their teams.
Dr Nav Chana, chair of the NAPC, told me: ‘There’s an understandable focus on recruitment and retention and workforce development in primary care at the moment and many initiatives are targeting this.
‘What must not be lost is the absolute need to support the development of practice managers in the changing context of primary care as we move towards different models of provision.
‘Inherent in this is a growing emphasis on collaborative leadership and business skills to support greater integration of services. Practice managers will play a critical part in the transformation and we must ensure we help them build on their skills to be able to embrace the changes.
‘The success of emerging new models of care, including the primary care home, will depend on investment in practice managers to ensure they have the skills and confidence to manage primary care at scale.’
Pauline Young, of Syder and Young training, said: ‘Practice managers are professionals, and like any profession, they need to continually develop. They are expected to take care of all aspects of the business, from providing a first-class patient service, compliance, HR and finance. So they need to maximise growth in the morning, manage health and safety in the afternoon and motivate team members during the lunch break.
‘Importantly, practice managers are at the heart of the changes that are happening right now and will ensure that general practice is sustainable in the long term. There are not just new skills to be developed, there are new ways of thinking to be understood and shared with team members. The business needs to be well led and expertly managed.’
Margaret Spence, regional representative from the Association of Medical Secretaries, Practice Managers and Receptionists (AMSPAR), said: ‘I agree with NHS England when it describes practice managers as “one of the most neglected parts of the workforce”. I feel practice managers need to be a little more selfish in their own professional development. They are so busy focusing on staff that they can neglect themselves.
‘In my opinion, today’s practice managers and their assistants must keep an eye on the future – and be ready for it. They should be networking and signed up for management alerts, reading, reading and more reading.’
So what support is out there?
Practice Management Network (PMN)
NHS England has committed funding to develop PMN, which I co-chair. For the first time since the National Director of Primary Care, Dr David Colin-Thomé, left the Department of Health in 2010, we have been awarded funding so that we can support our colleagues.
We are now developing our website to include blogs, latest news, useful reading and resources. We want to form a robust network, with a practice manager representative in every clinical commissioning group (CCG). This will mean we can send out regular newsletters about what is happening locally and share resources and best practice.
We already have over 4,300 practice manager members, but please sign up if you haven’t already so that you do not miss out as our website and network develop. We are hosted and supported by the NAPC, so while we remain independent, we are gaining more influence nationally.
New diploma in advanced primary care management
NHS England has asked the NAPC, in partnership with others including the PMN, to develop a new diploma, which launches in October 2017.
The one-year course is designed for anyone who is managing primary care or becoming responsible for running primary care at scale. The curriculum will incorporate the learning and experience of multispecialty community providers (MCPs), integrated primary and acute care systems (PACS) and primary care homes.
The course can be an integral part of a practice manager’s continued personal development (CPD) and will be equivalent to 60 credits at postgraduate level. On completion, students may apply to study the Healthcare Financial Management Association (HFMA) diploma and higher diploma, which provide a pathway to a full MBA.
AMSPAR is an accredited training centre and works with City & Guilds to provide a range of nationally recognised qualifications, as either full or part-time study programmes.
It has a full training programme and offers qualifications such as the Level 5 diploma in primary care and health management.
However, if you don’t feel that an academic course is for you right now, there are plenty of masterclasses in all areas of leadership and management, such as strategic development planning, available from training providers.
Make sure you keep up to date with all the changes. Sign up to relevant journals. On Twitter, follow primary care organisations such as the PMN, NAPC, NHS Alliance, Royal College of General Practitioners, Family Doctor Association and the British Medical Association. Also sign up for their free newsletters.
Look out for local opportunities to attend training and updates from your CCGs or local medical committees. In West Sussex, we have formed the West Sussex PMs Association, partly funded by our CCGs. We organise an annual conference and ‘lunch and learns’ as well as mentoring all practice managers in our area. If you do not currently have a network, you may want to discuss this with your practice managers and CCG.
There has never been a more important time for practice managers to invest in themselves, for the sustainability of primary care
Jo Wadey is co-chair of the PMN and practice business manager at St Lawrence Surgery, West Sussex.