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Halting the exodus of practice managers

by in GP Practice Management, HR - Human Resources, Practice Life, Stress

Halting the exodus of practice managers

Pressure on general practice has created a significant increase in practice managers thinking of leaving their jobs. Whether the ever-increasing workload, rising stress levels and suffocating bureaucracy being suffered by practice managers leads to a mass exodus or a steady outflow, nobody knows. What we do know however is that, while the GP shortage grabs the headlines, a practice manager shortage could be just as a big a problem for the primary care sector and therefore it’s a problem that needs addressing.

Wessex LMCs chief executive Dr Nigel Watson went public on the issue by saying that he had seen a 50% increase in practice managers contacting the organisation for advice over the past 12-18 months, with significant numbers threatening to leave their jobs because of workload pressures.

Other LMCs around the country had reported similar increases, he added. So what can be done to make the practice manager role more attractive, both to those already in roles and those thinking about taking up the profession?

Changing perceptions

Some GPs, Dr Watson warns, are responding to pressure by adopting a ‘bunker mentality’. But he warned failing to tackle the problem head on was making practice managers’ jobs even more difficult.

This, for many practice managers is the key issue. One PM, who preferred to remain anonymous, told us: “I’ve held the practice manager position in three practices; each and every time the GPs have treated the role as an admin job, not as a leadership position. Doctors don’t really know what we do and don’t seem to want to know, which means we don’t get the respect, the help or the resources that we really need in order to carry out our duties.

“We need a shift of mindset amongst the GP community, CCGs, the wider NHS and even the media before things will start to improve. Perhaps we need to form a public relations group to start shouting about our plight? Or perhaps somebody like Practice Index or the trade magazines could do it for us? We definitely need to increase awareness of the importance of our role though.”

In a study released earlier this year, the Institute of Healthcare Management suggested, amongst other things, that leading GP organisations such as the GPC, BMA and RCGP need to recognise and promote the leadership role of practice managers. It also suggested that individual practices should consider making their practice manager a partner in the business in order to bring the role closer to the heart of practices.

Lift the burden of bureaucracy

GPC deputy chairman Dr Richard Vautrey said practice managers bore a large part of the growing bureaucratic burden of general practice.

“It is something we recognise and growing numbers of LMCs invite practice manager representatives onto their committees to ensure their important voice and experience is heard,” he said.

Dr Watson added that his LMC was organising roadshows to help practice managers with work such as CQC checks and had established ‘supporters’ at the LMC to give advice. “Part of the thrust of what we are about as LMCs, is to point out to NHS England and area teams that they cannot just pile more work onto practices without consequences. Ultimately the solution is to reduce the mindless bureaucracy of general practice.”

A practice manager said: “Practice managers are stuck between a rock and a hard place. We’re told we have to change by the NHS but when we put ideas and potential solutions forward to partners they don’t want to listen. The stress levels are unbearable. And don’t get me started on the unnecessary box ticking we all have to do.”

Fair remuneration

Another issue facing PMs is decreasing salaries. Various salary reports released this year suggest that PM salaries have fallen this year (more so if you factor inflation into the mix).

“Practice manager pay needs to be in line with management salaries in ‘other’ businesses,” added David Turner, a practice manager from Lincolnshire. “Pay isn’t everything – the stress and workload is probably a bigger issue, along with demotivation – but being paid fairly for the hours that we work and the extra time we give would soften the blow. It would just be great to receive the recognition we deserve, which just might encourage more people into the profession as we’re definitely facing a recruitment crisis. I’m counting down to retirement in a few years and I’m not the only one!”

Merging functions

Could the only way to relieve the pressure on PMs be collaboration amongst local practices?

Family Doctor Association chair Dr Peter Swinyard said practices should come together to employ ‘super managers’. He commented: “There is no doubt that GPs cannot run a practice well without a good practice manager. Smaller practices need to start working cooperatively and collaboratively with each other.”

With morale and motivation at rock bottom, workloads continuing to increase, an ageing workforce and no sign of bureaucracy dwindling, the expected outflow of practice manager talent looks set to be a real issue over the coming years. That is, of course, unless the health sector starts to recognise the importance of the PM role and starts getting its act together to save it.

What would you do to improve the situation? Can we prevent the exodus or is it too late? Let us know by commenting below or take it to the Practice Index Forum.

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9 Responses to “Halting the exodus of practice managers”
  1. Jeff Wood Says:

    Advising that ‘practices should come together to employ super managers’ is hardly going to alleviate the stress is it? Adding the threat of redundancy to everything else, great.

