Recruiting new practice managers and keeping the good ones is a major problem for GP practices as the demands of the job continue to develop and change, and the attraction of better-paid jobs looms. I attribute my survival in the post from 1992 to 2010 to an ability to smile in adversity, a positive attitude, an interest in computing and training, and the ability to do all my own typing. I spent a great deal of time working on accounts, payroll and making and chasing NHS claims. My experience of GP finance and the management of FPCs, FHSAs and PCT added to my fountain of knowledge. In the past I had dealt with complaints at tribunal level and building new surgeries under the Cost Rent Scheme. I did not have a university degree but a series of minor management qualifications stood me in good stead and gave me a thirst for research and writing annual plans and bids. I also took an interest in training practice managers and their administrative staff at a time when local colleges ran AMSPAR courses; there were two video-based packages for receptionists, and companies provided a variety of excellent one-day courses. Nowadays practices seem less willing to pay training fees. Many practices are merging and may be moving into larger buildings. Does this mean that more good managers are losing their jobs and practices are losing their fountains of knowledge and expertise? Or are practice managers starting to wear two hats, working for practices and for the CCG or Federations?
Or is the real problem that practice managers are not given the responsibility and status that they deserve? A practice manager can propose, suggest and recommend but, dare I say, rarely decide what a practice should do. To be fair, across many aspects of staffing and premises issues, I generally took the lead. In respect of finance, with the support of one lead GP, I was left to manage the detail but not to decide on major expenditure or drawings levels. Regarding premises, I took the lead in a major £1.4 million building project, and when I returned to manage two practices on a part-time basis, one of which involved a CQC visit, I found that my advice and input was greatly appreciated. I felt that this was because my experience, knowledge and skills were respected.
So how do you find the ideal manager? A good manager is one who can weigh up people very quickly. One who is not afraid of hard work and will pitch in when necessary. One who has a good understanding of NHS funding and accounts. One who can plan ahead and go on holiday to return to no problems. One who can delegate both upwards and downwards when appropriate. One who can say I’m not right all of the time. Sometimes it’s like conducting an unrehearsed orchestra. There are personnel organisations who can help find a manager to suit, but it does cost. Be prepared to pay for and listen to their advice. A good candidate will have found out what they’re letting themselves in for. I’ve always believed that you can solve any problem if you do the research and know where to look.
It would be interesting to know the backgrounds of our current general practice managers. There are those who come from PCTs and their predecessors like me. There are managers who worked in hospitals, community health or even in dental surgeries. Then there are those who have come from the private and commercial sector, ex-bank managers and accountants. I have come across ex-army officers and policemen too. There are those who simply worked their way up through practices. I might argue that no route to become a practice manager is the right one or the wrong one, so practices need to have an understanding of what and who they want, and if that person falls short in terms of skills and knowledge, they should do something about it and help to encourage them. Better still, provide high-quality training and ensure that they participate in the wider management of practices at the CCG or in a Federation and use useful websites like this, Practice Index. A good network of willing minds is invaluable.