Improving working relationships with GP partners: what do partners think?

You may have a clear idea of what an effective relationship looks like between practice manager and partners but would the partners in your practice agree? What do they want from a good practice manager? And what do PMs need from them?

We asked GP partners from practices of varying size, in rural and urban settings, for their views on, and experience of, this important relationship. Some had recently parted ways with their PM after unsuccessful attempts to support poor performance, others had enjoyed a strong and productive relationship with their PM for decades.

Hopefully, most of it is common ground but are there any important differences from the partners’ perspectives?

Describe the ideal practice manager:

Aside from typical comments about multi-tasking and juggling priorities, there were also ‘softer’ qualities that partners appreciated in a PM.

“Our PM is open-minded when there is differing points of views among the partners, he considers the merits of all ideas brought to the table and gives equal value to them.”

“Ideally, the PM has an open-door policy and is truly accessible to every member of the team, not just the partners but administrative and support staff too.”

“They should be open to change and ready to deal with it – and prepared to be the person that the buck stops with.”

How can the PM best help the partners?

The main theme that came across in partners’ responses was that a positive attitude and shared approach to problem-solving is crucial for the smooth running of the practice.

Partners appreciate handing over the responsibility of multiple operational tasks and recognise that running the business component of the practice is beyond the skill-base of most clinicians.

A regular flow of information is key:

“We frequently rely on our PM to keep us informed of operational issues such as management problems within the wider team, progress on CQC compliance, health and safety updates, or considerations around staffing and recruitment.”

“As well as operational updates, we need the PM to keep the bigger picture in mind in terms of the business. We rely on the PM to calculate any future financial implications of decisions we may take now. Both the operational and financial information the PM provides to the partners is vital to maintain the success and efficiencies of the practice, as well as preventing any adverse events.”

Partners recognised the importance of the PM staying abreast of changes in the NHS nationally but also of forging strong links with local CCGs, federations and alliances. Partners want their PM to understand local healthcare economies and have a clear grasp of the challenges that lie ahead, in order to rely on their direction in these uncertain times.

What do you think the PM needs from the partners?

Partners were aware of the need to give clear instruction to their PM, not only on the practical day-to-day responsibilities but also guidance on the direction of the whole organisation in the medium to long term.

“Partners have to communicate clear goals and objectives for each clinical area, as well as highlighting the stressors, and explain to the PM what this means in terms of practical provision. For new service developments, we must provide the PM with a clear business case based on resources and income, in order for them to negotiate and establish new contracts.”

And relevant to PMs but from the partners’ point of view:

“I think our PM needs to know we are confident in them, and that we, as partners, will know when to intervene and when to step back.”

Food for thought

There were some issues the partners raised that are ongoing conversations rather than quick fixes, such as:

• When a partner’s retirement is on the horizon, what arrangements should be put in place to change or transfer the financial ‘buy-in’ each partner has made to the business?
• How many operational processes should be outsourced?

With the advent of Primary Care Networks an increase in outsourcing is likely, as processes are streamlined and efficiencies sought. PMs will be required to take an active role in the planning and development of all non-clinical activity within the PCN and partners will be relying on them to ensure workable solutions are found.

• Should the PM be ‘profit-sharing’ or not?

There were various arrangements in place from the PM being employed as any other salaried member of staff, through to being a managing partner and receiving a share of the profits. What do you think? Is there one model that works best?

There is no one-size-fits-all

Partners fully realise that every practice is unique with differing management and financial structures; these are often personality-driven, but this doesn’t necessarily mean there is a superior or inferior way of working.

As regards the relationship between partners and practice managers, one message is clear: strive towards your common goals with a flexible, positive, shared approach of mutual respect and understanding and you will not go far wrong.