General practice has changed. Gone are the days when practices consisted of a group of GPs working together, with an administrator providing support with the day-to-day running of the practice. Now practices operate with a much wider range of clinical roles working together as a multi-disciplinary team, all supported by a far more developed management function overseeing a whole range of clerical functions. The question is, should the makeup of partnerships be changing in the same way, to reflect the differences that now exist?

Of course, we’re not comparing apples with apples. It’s one thing for GPs to introduce new clinical roles, give their practice manager more responsibility and expand the practice support function, but it’s another to then relinquish control of the business and shift the ownership model in the same way. GPs have always been the leaders of the clinical team, and so it doesn’t necessarily follow that the partnership should change simply to reflect the changing workforce. There are sizeable cultural barriers.

This is taken from a 2016 article about nurses as partners in the BJGP:

Historically, health professional cultures have cultivated a hierarchical power struggle which tests the multiprofessional team process. The differences of power, perspective, education, pay status, class, and sex have traditionally made the relationship between nurses and doctors complicated. There needs to be a willingness by GP partners to accept a shift in the traditional hierarchy between nursing and medicine and nurse partners need to recognise and accept the power they hold.

It’s not just the relationship between doctors and nurses that these health professional cultures have affected, but all of the other clinical disciplines working in general practice too, including practice managers.

However, we’re in a place where the number of GPs, and the number of GP partners, is in decline and has been for many years. More and more practices have set aside historical cultural norms and become open to the idea of non-GPs becoming partners – and the more this has happened, the more open other practices have become to it as an option. I don’t think we’ve reached the end point yet, but at least we’re at a place now where it’s no longer unusual for a practice to have a partner who isn’t a GP.

Once partnerships are open to the idea of non-GPs being partners, it’s a very natural progression to consider the idea of having a management partner. The partnerships are, after all, ultimately responsible for the business of the practice, and the practice manager is the person to whom the partnerships entrust much of the decision-making about that business. So, there’s a logic to that person being a full member of the partnership team.

That said, the roles practice managers undertake and the amount of decision-making delegated to them can vary hugely between practices, along with the skills and experience of those in the role. It isn’t going to be right in every practice. Equally, some practice managers would love the opportunity to become a partner and have the same skin in the game as the existing partners, while others could probably think of nothing worse. Just as it isn’t right for every practice, so it isn’t right for every practice manager.

In this month’s podcast, Robyn Clark and Pete Maynard share their experience of transitioning from practice manager to partner. They provide some really helpful insights, for anyone considering taking such a step, about the difference it makes and what the process entails. Also, Dr Naj Seedat shares a GP perspective on practice managers becoming partners.

In an increasingly hostile environment, partnerships need to focus more on the skills, attributes, values and leadership abilities of those who make up the partnership, and less on the roles themselves. Having the right people leading partnerships is what will make them successful, and it does seem likely that in many practices, the practice manager would make a fantastic addition to the partnership team.