VIRTUAL clinics, Skype consultations, federated organisations and the need to achieve more with less resources. The future of general practice presents managers across the UK with a dizzying array of challenges.
The recent NHS reforms have already dramatically changed the general practice landscape in England, with PCTs gone and practice based commissioning replaced by clinical commissioning groups.
Now the RCGP has added to this a number of ambitious goals, outlined in its report The 2022 GP – A Vision for General Practice in the Future NHS. A decade from now it envisions a prominent role for technology and an expanded, skilled general practice workforce with a greater emphasis on multidisciplinary “micro-teams”. It also foresees a greater need for clusters of practices to work together to get the best results from limited resources.
Some may not be ready to embrace such a bold future, but these goals and the changes brought by NHS reform create real potential for managers keen to expand their roles and become leaders in general practice.
While the RCGP’s future vision contains few specifics about the practice manager’s role, in the report Liberating Practice Management, NHS Alliance chairman Mike Dixon says practice managers “hold the keys to the future NHS”. He believes that “as commissioning and increasing provision passes to GP practices and frontline clinicians, practice managers will be required to hold things together.”
General practice is evolving and changing differently in each of the UK’s four health systems, with the most profound changes likely to take place in England over the next few years. However, managers in Scotland and the rest of the UK will not be immune from changing work practices.
The future PM
So, how to define the role of practice manager? It is a job title that covers a broad spectrum of skills and responsibilities. In some practices the PM’s main function is as office administrator dealing with basic day-to-day tasks. But in others the PM assumes greater responsibility and plays a more strategic role in managing the direction of the business, often across multiple practice sites.
It is this pro-active, leadership role that looks set to be a more prominent feature of future PMs.
Fiona Dalziel has been a practice manager in Aberdeenshire for 23 years and runs DL Practice Management Consultancy. She is also the RCGP’s Quality Programmes Assessment Lead. She believes practices whose managers work at a basic administrative level will soon need input from an individual working at a higher level, whether full time or part time.
She says: “Practices, especially in England but throughout the UK, are not going to be able to cope with the amount of change that is taking place if they do not have a manager who is looking outside for ideas and bringing innovation. They will need someone to act as a leader in the practice, and someone who is regarded as such by the partners.”
Fiona believes the basic administrative functions of running a practice will clearly still need to be done, but says: “Practices will need someone working at a higher level, whether that is someone employed in the practice every day or shared across a group of practices working in a co-operative. That is inevitable.”
While this may present smaller practices with even greater budgetary pressures, Fiona sees it as an opportunity for career progression that has not been present before. “This will be a great opportunity for ambitious, forward-thinking, skilled managers who can work as leaders and develop their careers,” she adds.
Such changes could also pave the way for a rise in self-employed managers who may choose to swap a fixed, salaried position to instead work on a self-employed sessional basis for a number of practices.
These steps forward will rely in no small part on the establishment of a more structured training pathway for managers.
This is echoed by objectives detailed in the RCGP’s vision report which identify a need to “enhance the skills and flexibility of the general practice workforce to provide complex care” and “to put in place additional training and development opportunities for practice managers, with the potential to include specific vocational training.”
While such additional training opportunities would no doubt be welcomed by PMs, it is not yet clear how these would be provided/funded.
The RCGP report goes on to predict that practices will “work in federated organisations, with interconnected clusters of practices and other care providers, spanning traditional primary, secondary and social care boundaries.” This would allow practices to “combine ‘back-office’ functions, share organisational learning and co-develop clinical services.”
Such resource-sharing could help make limited budgets go further, with practices joining forces to generate greater “buying power”. Sharing could extend to functions such as HR services, accounting or even indemnity provision. But these arrangements would not be entirely trouble-free as employees asked to work in new or unfamiliar settings could present their own challenges for managers.
The RCGP also foresees practices working in multidisciplinary micro-teams to care for patients with a range of complex needs, especially those with long-term conditions, the elderly, and mothers and young children. This would, the RCGP says, improve continuity of care through a focus on team-based continuity. It would also have implications for PMs.
Fiona says: “I’ve noticed during meetings and conferences recently, particularly in Scotland, there has been a lot of talk of micro-team working where we will be grouping service delivery by patient group. This may indeed be an improved way of working but it’s clear that co-ordinating micro-team working and resource-sharing with other practices, in addition to all the other new responsibilities, will have a huge impact on practice managers.”
“Greater use of information and technology to improve health and care” is a prominent theme in the RCGP’s future vision of general practice. So-called “telehealth” and “telecare”, where patients monitor issues such as blood pressure via machines in the practice or at home, is already a government priority. Virtual clinics and patient consultations conducted via Skype or similar online media, as well as communicating with patients by text or social media, are also expected to play a greater role.
This raises a number of issues for PMs who will be the main gatekeepers of this technology.
MDDUS senior risk adviser Liz Price says: “Practice managers will assume greater troubleshooting responsibilities in the future as they will be responsible for risk-assessing the local implementation and use of all the new technology.
“Many practices are already using a variety of new technologies day-to-day. This looks set to increase further and managers need to be aware of the implications in terms of data protection, patient consent and confidentiality.”
Many changes lie ahead for UK general practice and it seems practice managers – with the right investment and training – could indeed hold the keys to future success.
Joanne Curran is an associate editor of Practice Manager