Don’t Forget the Caretaker of the House of Cards

Don’t Forget the Caretaker of the House of Cards

Eighteen months or so ago, I was asked to stand up in front of all our local GPs and promote the concept of a Primary Care Network. I started by describing the state of the partnership model in my area as a “House of Cards”. GPs were bringing their retirement plans forward, 35% of practices were advertising for GPs and newly qualified colleagues saw the concept of partnership as a millstone. It was getting to the point where some salaried GPs were close to earning more than the partners that were employing them.

I argued that working as a PCN could help to bring in other healthcare professionals that could stabilise this “House of Cards”.

Hence, when I heard of the New to Partnership Payment Scheme, I considered it a sensible measure to embed some of these new primary care health professionals into practices and stabilise the partnership model. However, it was with total disbelief that I read the draft guidance, noting one glaring omission from the list of “professionals”. What about the Practice Manager?

In 2017, I and my opposite number in another practice had worked around the clock to stabilise our own “House of Cards”. We proposed and underwent an administrative merger in order to make two weakening partnerships into one stronger one. It was the most stressful thing I have ever experienced and it impacted on my mental wellbeing. Our partnership has grown, we have recruited 4 salaried GPs and both practices are now training practices.

I am not mentioning this as part of some exercise in self-adulation. It is merely to emphasise the pivotal role that a practice manager has in the organisation; the caretaker of the “House of Cards”. By all means, we should embrace a wider population of health professionals within our partnerships. In doing this, we are probably making our organisations more complex and larger; and whose role does that make more challenging?

General Practice does not exist in a bubble and we ignore the lessons of the business world at our peril. As organisations get larger and more complex, there will often be on the board a Finance Director, a Personnel Director and an Operations Director. They bring critical focus to the table. Is NHS England really saying that in their model practice structure there should not be at least one partner responsible for all these roles?

The Practice Management Network totally endorses the open letter sent by colleagues to the great and the good. We must get this draft guidance changed. If NHS England is reluctant to recognise practice managers because we have no recognised accreditation, then the solution is to work with us and others to fix that not to overlook the professionals at the core of general practice.






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