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This is not so much a rant, more a ‘call to arms’ – By Nicola Davies

by in GP Practice Management, Opinion

Earlier this week on the forum, there was an anonymous post from one of our colleagues asking if they “should stay or go”. Alarmingly, there were a number of comments posted saying that they too were going, or would be going shortly. This made me incredibly sad at the rapid exodus of good, solid managers who have just had enough.

You may be aware that I’m participating in a series of podcasts for Practice Index (yet another platform for me to mouth off!!) and this week’s – is about our wellbeing, what makes us ‘heartsink’, how do we cope, and it’s clear that as a profession, we’re feeling more isolated, more remote, more unsupported.

We know that the practice manager role is not an easy one – and if you’re expecting an easy life, then you’re totally in the wrong place!  This year has been crazy, and it looks like we’re in this for the long haul – there is no light at the end of the tunnel and coming from me, as the ‘optimist/glass half full’, well that’s saying something.  We’re getting loaded and loaded with more and more c**p from on high, and as I say in the podcast (which obviously you’ll download the minute you get the message from the PI team!), the pressure is on  us to respond to the constant emails to do what ‘they’ say – without consultation – and do it now.

It’s no wonder many of us are saying we can’t hack it anymore.

There are two strands to my concerns here – firstly,  it’s clear managers in primary care are just not getting enough support. Secondly, if you decide you’ve had enough, what support is your replacement getting? Are they the right person for the job? And that’s not necessarily about their skills with the accounts, or change management or HR etc., the question is “are they robust enough to take the c**p, deal with it, sort it, manage it, cope with it?

Do you have a ‘recruit from within’ option?  Is that person getting the necessary support and training to hit the ground running?  If not, they’ll fall at the first hurdle, and that can be said for those new-in-post who may already have other, proven skills – but if they’ve not experienced the ‘joy’ that is primary care, they’re in for a shock.  Let’s not beat about the bush here – this is a HARD job, full of stress, but some of it IS positive stress, it’s not all negative and I don’t want to be on a complete downer!

The point I’m getting to is this – in the ‘olden days’ (when I first started) the practice manager was often the receptionist who had just worked there the longest.  Her day (and yes this is sexist, but it was, back then, a 100% female environment behind that desk) was filled mostly with rotas, ensuring that the letters got filed (all paper and all by hand) and maybe payroll, and my practice manager at the time sat behind a desk directing everyone, while she drank coffee in between fag breaks.  It was at that point that I thought “I could do that”.  Be careful what you wish for!

As the years passed and I took on more qualifications, more responsibility and worked my way up, I’ve seen massive changes in primary care and the role itself. We have totally and utterly become a profession in our own right – and yet, we are the most isolated, often the most lonely person in the whole organisation.  We are everybody’s friend and nobody’s best mate – that cog right in the middle of everyone else – and if we stop working for whatever reason, the whole thing falls like a pack of cards.

My ‘call to arms’ is to ask whether we feel that we need someone on our side, truly on our side? Is that a union? Is that some other official ‘body’ that would give us what we need, a voice, a mechanism for support, an outlet for frustration – and we know that we have our colleagues on the PI forum.  Practice Index fills a massive gap for those of us who might not have support locally.  We know that not every PM has supportive partners. We absolutely understand that every PM has difficult days with staff where we could literally smack them across the back of the legs and tell them to grow up and behave like an adult – but we can’t and so we internalise all that frustration until we blow.

Everyone needs that pressure cooker valve to blow every now and again – but if you’re anything like me, you can only spout off to yourself or your other half who knows absolutely diddly-squat about what you’re going through but at least you get it off your chest!

I feel like I need to absolutely do something about the numbers of our colleagues who have just had enough but I can’t do this on my own, not even with my loudest Manc voice!

I can ‘tweet’ Nikki Kanani, I can contact my local director of primary care – but what are they actually going to do – nothing – BUT, if they don’t know how absolutely strongly we feel about the lack of support and the pressure being placed on us, then we’ve only got ourselves to blame.  Is it time for a revolution?

[Total: 13   Average: 5/5]
Nicola Davies

Nicola Davies

Practice Manager regularly ranting about the NHS. 35 years in Primary Care and still getting irritated by constant change for change sake!

