Avid blog readers of the Practice Index forum will have read, hopefully with interest, my recent series of blogs on grading practice staff, but sadly the same readers will probably also have read the threads about the poor treatment some of our erstwhile practice managers experience. I’ve worked either in or with eight practices since the early 1990s and, yes, I’ve seen and heard both the good sides and the bad sides of general practice. On balance, I have to say, I’ve been lucky and my pendulum has swung more toward the good side of general practice than the bad side, with the odd exceptions.
‘The good, the bad and the ugly’
It’s quite obvious, however, that practice managers (PMs) and their staff are treated very differently from practice to practice. In fact, it might be true to say that in any walk of life there are always good employers and those that let the side down, no matter where you work. Yes, I’ve met those who shoot off at staff in such a bad way that managers and staff alike feel ‘de-graded’! This type of bullying and demonstrative behaviour cannot just be attributed to doctors, you may experience it among your surgery staff too. In any event, it can’t be justified.
Show me some respect
I recall in the 1970s promoting the idea of a Patient’s Charter, which culminated many years later in the NHS Constitution. These efforts were fine, and had their place. It seems to me that GP practice managers, as a profession, need to engender more respect from their GP employers, and maybe we need a charter too. It’s all very well expecting managers to represent the practice at CCG, PCN and Federation levels and to be one of the principal advocates for the practice when facing a CQC inspection, but there needs to be a payback, which starts with respect. Of course, it involves much more too, such as a decent contract and pay levels which reflect the duties and responsibilities of the manager. Various staff surveys suggest that there’s a great variation in hours of work and pay levels in the profession. Working overtime and not being paid for it seems to be a big issue. Probably, there is little consideration of a work-life balance for staff. Yet GPs in the main now work part-time or at least take off a half-day each week, even though they no longer work on Saturday mornings. Staff do have a home life and a family and friends. A work-life balance shouldn’t be working more than 40 hours a week, let alone more than 48 hours consistently.
On a day-to-day basis, there also needs to a good standard of communication between the employee and employer. This shouldn’t be short, sharp bullying exchanges but discussions between colleagues who have an equal respect for each other’s views and ideas. A five or ten-minute chat each day hurts no one. How many times have you been cut short? It’s no good your ‘boss’ going off on one and then expecting immediate cooperation. It’s no good barking orders and expecting compliance. It’s no good having a wonderful set of personnel policies that will attract praise from the CQC and tick their boxes while bullying and harassment are actually a way of life. Constantly ticking people off is not equal to ticking a box. The communication needs to be regular, open and honest. A little praise now and again, along with a thank you, hurts no one.
Start to trust each other
It’s no good being secretive either, as this leads to mistrust. I’ve come across situations where the PM isn’t involved in the financial side of a practice. The manager had no access to bank accounts or bank statements, and there were battles about paying bills. Worse still, there are inconsistencies in staff pay levels, creating discontent and low morale. Sadly, there have been a number of reports over the years of PMs who have dipped their fingers in the till, but these renegades are few and far between. Practices just need to have clearly defined guidelines on how to keep the practice financially above water.
Value all your staff
PMs, like all practice staff, should reasonably expect to be valued. It seems strange that some clinicians find themselves in direct contact with patients and are expected to be caring and considerate towards their patients, yet five minutes later when consultations have finished, they manage to bite off the heads of their staff. Why? Is it a release of tension – a way of letting off steam? If it is, they need to go back to the drawing board and consider their position. A pay-out arising from a successful constructive dismissal claim might equate to an employee’s annual salary with a maximum of £86,444. Ouch!
Encourage your staff
It surely is the role of the employer to encourage the performance and development of their staff. I’ve read recently of practices trying to delegate staff appraisals to ‘outsiders’. The idea is for a PM to use a ‘peer’, i.e. a PM from another practice. Now this may reduce the workload of the GP, but unless the employer keeps out of staffing matters totally, appraisals still need to be carried out, in my view, by the employer. Objectives need to be set and reviewed.
Support your staff
Finally, PMs should be able to expect full support from their employers, not constant criticism brought on by allowing staff to run to partners behind a PM’s back. Yes, I’ve known this one too, and it’s not pleasant. The morale of the PM is just as important as the morale of the staff. One way to provide support is to appoint a partner to watch over the interests of the manager, to act as a ‘confidential’ punch bag when necessary and a shoulder to cry on metaphorically. I found it helpful to have my outside interests and commitments supported. This, for me, included involvement in staff training events and AMSPAR courses. It might involve working with a PMs’ group or having a role at the CCG, PCN or local Federation.
A charter for practice managers?
It’s sad, as I’ve already mentioned, to see the post of a PM degraded by the behaviour of partners, or a partner, who in effect are the ‘employer’. Managing GPs is an almost impossible task. But managing practice staff – certainly, the non-clinical staff – should be straightforward and a PM should quite simply be able to get on with it. The independent nature of general practice is part of the problem. It’s difficult for a PM to run to the local medical committee, the Clinical Commissioning Group or NHS England for help. There would need to be a case full of evidence to go, say, to the General Medical Council. There’s no structure or support network for a ‘degraded’ manager. Perhaps what’s needed is signing up to a Management Charter.
Here I set a challenge: What do you think should be included in a charter that you’d give to your partners, asking them to sign up to it?
A GP Practice Manager’s Charter might look something like this…
We, the owning partners of the practice, will ensure that:
- The practice manager is given due RESPECT and the opportunity to give advice and support to the owners of the practice
- Positive channels of COMMUNICATION are always open with our practice manager
- The manager and practice team are TRUSTED to make their contribution to the success of the practice without being inhibited
- The practice VALUES, in real terms, the contribution made by the manager and practice team
- The manager and staff should always receive ENCOURAGEMENT in their work and not be subjected to bullying or harassment
- The practice manager is fully SUPPORTED by the partnership and should not feel ‘degraded’
I’m sure there are many of you who can come up with a much better version.