Practice managers are being wrongly excluded from involvement in the formation of commissioning consortia, a delegate at yesterday's (20 October 2010) Management in Practice Event in Birmingham warned.
During a question and answer session with keynote speaker Jill Matthews, Director of Primary Care Improvement at the Department of Health, one delegate criticised the "GP-led" white paper.
"I think you've forgotten practice managers," she said. "The GPs think they've got to lead all of this [the commissioning consortia], including the management, and I feel there's no room for me at all.
"That can be quite negative," the delegate added. "The GPs think they've got to do it all, and the managers can just sit in the back room and not have a part to play."
Responding to this, Jill Matthews affirmed that the NHS reforms outlined in July's white paper "cannot and will not be successful predicated on two or three clinicians talking about pathways. I think as GPs come to realise the magnitude of the task, many of them will look to build teams to do this."
Speaking of the radical plan to hand commissioning responsibilities to GP-led consortia, she added: "This is big business in the future. This isn't practice-based commissioning. It's essentially doing everything that the current NHS system does."
"The Secretary of State has a passion for general practice and GPs, and he wants them to feel responsibility for this, but he is very clear that they won't do it all, and nor should they.
"GPs will be leading the consortia, but we don't believe they will be doing all the work to establish them. Over the next few months, as we start to develop shadow consortia, more opportunities about the role of others will emerge."
In a separate speech, Dr Beth McCarron-Nash, a negotiator for the BMA's GPs' Committee (GPC), told delegates that practice managers had a key role to play in advising their GPs who the best PCT managers are, so that they could be retained in the new structure.
"I'd urge you to speak to your partners, work with your practice teams and identify good PCT managers and local leaders who you think you want to keep within these new [commissioning] organisations," said Dr McCarron-Nash.
"In my area we've already seen a leeching of skills, and we don't want that to be lost."
But any practice managers who believed the government would soon be revealing more detail about the shape, size and structure of commissioning consortia would have disappointed.
One of the key messages of the conference was that such information will not be forthcoming from the Department of Health anytime soon.
Jill Matthews told delegates: "Lots of the detail [of what commissioning consortia will look like] is up to you guys, not us. The Department hasn't got a massive truckload of transaction manuals coming your way anytime soon.
"We genuinely believe this needs to be built and designed by primary care practitioners and managers, and not by the centre. There will be some more stuff coming up, but most of it is up to you, working with your colleagues, to design and implement yourselves, and we will support you to do that.
"I hope that's empowering, if not a little scary," she added.
In an event dominated by discussions about commissioning and the role of general practice in the "new" NHS, Sally Simmonds, a commissioning adviser at Primary Care Commissioning CIC, reiterated Jill Matthews' "bottom up" message.
"For the first time in your working lives, you're not being directed to deliver services – you're expected to direct them yourselves," she said.
Your comments (terms and conditions apply):
"Practices will still need to continue with the day to day running of services. GP consortia will be holding the funding for services currently provided by the PCT and for the hospital referrals etc; and ensuring targets/budgets are met in these areas. The GMS contract will remain separate and will not be managed by the consortia – therefore the role for practice managers would still exist. Yes, practice managers are overlooked in the white paper but I have certainly not been overlooked within my practice and indeed my local consortia – I am a practice manager representative on the board and also my partners are looking more to me to inform them of what is happening then ever before. It is up to us to accept the challenge and make it work – at the end of the day, the majority of GPs will admit they are not managers and want to get on with doing what they do best – treating patients" – Julie Jones, Kent
"The experience described above seems to be quite typical. GPs seem to be making two fundamental errors in the way they are approaching the challenges that are ahead: 1. They are forgetting they are running, in my case, a £1.5m per year business employing 32 staff that needs effective day-to-day management of people and resources. Most local GPs are confusing Practice Management worth with that of PCT Management staff, some of whom have been responsible for not properly monitoring and controlling contracts and activity with the acute sector. Hence, in many cases, a large financial deficit. Which leads me to point 2. Why do I keep reading the recommendation being made at this and similar seminars that new consortia should be employing ex PCT staff in commissioning roles? These are the very layers of very expensive and less effective bureaucratic management the white paper is trying to eliminate. Don't get me wrong, many of the local existing PCT staff are very good, but many are very lacking in the commercial skills that will be needed to move the new agenda forward on the cost effective basis that is expected to be the outcome. Consortia will be cash strapped in terms of their management allowance. Who can afford the salaries the PCT are paying at the moment? Transfer of duties and PCT contracts could be a total nightmare, HR wise and financially" – Ian Petrie, North London
"Perhaps consortia will want "commissioning managers" to oversee six or so practices each to ensure those practices with less expertise are not left behind – give work to the practices and support them in the early days??" – David Rose, Staffordshire
"Presumably someone will have to be back at the ranch running the practice, which after all is the GP's day job!! Of course practices will still need Practice Managers we will be providing services in primary care, we may not be at the forefront of commissioning but most of us don't have those skills anyhow" – Janet Newman, Oxfordshire
"No surprises. I find many in the health service do not know what practice managers do including one snotty consultant who told me I was not fit to speak to him as I was just a jumped up receptionist! He was shocked when I pointed out that I hold both a masters in law and a masters in management. I think there is a role for practice mangers we will have to do what we always do, make it work so the GPs get to see patients the way we do it will change but that is nothing new. As for lack of direction from govt – well it just means that if this goes pear shaped the GPs will get blamed – so nothing new there either – cynical who me??" – Name and address withheld
"GP consortia will want to share back office functions. They won't want an expensive manager in every practice duplicating a great deal of work. The skills in demand will be commissioning and engaging patients, so practice managers won't get a look in. Start dusting off the CVs ..." – Ian Anderson, Kent