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Sunday 21 July 2019
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Practice managers belong at the forefront of primary care transformation

Practice managers have a key part to play in the development on primary care networks but they need development and support, says NAPC chair Dr Minesh Patel
 
Recruiting medical staff, balancing the books, dealing with patient complaints and meeting Government targets. These are just some of the duties that are in a day’s work for practice managers.
 
Yet I don’t believe your skills receive the recognition they deserve. The need for greater investment in practice managers was emphasised in the General Practice Forward View (GPFV) three years ago but, in my view, it didn’t go nearly far enough in terms of putting practice managers where they belong – at the forefront of the transformation of primary care.
 
Now we have the long-term plan for the NHS, which sets out the vision for integrated care systems (ICSs) founded on strong primary care services. In the new GP contract, NHS England makes it clear that primary care networks (PCNs) will be the foundations of this new system and will be key to the very survival of many GP practices. These networks have a long development journey ahead, building on the independence of each practice to create a more sustainable primary care system by working at scale.
 
Practice managers are integral to this development, with a key role in the emerging leadership structures of PCNs, working alongside the newly appointed clinical directors. These new leaders will, in the next few years, collaborate closely within the evolving ICS structures. As chair of the National Association of Primary Care (NAPC) I talk to many practice managers who tell me they’re unsure of what the future holds for them in this new world of primary care networks.
 
There are those who have spent years competently managing the smooth-running of a single surgery and who now feel daunted at the prospect of taking on a more strategic leadership role in what can seem an alien environment.  I see an exciting future for practice managers, but there are undoubtedly also many challenges ahead, now and in the years to come.
 
At the NAPC, we created an early formula for PCNs when we established our primary care home (PCH) programme back in 2015. We now have more than 230 PCHs across England and, as the programme developed, it became clear that practice managers would need new skills to ensure the success of this primary care transformation.
 
It was no longer enough to be an efficient business manager. Our PCHs needed strong leaders, people hungry for change and with a talent for inspiring others to join them in finding a better way of doing things. That’s why we developed our Diploma in Advanced Primary Care Management – to equip practice managers and other health professionals with the skills to manage primary care at scale.
 
Of course, not every practice manager has the desire or potential to step up to some of the new and demanding PCN roles. However, every practice manager must be willing and able to adapt in this fast-changing general practice world. Financial management will remain a core skill but, added to that, practice managers now need to be capable of devising and implementing new systems to improve efficiency, reduce staff workload and, above all, provide a better service to patients.
 
For those with the tenacity and motivation to step up to a more challenging role, PCNs offer exciting opportunities to lead the transformation of general practice. You may, for example, want to move into business development for a GP federation, become a PCN manager or lead the service transformation for a group of networks covering an entire county.
 
The sky’s the limit, but the higher you fly, the more skills and confidence you’re going to require. A network manager needs advanced management and leadership skills, a thorough understanding of service and workforce redesign tools, and the ability to influence key stakeholders and drive change across different organisations.
 
I’ve spoken to practice managers who are keen to develop these skills but lack the time and funding to undergo the necessary training. I would like to see funding ring-fenced for the development of practice managers, to help you lead the implementation of the laudable objectives contained in the GPFV and the long-term plan.
 
Over the next few years, all of us working in primary care will be stretched by the need to work at scale and take a much broader approach to the overall health and wellbeing of local populations than we currently do. These are tough challenges but I believe the potential rewards, both for patients and frontline staff, are huge. And just maintaining the status quo is not an option.