Having spent the best part of four decades as a practice manager, it goes without saying that Elaine Wilkinson has witnessed an awful lot of change in general practice. In 40 years, Elaine has had to deal with countless clinical, administrative, technological and funding changes – which she has successfully dealt with by following two clear rules: never stop learning and focus on leading the business.

Elaine didn’t set out to work in healthcare. “I always wanted to be a police officer – but after I had completed college in 1969, they weren’t taking cadets in the West Midlands Police, where I’m from,” she explains. “So, I went for an exam at the West Riding of Yorkshire where 50 people applied for three places and I didn’t get in. However, the local GP practice was contacting people who had recently left school and gone to college, and they asked if I’d like to do some reception work. I agreed, while continuing to study, and ended up working in secondary care.

“It wasn’t until 1980 that I went back into GP practice work, at which time I successfully completed the AMSPAR Medical Receptionist certificate, then the Practice Managers Diploma and within two years I was a practice manager.”

Elaine says that this mix of studying and work experience set her up well for the rigours of practice management.

“A lot of practice managers just go straight into management from reception. For me, that’s just not the right way to do it. I think there’s a definite need for appropriate training – and practice managers must continually train. I enjoyed the career I had because I never stopped learning and I’m not talking about specific training on general practice processes and procedures – it’s a given that you do that. I’m talking about doing everything you can to get an understanding of leadership and business management and general practice, because that’s what the job is. We’re not ‘lead admin staff’, we’re practice business leaders, practice business managers; we need to get into the right mindset.”

This ethos stood Elaine in good stead in 1991 when GP Fundholding was introduced, providing individual practices with control over some of the budgets for hospital care for their patients. elaine says this was one of the best things that happened to general practice, because it provided autonomy – and increased the importance of the practice manager role, making it more leadership and business management focused on the process. that introduction was quickly followed by the arrival of software to manage the process and the introduction of computers.

“The introduction of computers was a game changer,” comments Elaine. “The shift from handwritten Lloyd George notes and prescriptions to computers was huge. It was a bit scary if you think back. We were continually filling in and submitting forms in order to be paid and trying to decipher handwritten notes. Computers transformed the way we worked, because the you really had to think about your processes. An enormous part of a practice manager’s role was about leading practices through the changes, which often meant changing habits that were decades old!”

Skills and mindset

Elaine laughs that she could talk for days about the changes that she’s seen over the last 40 years, not all of which she thinks have been positive for practice managers. “It’s a hard career to come into now. In 2012 I graduated with a degree in management and leadership, because I felt that even though I had a lot of experience and had completed plenty of training, it wasn’t enough. The job has changed, and I don’t think you can effectively move from receptionist to practice manager without wider competencies.

“I have some practice managers asking me to mentor them and when you start asking them what they’ve done and how they got to where they are, most of them have been a receptionist. There are exceptions, of course, but generally I think the role of a practice manager is underplayed and therefore there’s a lack of knowledge and skills. This is not the fault of practice managers. In some practices it is difficult for some managers to obtain funding for training. This undervaluing of the role is a big issue and one that’s holding back the success of general practice.”

Greater pressures

It’s no surprise that Elaine points to the stresses of the job too while thinking about how it’s undervalued, recalling the many times when family plans have changed because of work pressures or, many years ago, late night calls to the practice when the alarm goes off!

When asked if this problem has progressively got worse over 40 years in the job, Elaine answers: “It’s a lot worse because we’ve got more to do now, and the pressures are greater. Take inspections, for example. I am a CQC SPA; I applied for the position as it’s something that I needed to understand and gain more knowledge in. Practice managers’ knowledge on the regulation requirements for CQC inspections is invaluable.

“It might not be something we all agree with. I didn’t. So, I thought, well, it’s something I need to find out about, so went and did it. I was lucky enough to have the time and the backing to do so – many PMs aren’t in that position, which is sad.”

Elaine goes on to reiterate a point she made earlier about the need for a shift in mindset, both from partners and from practice managers, if practice management is to be fully recognised for what it is – a leadership role. “It’s a business role, rather than an extension of the other admin functions within general practice. You can’t easily make the jump from receptionist to practice manager. They don’t always understand the finance side, the leadership, the overarching view of the practice processes and the impact decisions will have on the practice. It’s a specialist job that requires specialist skills. I’m not saying receptionists can’t do it – they can with the right skills and support. More than anything, it’s unfair to put somebody into a PM role without giving them the knowledge they need.”

A comment made to Practice Index recently that backs up this point is about the extension of flu vaccinations for the coming season. Many practice managers see it as a problem, focusing on the clinical issues, rather than seeing the business benefits of being able to increase income. Elaine agrees that this is a great example of where a practice manager as a business leader will find a way to deliver as many vaccinations as possible by finding the most cost-effective and efficient way. In the case of Elaine’s former practice, that means using a local football stadium, which it was decided was the best way forward after all factors were considered. Elaine’s successor has successfully taken the lead on this project.

Business focused to the end

Elaine was due to retire in April 2019 (while continuing her CQC work) but following the following the loss of the practice’s finance manager and subsequent hunt for a replacement, her exit from practice manager was delayed until August 2020.

“I didn’t want to just leave, without having a replacement,” explains Elaine. “We had recruited a new finance manager on a temporary basis, who started in January, and after a few months I was happy that he had the skills and competences to fulfil the role. I gave it a few months and in May spoke to the partners to tell them I was going to resign. Another person was going to take on the management of staff and business side of my role, which meant the practice was in safe hands. The succession plan had been fulfilled!”

This exit from her practice highlights how, throughout Elaine’s four decades in practice management, she has very much treated the role as one of leadership – senior leadership at that – rather than getting bogged down with admin and menial tasks.

Elaine concludes by saying: “From my 40 years as a practice manager, my biggest learning is that you can’t be an effective practice manager without being a business manager. Without that knowledge you’re basically stumbling along.

“It’s not always easy, I do feel the role of practice manager is undervalued, although I was lucky enough to always be made aware that I was valued, and it does require a real shift in mindset, but if we continue to learn, continue to deliver benefits to practices and keep shouting about our successes, we will earn the respect and recognition we deserve.”