    Reply

    • Practice Index
      Practice Index Says:

      Hi Jeff
      It’s a view held by many that the creation of ‘Super managers’ doesn’t have to be about redundancies. As the article says, “Smaller practices need to start working cooperatively and collaboratively with each other”. Practice managers could specialise in certain areas of expertise and manage specific roles and responsibilities across multiple practices, while a colleague looks after others. In the business world you have departmental managers – why not in GP practices? It’s just a thought really.
      James

      Reply

  2. Kurt Says:

    Indeed we’re seeing greater change than ever and at a much faster pace than I’ve personally seen a government move at. I think people have felt the impact at all levels over the last 5 years.
    That said there have been big changes to primary care before, granted at a much slower pace. The key issue for me is the agenda behind it all. Lots of people seem to have theories and not particularly savoury ones, I for one am extremely concerned at the overwhelming degree of uncertainty. We could really do with some clarity on what the government’s true intentions are for primary care and the NHS as a whole because right now all we have is speculation and a very unsettled workforce. Surely the people who work within the organisation and deliver the care need to be in the loop here!

    Reply

  3. Alison Says:

    I used to enjoy my job, but i am definitely feeling suffocated by bureaucracy.

    The creation of ‘Super managers’ just adds to a worse situation in my view, its not top of my list thats for sure, i will probably go the other way, such a shame really.

    Reply

  4. denise Says:

    Too many different on-line systems to become an ‘expert’ on using; CQRS, immsform, ORACLE, nelie, open exeter, NHS Choices, primary care web toolkit to name just a few. Just keeping up with different log ins and passwords is a big enough headache without figuring out who to invoice for what and when. Is it really necessary to make everything so complicated?

    Reply

  5. Andy Says:

    I fully support the ideal of the super practice having now seen the model adopted by Birmingham it really is and an effective use of resources and also puts the right skill in the right place at the right time. If you have 10 people across 10 practices trying to achieve the same aim with the same limited resources why not share the workload that way you should ensure a quality product at the end of it.

    Reply

  6. Alan Says:

    Its a bit like Turkey’s voting for Christmas, but super practice type amalgamation is the only way we can be good enough to do the job properly anymore.

    It can’t be cost effect for me to be a purchase ledger clerk on my wage, better to have an admin doing it for 5 practices, with a supervisor checking things, than 5 PMs doing this during their working day.

    Unless practices do actually come together the sharing of resources will never work, as we are all too selfish when we see one practice gaining out of sharing to the detriment of the other, or a PM being taken advantage of, while not getting any help back.

    Reply

  7. Nicola Says:

    I have to say chaps, I love my job, including the stress it brings, but then I’m just weird!! The idea of a super practice is a good one because we all have strengths/weaknesses and each PM could take responsibility for their particular strength – so if you really love dealing with staff or finance, but hate dealing with complaints……it could work. Does this format though only work if you have groups of practices actively working together? Would the ‘control freak’ in you allow someone else to do bits of your job? Could we form some sort of locality based group – but then, which group of docs is vicariously liable for which PMs?…….and when you have practices spread over a huge area, with massive rurality, super groups become difficult to maintain because of geography. As Andy has said above we’re all replicating the same bits of stuff each day/week/month and that’s completely batty!

    Until we are all amalgamated as one GP practice, with our existing sites operating as ‘hubs’ for Primary Care Ltd (which I think is where Mr Hunt would like to take us) I can’t see that we could sort it – but that doesn’t stop local groups of PMs getting together regularly for support. This might mean sharing protocols (as we do already) but also sharing experience, providing a sounding board, acting as a go-between in times of crisis etc. I am not in the least bit territorial about my protocols/procedures – anyone can use them if it helps – but I think we need to all be offering our colleagues help and support from a pastoral perspective, as well as a business one. There is masses of experience out there – I had support from an ex-colleague on another patch when I went through a particularly stressful time as a previous practice having taken a receptionist through a disciplinary process that ultimately went to solicitors. It was a total nightmare and although I knew I was on the right side of the law, it was a huge help to know that someone was there, not only providing a shoulder, but also looking at the evidence with an unbiased eye and making me look at things from a different perspective. I wouldn’t have got through that had it not been for that help.

    Reply

  8. Robert Says:

    I was a GP Practice Manager for over 20 years and prior to that spent 25 years working in FPC, FHSA world. The problem with general practice is that it is independent from the mainstream of the NHS and does not always offer the same terms and conditions of service as the mainstream. There is an expectancy amongst mainstream staff that they can move to a ‘better’ career in general practice.. They see it as a challenge. Some see it as a stepping stone. Practice Managers need a wide set of skills the main one of which in my view is new technology. A failure to adapt to all the changes in computers and software would both in the mainstream of NHS management and in general practice result in failure. The pay is ok but not the best. The conditions such as leave, sick leave etc are poor unless Agenda for Change has been adopted. The reluctance to adopt AforC is purely financial. It hurt when practice staff were allowed to join the NHS Pension scheme. Now looking to next year there is likely to be another blow as the cost of state pensions is added into the NI contributions for both employees and employers. Oh dear – more excuses for not bettering pay.

    Reply

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