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11 Responses to “This is not so much a rant, more a ‘call to arms’ – By Nicola Davies”
  1. Avatar
    Clair Says:

    Yes, yes YES!
    I fail to understand how undervalued Practice Managers are by a lot of NHS organisations, and even our own primary care clinicians in places.
    I get that there can be a chasm of difference between the experience of some in the role that might cloud some judgements but that doesn’t mean they should be judged differently, nor should the role itself.
    We work DAMN hard. We have to manage up as well as down. We are the conduit for every other organisation to contact because no one else can be ARSED to find out who the correct contacts are in a practice.
    I’ve tweeted at Nikki Kanani and received nothing. If you agree to be the face of something, DO SOMETHING NIKKI!
    I am with you, Nicola, 100%. Now is the time to stand up and shout down our naysayers.
    We also need that Golden Handshake for partnership…..!!


    • Avatar
      Rob Noel Says:

      I couldn’t agree more. We need an official body akin to a union and we definitely need to be recognised and equally valued when entering into partnership!


  2. Avatar
    Steve Says:

    This is an interesting and complex idea. There are many variables and differences with respect to PM support needs. Everyone will be different. My initial thoughts would be to have a detailed discussion about the root causes of the problems PMs face so we can define the issues to solve specifically.

    LMCs are often very good when it comes to personal support, maybe they might help facilitate a process. There is also the PMA and no doubt others.

    I would also imagine there is a pot of money available out there somewhere for something proactive and beneficial to the NHS and/or PCN development.


  3. Avatar
    Steve Mowatt Says:

    As usual Nicola, a passionate and rousing speech but I, like you, cannot identify who or what that support would be and how they could help.
    The problem with General Practice is the fact that each surgery is a separate organisation, run on different terms, with different goals and ambitions and owned by GPs, who are only in that position because of an outdated contractual agreement.
    Some of us are lucky in the fact that our partners recognise the value of their senior management and allow them to run the practice properly. That means that the PM should NOT be the sole cog in the middle that holds it all together This is a specific leadership role (especially in today’s world of primary care) and the organisational management should be distributed to other members of the team who do it a lot better than me!
    Others unfortunately, do not have this support and, like many small businesses are owned by people who don’t have a clue apart from the amount of money going into their pockets. PMs in that position have to take the hard decision and, when the negatives of their job outweigh the positives, leave for better roles. They ARE out there – you just need the confidence to seek them out.

    So, I’m afraid the cavalry aren’t going to ride over the hill to our aid; we DO have to circle the wagons and defend ourselves – by using this type of fora and picking up the phone to check on our buddies – and remember that 80% of what we are asked to do isn’t important; is based on someone else’s arbitrary timescale and will be forgotten about in 3 months time.

    Keep healthy, work only the hours you’re paid for, appreciate the people that love you, reach out to others if they need help and don’t be afraid to raise your hand when you are in need. You’re a great bunch of unsung heroes, just don’t be martyrs to the cause, it isn’t worth it.

    Enjoy your weekend xxx


  4. Avatar
    Ana Weston Says:

    Nicola, wow. I rarely read an article word for word but your article struck a chord. I do think the profession is undervalued and under supported. Even during this time there is talk about clinical resilience but nothing much for the true facilitator, ‘jam in the sandwich’ manager. I think there is a real problem with the word ‘manager’ in this scenario.

    We are being demure as a tribe by allowing our roles to be pigeon holed this way. The truth is, we aren’t managers, administrators or supervisors. We are leaders who collaborate with very powerful and clever people, to shape and deliver their vision, on time and below budget.

    Born leaders at that, the surviving species if we make it past the two year mark. Never breaking, always bending.

    Some of the bodies around the profession behave the way that they do because they have the power – so they believe that they are talking to managers from their position as leader. And we allow them to do that, because we do whatever we need to, to get the job done. There is no point in arguing, we have a stack of work.

    I was an HR anorak before my 11 years in Primary care, I worked in community NHS, Mental Health and Commissioning units. I also moved on to the private sector where I am glad to say I was deprogrammed of the ‘institution’. I observed the attitude towards PMs in my history – they were seen as somewhat ‘less than’, privileged, underworked, parochial, argumentative, not pulling the party line, naive. It isn’t an up to date picture I’m sure, but it is what I saw of the perception.

    But that isn’t everybody and there is a gradual recognition as the system creaks – it has to be obvious that we are all still here, on site, conducting business as usual, during a national crisis – a global emergency.

    It saddens me that negative lowering opinions have existed about our profession. I have had the most frightening, thrilling, up and down journey over recent years and those PMs around me never fail to stun me with their resilience, ability to deliver, Teflon coating, lead from the front, be ‘seen to take one for the team’, abilities.

    PMs are the biggest talent pool of potential Chief Executives I have seen and they should be thoroughly proud. They are the best leaders I have ever met.

