Did I sign up for this?

Medical practice adviser Mimi Salgado offers a perspective and advice on handling the stress that comes with being a practice manager

Woman spinning plates
  • Date: 28 September 2022

THE clinical systems are down, three admin staff have called-in sick, a doctor is stuck in traffic, the cleaners have failed to show-up, there is a queue of patients around the block, three lightbulbs are out, there are two new complaints on your desk, a GP trainee needs an urgent form to be filled-in for the deanery, and the phones turn-on in five minutes.

You were going to spend the day preparing for staff appraisals, completing the practice’s data protection toolkit, submitting the controlled drugs declaration, and most importantly running the monthly payroll.

Now, you are going to spend much of the morning on the reception desk until someone responds to your desperate messages for staff to cover, and the afternoon dealing with the AWOL cleaners, completing the trainee’s urgent form, and getting payroll done. Maybe at some point you’ll get to the 200-plus emails that have landed in your inbox since yesterday. Oh, and you mustn’t forget that there is an LMC evening meeting today to discuss the new GP contract – better also find the time to read the contract!

Sound familiar?

As the practice manager, it all falls to you to deal with. This, on top of your never-ending list of ‘normal’ duties, both pre-planned such as staff appraisals, budgeting, rota management, compliance monitoring and bank reconciliation, as well as the reactive work such as complaints management, staff disciplinaries, SAR requests and an accident in the car park. It involves long hours, often including weekends and times when you are on leave, isolation, trying to please your employers, your staff, your patients, the commissioners and the regulators.

Reward and challenge

Who would do such a job? Let us be honest that we never signed-up for the reality of the life of a practice manager but we do it because we care. We genuinely care about our colleagues, our patients and our businesses.

The job can be rewarding and challenging in equal measure. Sometimes though, it can all get a bit much. We can find ourselves at the end of our tether and can be at a loss as to who to speak to who will both understand and have some words of advice to help us look after our own wellbeing as well as that of our team. Some fortunate practice managers have understanding and supportive colleagues, both inside and outside of the practice, but still struggle with the relentless pressures.

We know the strain that general practice is under. Patient expectation is at an all-time high and resources to provide the services that both practices and patients want are simply not keeping-up with need. As the accessible face of the NHS, the GP workforce is being pushed to the limit.

"We can find ourselves at the end of our tether and can be at a loss as to who to speak to..."

Touching base

I worked in general practice for 21 years and in practice management for over 15 years. I found that teamwork in general practice is key. Finding regular opportunities to touch base with colleagues is fundamental to the survival of individuals and the team more generally. Be this a mid-morning coffee, a chat in a corridor or a drink after work, the sharing of the strain and discussion of matters completely unrelated to work can help make everyone feel better.


More personally, when things became overwhelming, I would go for a walk. This could be five minutes or an hour – whatever was needed to clear my head and reset my emotions. I would switch off my phone or leave it in my office so that I was undisturbed. Sometimes, these walks would take me past the shops, and I’d return with goodies for the team. The healing properties of cake should never be underestimated.


When a coffee, a walk and cake aren’t enough, talking to an expert can be very helpful. MDDUS members and practice staff in a DPS scheme benefit from access to the MDDUS Your Halo service available 24 hours a day, 7 days a week. There are trained healthcare professionals at the end of the phone who can give expert, independent, and confidential wellbeing advice and support to anyone who might benefit.

At MDDUS we understand the challenges practice managers face and would encourage you to consider whether a quick ring to YourHalo might help you or any other member of your practice team when the going gets tough.


Quick tips

  • Network and build relationships with other local practice managers.
  • Build time into the day for team interaction.
  • Recognise and act when things are getting too much.
  • Get out, get fresh air, and turn your phone off.
  • Remember YourHalo can help.

This page was correct at the time of publication. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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