Specialist knowledge

As patient list sizes continue to increase as a result of practices facing closure, practice managers are generally expected to carry the can and are arguably more involved with the business affairs of their practices than was previously the case. Will the role become more specialised in the future and how will financial, HR and administrative responsibilities be split across collaborative healthcare organisations? Sarah Longland, practice manager at Swadlincote Surgery, offers her thoughts

Q. What signs are there currently that the practice manager (PM) role is becoming more specialised?

A. I’ve been involved in recruitment at several practices recently where each practice has been looking for something different but similar. They are all still looking for people who can come into general practice and bring something different to the job but, certainly, each practice has been directing their approach with a HR bias, finance bias, or – if they are about to do a large-scale IT project – looking for someone with those kinds of skills. It’s tough because, whoever takes on the role, still has to run the general business too, but those changes within the recruitment market are clearly evident.

Q. Will the degree to which PMs are involved in the business affairs of their practices continue to depend on priorities set by GP partners?

A. From my perspective, every practice and every practice manager is different, so some practices will very much operate with their partners setting the direction of travel and telling the PM when to carry out certain tasks. However, I think the emerging practice manager is someone who sits alongside the partners, informing decision-making rather than being directed. I would liken it to a commercial organisation, with the PM having a board level role. Breaking that down, I mean they work closely with the partners on strategic planning, where the business is going and what the future might hold whereas, in contrast, older style PMs aren’t having a say in many of those affairs.

Q. Are financial management aspects of the job becoming harder?

A. I wouldn’t say things are necessarily harder, but different. There are some practices that seem to struggle to embrace the way in which funding streams have changed and to deal with claims. However, you could argue the job has been made easier in some respects, with data extraction being much improved. I imagine other PMs might disagree with me because the data that’s extracted isn’t always high quality; in this case, practices are, unfortunately, forced to do a lot of work to ensure all data is correct.

I’m not sure the PM of the future will be someone who will be filling in claims forms and dealing with multiple funding streams but rather someone who has an oversight role that looks at those areas – knowing about the finance position of the practice, being able to predict cash flow, managing profitability, having a day-to-day understanding of what’s happening in the organisation and making sure that the monies and resources that should be coming in are coming in are becoming much more of a priority.

Q. What evidence is there that those moving into the PM role are specialists rather than generalists?

A. There’s anecdotal evidence. In different parts of the country groups of PMs are working together and I think it’s true that there’s always been evidence of PMs sharing ideas with one another and local networks of PMs continue to meet to discuss changes within the sector. What I see very much emerging, particularly in Derbyshire and the West Midlands, are PMs who aren’t just working together on an informal basis; they are actually coming together and saying, ‘I’m really interested in this so I’ll work on the project on behalf of all of us,’ and I think the NHS collaborative agenda encourages general practice to work in that way. For example, it makes sense for all practices in one region to have a single employment contract, meaning that all employees are employed under the same terms and conditions, so we aren’t all competing for staff.

Q. In larger collaborative structures are senior leaders likely to pick a PM who they trust to take charge of financial responsibilities, or opt for outside hires?

A. I think it will be a combination of both. I think organisations will have to develop a more streamlined type of approach. Rather than thinking, ‘We have a group of PMs and we will divide various tasks among them,’ approaches will have to be well-structured and planned accordingly. Rather than looking at individuals within the organisation and working out where to put them, I think organisations will have to have a vision, map out where they want to go and work out the skills they think they will need in order to progress. That all has to happen before trying to move people around to fill gaps.

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If an organisation has a PM who – rather than just enjoying finance is actually really good at it, and has the necessary skills to do the job – it makes perfect sense that they would take on financial responsibilities for the organisation. What would make no sense at all – particularly with respect to a PM with workload pressures – is a senior manager simply saying ‘OK – now you’re in charge of finance.’ That’s the wrong way round.

On the other hand, if an organisation recognises that they have a huge skills’ gap – or, for example, needs a HR specialist – then they will recruit someone that meets their need and this may well be someone from outside the NHS. NHS and general practice experience are, of course, still valid but the organisations which are moving at pace are very much those that are thinking about what they need rather than what they’ve got.

Q. Can you explain why NHS experience would be valid and important to larger organisations?

A. The thing that I’ve found, having come from outside the NHS originally, is that you must hit the ground running very fast. There are deadlines in general practice that you can’t afford to miss and I think experience is valid as long as you aren’t looking backwards as a PM. As long as your experience allows you to show professional progression and you can talk about what’s likely to happen in the future, rather than what’s gone before, then the experience aspect will be attractive to a new employer.

The NHS is complicated, more so than any other organisation I’ve worked in. Some of those complications are self-made, and some of them are from the wider NHS which work their way into into general practice, but I don’t ever foresee a time when the culture changes so much that we’ll say, ‘We’ll do away with all PMs and start again from scratch with no-one from within the NHS’ – that’s just not realistic.

Q. How can PMs prepare themselves for the future and changes to their core responsibilities?

A. PMs often undersell themselves; generally speaking, they have to be much more positive about what they can offer other organisations. They know they are important but they aren’t great at selling the benefits of good practice management. I talk to a lot to GPs and they will often say, ‘My practice manager is amazing,’ and I’ll say, ‘How do you know? What are the competencies that make a good PM and how are you measuring them?’

What PMs can do much better is have people listen and let them understand the value of good practice management compared to poor practice management. We are managing small-to-medium sized enterprises. This is not a little part-time job that we do; it’s a serious business. If we are going to be fit for the future as a community, we must celebrate all that we are good at and what we do within our various organisations which allows them to run effectively.

A lot of PMs will say, ‘It’s not me, it’s the team’ but a team can only function with the right direction, support, coaching and all the information we provide as managers. My key message would be, ‘Keep looking forward’ and, as long as we are seeking out opportunities in general practice, then we will continue to be relevant to wider discussions about our place within the NHS.