    I say we should start blowing our own trumpets. Yes we should have a professional body, a nationally recognised Post graduate level qualification and chartered status. Just like accountants, HR etc.


  5. Avatar
    Emma Prince Says:

    Goodness Ana, what a response! I couldn’t agree more and I think you are completely right about the massive pool of hugely talented people who work as PMs. At times I think we don’t do ourselves any favours and can be seen by some, as others have said, as a little negative and narrow focused often because we are so committed to our practices that maybe some find it harder to work collaboratively across the system. This can be a challenge as PCNs develop…
    I quite agree that we should have a professional body – is there scope for seeing if we could develop a Primary Care Managers arm of the IHM for example?


  6. Avatar
    Carol Tilley Says:

    I think that something needs to be properly actioned and there needs to be a formal mechanism to protect Practice Managers. The stock response is to offer me resilience training and a webinar to either ‘cheer me up’ or to join in a ‘mass moan’.

    I do not need any of this. I am an experienced, motivated, competent and resilient human being. What I need is for a manageable workload. We cannot easily say no. Everything we do is tied into financial reward that funds our Practice. I say no and the Partnership as a whole suffers (I am a Partner too). So this is thinly veiled blackmail to either suck up an unrealistic workload at the cost of our health and mental wellbeing or NHSE / the CCG reduce your money. Ironically if the NHS burden we are forced to carry does tip me over the edge and I go off sick; as a partner I get virtually no sick pay (unlike the GP Partners who get funded by the CCG). Second class citizen or what?


  7. Avatar
    Ali B Says:

    Thanks Nicola for another great blog. Practice Management has always been a demanding and diverse role with those demands coming from multiple directions and I think generally, as you say, we manage this well if not a bit swan like with a calm exterior and a panic within.

    The problem is – when someone asks what they can do to help it is hard to think and lots of our work is so ad-hoc how do we define what we need and how much help? Our team as a whole is really supportive and the partners are really good at “checking in” on how I am and things are in general. They also talk of Practice Managers as being a scarce resource which I do think is really true. We once discussed here about having a similar system for a Practice Manager as for a GP with regards to appraisal – as in, having someone external to the practice meeting with the PM to see how things are going and offering advice, guidance and support – is this something that others would find helpful or would people feel a little threatened by that?

    Locally we are pretty open to messaging each other to ask questions or advice but sometimes you don’t want to ask the practice next door and having someone a little further away to talk scenarios through with or even vent frustration can be really helpful. I would be really happy to support this in some form (not sure how or when) but….


  8. Avatar
    Julia Says:

    Well said! I share your concern about a mass exodus from the profession, be it resignation or early retirement.


  9. Avatar
    Nicola Davies Says:

    Thanks for all your feedback. I did send a copy of this link to Nikki Kanani at NHSE….amazingly she sent me a direct message back saying it was a great blog….. but nothing about any support, or setting something up (whatever that may be) which makes me think they don’t actually know themselves!!

    I have sent a copy to my local LMC who are very supportive of PMs – but this is about workload, expectation of what we absorb – so maybe we need to do something else…… BMA??….PMA??? I have a contact at PMA, might be worth exploring with them? If anyone has any other thoughts, please send them my way!


  10. Avatar
    Melanie Jones Says:

    The problem we have as managers is the constant flux of work. The NHS are constantly changing everything and reinventing the wheel… There is no time to bed in processes
    The failures of all aspects of the NHS seem to fail on the doors of GP Practices with improvement targets and standards that are overly complicated for absolutely no reason, whilst NHSE give out 7 year contracts to incompetent but cheap companies like Capita which means we spend half our time chasing PCSE or telling them how to do their job properly – In fact I find that I spend more time chasing ppl for answers or responses that I am waiting for than I do being proactive
    In addition every task thrown at us comes with a document that’s twenty zillion pages long that then in turn has imbedded documents within in that we have to digest and decipher to figure out what the hell we have to do to meet targets , requirements or goals in order to get paid….
    The problem is the bureaucracy, red tape, unnecessary information overload and unreasonable CQC requirements on top of HR, H&S, QOF, KPI’s, IG, IC those of us in buildings not NHSE Property have all that added hassle as well.
    No other Manager in the world has to juggle all of that – they have HR department, a H&S Department ! A finance department !
    I have always said Practice Management is akin to a chef with 100 eggs in different pans on the fry… we have to decide which ones to to serve just about done, medium done, well done and which ones we leave to burn for the good of the others whilst getting scalded by the fat and yelled at by the owner of the restaurant …..
    I guess you could say mine was a rant :0)


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