Each of you will have a different story and will have followed a different career path as there’s no single route to becoming a practice manager. A recent survey suggested that around 50% of practice managers (PMs) had been in the job for less than five years. Therefore, to argue that a manager must have a degree of experience might not stand ground. Neither might the argument that a manager should have a university degree or higher qualification. But it’s clear that a manager does need to have a range of skills, knowledge, experience, flexibility and training to do the job, along with a great deal of patience.

In effect, as a PM, you’re a ‘jack of all trades’ and you’ll definitely need some skills in finance (accounts and payroll), knowledge of personnel matters, and planning and reporting skills. Being able to use up-to-date IT packages must be high on the list, as is health and safety awareness. But versatility is undoubtedly the key!

The early days

In the 1960s and 1970s, PMs were starting to come to the forefront but many had no office to work in and probably started their working life as a receptionist. GP fundholding brought with it, for the first time, financial and data-management skills. It also brought into general practice many new people from different backgrounds, in the same way that primary care organisations had seen a new, higher paid level of management mostly brought in from outside the NHS in the 1990s.

Training

Over the last 50 years, a limited number of good-quality sources of training for practice staff have become available, including video collections and workbooks. Personally, I undertook a Certificate in Management course. But there are so many facets of management and of running a medical practice that a PM needs to be aware of, and skilled in, that the website Practice Index is a godsend! With policies and protocols available on every aspect of running a general practice and many specialised courses in, for example, data security, health and safety, change management and much, much more, Practice Index is an excellent and useful resource for all new and experienced PMs.

A career path

In my opinion, there is no definite career path for PMs as you tend to make it up as you go along. I worked my way through three practices, one of 5,000 patients and two with more than 10,000 patients, before I settled in one place for 13 years. During that time, I had little actual training, but became a tutor on an AMSPAR Practice Managers Course in Leeds, which in itself was an education. The sadness is that a great deal of practice manager development is left to the individual. I recall being supported to attend practice manager meetings – you need to have colleagues to talk to, exchange ideas and share information with, I was rightfully told by my employer. Otherwise a PM could end up being a lonely person. After formal retirement, I worked with three practices as a consultant and, to be honest, thoroughly enjoyed working in small practices of around 8,500 patients. There are obstacles, however, to moving to and working in different practices and the idea of a clear career development path becomes very muddled.

Choosing a practice?

Practices vary in list size from fewer patients than 5,000 to more than 20,000 patients. Some practices have joined a Federation. There may be a different contractual relationship with the CCG and NHS England. The practice may have more than one surgery or be in a rural area, university town or seaside resort, all bringing different problems and ways of working. I found a key obstacle to working in a practice was knowledge of the clinical software system. Another problem I encountered was limited or no access to bank accounts. In my view, an involvement in the financial management of a practice is essential for PMs and I can’t see how you can help a practice without a high level of involvement in NHS claims and practice accounts.

Researching!

So, with so much diversity, how can you find out what you’re letting yourself in for and whether a certain practice might be the next step in your career? The job advert and any information sent to you about the practice might give you an inkling, but I doubt whether a job description would offer much of an insight. However, you’ll find the practice website provides useful background information – though check that it’s up to date! Next, have a look at the NHS Choices website and the entry for the practice. Here you may find that there’s a mismatch of information about the practice, or you may be able to discover if the practice has a history of patient dissatisfaction. Then refer to the CQC website which might reveal further discrepancies between the practice and NHS websites. Adverse CQC inspection reports showing poor ratings might be off-putting. I’m not sure a budding practice manager would be prepared to take on board a practice that does not present well on the various websites I’ve mentioned. For instance, is the CQC registered manager still working in the practice? Have complaints on NHS Choices been responded to? In any event, good luck if you apply. Ask plenty of questions. A walk around the surgery may also be revealing.