As we’ve discussed before on Practice Index, appraisals are an essential part of your role, and are vital for the development of your team. But what about you? Who appraises the appraiser? Where can Practice Managers turn for help? After all, the NHS constitution requires organisations to provide staff with clear roles and responsibilities, opportunities for personal development and line management, to support them to succeed.

One hugely successful initiative that has tried to address this very issue is the Wessex LMCs’ Practice Manager Appraisals scheme. This programme, led by Louise Greenwood, Head of education, training and development at Wessex LMCs, has recognised the value of practice/business managers to general practices within Wessex and has supported an initiative to develop a system of appraisal for them. In a nutshell, the scheme uses a network of PM appraisers and supporters to conduct appraisals with PMs – an idea Louise says is being embraced by PMs, who can often feel isolated in their roles.

When asked how the scheme came about, Louise told us: “I sent an email to PMs in our area saying, “do you feel valued?”, and that little phrase really pressed the button of a lot of people. It resonated with them and we had a great response from PMs saying, ‘you know what, I don’t feel valued. I do want an appraisal and I want to get it sorted’.

“I thought that specific phrase might be useful because I was a practice manager myself and that’s how I remember feeling. I’d been a practice manager for about five years when a new partner joined the practice. That partner did my appraisal and it was clear they had no idea what I was doing. As a result, I really wanted to develop the appraisal system because I think there’s value in having an appraiser who will take some time with you to actually learn about you and your own development. So, I matched the practice manager supporters who run the appraisal with those who responded to the email and went from there.”

Peer-to-peer

Crucial to the success of the appraisal scheme, according to Louise is that it’s a peer-to-peer scheme. “When I finished working as a practice manager, I thought it was just me thinking I was a bit inadequate and not very good at my job. But, in fact, a lot of practice managers feel like that and feel vulnerable. It’s quite a lonely job, because you’ve got the partners above you, the staff below and you’re trying to do the right things all of the time, fighting fires.

“So, when I started at the LMC, I just said, well, it would be very good if we have some experienced practice managers who could form a group network across our patch to support other practice managers who are struggling with anything. So, these practice managers, especially the ones with a positive attitude, were recruited. And that’s key, because there’s a lot of moaning out there. The last thing we wanted to do was to promote any negative feelings. We want honesty, of course, but actually we want people to think practice management is an exciting career, who embrace change. As we went forward, the natural evolution was to introduce the appraisals.”

Constant development

When Wessex LMC started off, they used Word documents that were emailed out to practice managers. Now it’s all completed online using the FourteenFish platform – an organisation who specialise in medical staff appraisals, who have adapted their GP appraisal toolkit for practice managers.

This development has been undoubtedly helped by the fact that funding for PM appraisals was made available via the GP Forward View, something that Louise says has allowed the message to be spread beyond Wessex LMC.

“I’ve talked to lots of people, all over the country at CCGs and LMCs, to say “this is what we’ve done, and this is how we’ve done it”. I’ve been up to Wolverhampton CCG, to talk to their practice managers to get them involved. I’m happy to talk to anybody about it because I think it has made a phenomenal difference to those who have got involved.”

For PMs outside of the Wessex LMC area, who would like to set up a similar programme, Louise says funding is available – it’s just a case of asking for it!

“Funding is available from the GP Forward View. If you don’t know where it is, you need to ask your CCG or LMC. It will vary from area to area in terms of how that money filters down, but funding is available – you’ve just got to ask for it. Somebody must have it!

“Once the funding is sorted out it should be easy to scale the project up. I’ve written a template for anybody and everybody on how we recruited the practice manager supporters, covering how we do it, and so on. We have a template letter and job description too – it’s all available. We have resources available as Word documents, or everything can be done online with FourteenFish. Loads of resources are available. None of it is really sophisticated. It’s all very logical and very self-explanatory. We haven’t made it complicated.”

A good appraisal

The successful work completed so far by Louise and her ‘army’ of PM supporters means that they have developed a wealth of knowledge about appraisals. So, what makes a good one?

“Some of the things that have made a difference are not easy to quantify,” says Louise. “We found when we went around the country to London, Devon and Harrogate, that some PMs towards the end of their career, who tend to be supporters and appraisers, loved it. They really enjoyed giving something back and it keeps them working within the profession, which I think is important.

“One of our practice managers said it was transformational for her. She appreciated that, at last, someone had sat down with her, and taken the trouble to say “actually, you do a really good job, look at all the things you have done, not the little things you haven’t done on your to-do list”. It just encouraged them to re-evaluate where they are in their life and where they are in their practice.

“Likewise, and just as important, a couple of people have left practice management because of their appraisal, which made them realise they are in the wrong place. It’s basically holding a mirror up to somebody to say, honestly, where are you? Where do you want to go? How are you going to get there? The real benefits come out of these open questions. What do you want to do next? How do you think that might work? What does a good day look like? And just trying to encourage the practice manager who is fighting fires all the time and having to be so reactive, to be proactive and think, perhaps I could do it this way? Perhaps I could ask this person and delegate this down, to release some headspace. It’s all completely confidential, which helps people to open up.”

When we suggest to Louise that this sounds like as much of a motivational tool as an appraisal tool, she responds: “I think if you feel you are valued and that somebody is investing in you, it is motivational. To meet a peer who says, “I can’t get around to doing that in my practice, either”, is hugely positive. Practice management is becoming an almost impossible job. I remember when I was training to be a PM, I was told, ‘if you’re the sort of person that wants a clear desk and to have achieved all your tasks by the end of the day, don’t do it, because you’ll never manage it!’ Being reminded of this and knowing that you’re not the only one out there feeling the strain is hugely motivational.”

Finally, given the success of the PM appraisal scheme, does Louise think there’s merit in a programme like this to be extended beyond appraisals? And should more networking between practice managers happen?

“I think the less isolated practice managers are, the better. The difficulty is, and I know that the GP Forward View has tried to address this with their hard to reach category, is that when you’re really overwhelmed it’s easy to put your head down. Yet, it’s harder to survive if you do this. You need to get out and you need to work with others. Being too busy shouldn’t be an excuse. If you value yourself enough and your own development, you have to get out and learn from others. It can only be a good thing!”

Would you like to see this scheme extended in your area? Comment below or share your opinions in the forum here.

Useful:

Wessex LMCs has some fantastic information for Practice Managers here.

If you are looking for some support with carrying out appraisals, there are lots of PLUS resources here.

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