In December 2021, the Health and Social Care Select Committee called for submissions to its Inquiry into the Future of General Practice. Below is the Practice Management Network’s (PMN) submission, looking at the challenges and some solutions. The PMN has also responded to the second HSCSC Inquiry into Workforce. This will feature in the next newsletter.
The PMN is the recognised collaborative of senior practice managers, practice manager partners and experts in strategic practice development. Founded in 2005, their Board members provide expertise and advice, with the benefit of organisational memory, to a variety of NHS organisations including NHS Digital and the National Association of Primary Care. It has a strong patient focus thanks to a memorandum of understanding with the National Association for Patient Participation.
What are the main challenges facing general practice in the next five years?
There is a well-documented workforce crisis in practice management which over the next five years, will impact the viability of many general practices and patients, carers and communities’ ability to receive locally based general practice services.
Practice managers are the leaders, lynchpins and organisational continuity of many GP practices. This critical management role is often undervalued or unrecognised by the wider NHS. Given that the GP workforce is shifting to be flexible, the consequence is that someone has to hold it all together. Practice managers are the system ‘glue’ and safety net, offering value for money within the NHS and across social care too, with demonstrable impact on referral management and support for carers etc.
Practice managers are the single point of access to the GP practice, the organisational continuity within the Primary Care Network. They are under increasing pressure to deliver new and more complex services to their patients, plus filter and action multiple requests from CCG, NHSE, DHSC all asking to some extent for the same thing but with slightly different wording. It is timely to remember the numerous additional staff roles being introduced into primary care with the practice manager acting as the conduit for both the patients and staff to introduce the new roles and service.
Practice leadership is now provided by this cadre of managers who are increasingly taking on Partner status, without the benefit of the NHS ‘golden hello’ incentive offered to clinical colleagues who become partners. Practice Managers are increasingly taking on accountability for contracts and delivery responsibilities
These factors make an already challenging role unsustainable and increasingly unattractive to new recruits. Retention is increasingly difficult as demonstrated by increasing numbers leaving due to burn out and earlier than planned retirement. There is no clear pipeline of replacements for those with planned retirements.
As a management role within the NHS family, practice management is the forgotten part of the profession. There has been little system investment in formal training, no clear career path, career development unlike other NHS management roles. Plus there has been a ’brain drain’ of senior practice managers into strategic roles at Primary Care Network and Integrated Care System level.
What can be done to reduce bureaucracy and burnout, and improve morale, in general practice?
Practice management is the system architecture in general practice and needs strengthening. This requires:
- NHSE&I to review and strengthen partnership working with practice manager groups and to involve practice managers early in strategy and decisions affecting general practice business and more importantly, delivery of patient services.
- Investment in practice management training and career development and the workforce in general i.e. the speciality of practice management as part of the NHS Graduate Management Scheme as well as a funded PM Vocational Training Scheme. Recognition of accredited practice managers would be a positive step for those currently accredited and encourage others to formalise their role within the profession.
- NHS Jobs and Careers to provide stronger marketing messages to promote practice management as a worthwhile NHS career, leading and developing general practice provision in the NHS.
- Parity of esteem and formal acknowledgement for Practice Managers as Lead Partners and Partners in GP practices, demonstrated by inclusion in the ‘Golden Hello’ initiative.
- Investment and recognition of PMs acting as mentors as demonstrated during the pandemic offering pastoral care and well-being support both to colleague PMs, practice team members and GPs.
- Stronger voice for practice managers within the Primary Care Networks and at Integrated Care System level, supported to deliver services that keep patients out of hospital.
- Recognition of the skills in working in partnership with patients and Patient Participation Groups to learn together and introduce the new changes around access and service delivery, often at speed, highlighted by the pandemic. This includes the vital roles of rebuilding trust in primary care and patient education around new services and delivery modalities.