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Practice Managers: Should we expect a mass exodus?

by in GP Practice Management, Practice Life, Stress

Practice Managers: Should we expect a mass exodus?A well-publicised research report published by the Institute of Healthcare Management (IHM) this week revealed that over half of current practice managers have applied for new jobs and the majority of those are aiming to get out of practice management altogether. While the survey only spoke to a relatively small number of PMs, it does paint a picture of disillusionment and frustration among many practice managers. The IHM said that key reasons for this potential exodus are:

  • Workload
  • Change fatigue
  • Overpowering bureaucracy

Shirley Cramer, Chief Executive of IHM said the research was a wake-up call: “The healthcare sector is under enormous strain, but practice managers are often forgotten – they are instrumental in ensuring the smooth and effective running of the nation’s 8,000 GP practices. Initiatives such as the 7 day NHS, changes to funding and CQC inspections have a significant impact on practice managers but their concerns are often overlooked.”

Stressed and demotivated

Talking to PMs, Practice Index has discovered just how widespread the stress and demotivation is. The biggest cause according to those we heard from was the sheer volume of change and the resultant lack of feeling in control.

One PM, after decades in her job, stated that never before had she felt so inefficient and out of control. Another suggested that what used to be a challenging yet rewarding job is now an impossible task, while one told us that they now have zero life outside of the practice due to the fatigue of trying to do the job. Other factors include:

  • Falling pay in comparison to other management roles
  • Feeling undervalued
  • GPs who don’t appreciate or value the PM’s role
  • Lack of job security and the likelihood of near-future practice closures due to GP shortages
  • Funding cuts making the job impossible

Defusing the ticking time bomb

The comments we received (you can view more on the Practice Index Forum here) also suggested that we could face a PM retirement crisis. Numerous experienced PMs told us they were set to take early retirement while others were already counting down to retirement. So what can be done to make the job more appealing?

Among the measures IHM is calling for to support practice managers are:

  • Addressing the issue of inappropriate workload by reducing unnecessary burdens, including highlighting areas of work that can be legitimately refused or redirected. In particular IHM is highlighting the BMA’s guidance “Quality First: managing workload to deliver safe patient care”.
  • Calling for NHS England and the Department of Health to examine ways of reducing pressures excessive bureaucracy may place on practices by improving their communication with practice managers and addressing issues of duplication, response time demands and complications caused by fragmentation of services. Completion of the Workforce Data Requirement, necessitating submission of extensive staff details on a six-monthly basis is one example which could be reviewed.
  • For leading GP organisations such as the GPC, BMA and RCGP to recognise and promote the leadership role of practice managers and for individual practices to consider making their practice manager a partner in the business.

While the above will no doubt take time to be sorted out, if indeed they ever are, is there a short-term solution? Suggestions that PMs gave us include:

  • Simply sticking together – PMs and other practice staff all need to hang in there together and share the pain and support.
  • Be ruthless with admin and not be afraid to delete emails or delegate tasks in order to prevent a backlog of tasks building up.
  • Think creatively about staff roles – could you be radical and reassign jobs or mould roles in order to ease pressure points? Who knows, but it’s something we’ll look at in a future post.

Finally, the good news is that the problem has at last been highlighted. Let’s hope the work of bodies such as the IHM encourage the powers that be to act before it’s too late.

Are you thinking of moving on? What measures should be taken to make the practice manager role less stressful? How can we recruit new talent to the role? Comment below or discuss this topic in the forum here.

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Practice Index

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4 Responses to “Practice Managers: Should we expect a mass exodus?”
  1. Avatar
    Ian Wilson Says:

    Sat answering the phones this morning, because of staffing issues; dealing with bungled appointment issues, because of conflicting GP opinions; dealing with the police over a crash on our car park, and having to do DoH work for them on new services, because they have not been introduced effectively. All in days work & stress levels are ridiculous!

    More ownership from DoH & NHS England would be great to at least allow us to concentrate on internal issues.


  2. Avatar
    Donna Says:

    A great article. I’d like to know where else is it published ….”well-publicised research report published by the Institute of Healthcare Management…” Is it in publications like Pulse, BMA Journal etc?

    It needs to reach those other than PMs who already know all this because we are the ones saying it. We are the ones reading healthcare management journals. My GP Partners certainly won’t be.


  3. Avatar
    Chris Says:

    As with all things, the article highlights a range of issues:
    1. Why such a small sample? It could/should have been larger.
    2. A mass exodus is unlikely. More likely, a steady outflow.
    3. The NHS is a train wreck in slow motion, and no party has the guts to be honest about it.
    4. Unconstrained demand from the public with a funding model that isn’t viable is the core issue.

    Each PM will need to take unique steps to deal with their roles/practice circumstances, using well-known management techniques to cope.

    Fundamentally, I wouldn’t recommend a PM role to anyone, and 7 years ago would have. That’s the timeframe of the deterioration.


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