by Dr Mary Clarke CBE, Director of Workforce, City and Hackney GP Confederation

Practice manager burn-out is a recognised problem in primary care and one that is discussed widely on various forums and networks. In a 2013 Pulse survey of 471 practice managers, two-thirds were considering a new career and the vast majority surveyed were feeling demotivated, and in a 2016 survey over a quarter of practice managers were ‘actively planning’ to quit (£).

In City and Hackney many of our GP practices are managing a number of practice manager vacancies, some for over 12 months. The turnover of the practice manager workforce locally and nationally is increasing. We are also mindful that a number of our current practice managers will be retiring over the next two years.

The practice manager role requires a wide range of skills. Over recent years it has become more complex as primary care has expanded and the health economy becomes more integrated. The old model of ‘learning on the job’ isn’t a sustainable one for the future.

Increasing workforce capacity to respond to the changing NHS landscape

With this in mind we looked at ways to address the current practice management workforce issues. We have also been looking at the future ability to increase workforce capacity to ensure primary care is able to respond to the changing NHS landscape and effectively contribute to the transforming primary care agenda, the care closer to home vision, and the primary care and community contribution to the transformation agenda. This also links with the Next Steps Strategic Commissioning Framework, building our organisational capabilities through strengthening workforce wellbeing and resilience in City and Hackney.

Trainee practice managers programme pilot

We received funding through our community education provider network (CEPN) to pilot a trainee practice managers programme to help us with our succession planning. The practice manager role this envisaged would be very different. Previously, the role was learnt on the job. This pilot would train, equip and skill up practice managers so they understood budgets, income generation, quality improvement, managing change, modelling the workforce, staff management and the many variables that the role can bring.

We wanted to create a programme that would give individuals the skills to undertake the role and feel equipped when carrying out their duties. We scoured the country to look for similar programmes but we found nothing that met our needs so we developed a bespoke programme to run for 12 months.

We advertised on the NHS job site for six candidates and had to close the post after a week due to the amazing response we received – 136 applicants! Four of the six already had some general practice experience, one had a background in local authority human resources and one had undertaken a practice management programme but could not find a role because of lack of experience.

The scheme piloted six practice manager trainee placements in six practices across the borough. The programme ran from September 2017 to August 2018 and took the shape of four days in practice and one day of taught learning. The scheme comprised of 12 modules, one day a week. Each module covered a four week period, tailored to specific subjects including HR, workforce and managing patients and staff. It also involved exposing trainees to transformation and sustainability approaches. The scheme included internal and external trainers including Health Education England and the Care Quality Commission.

We also recruited a co-ordinator for the programme. This was invaluable. They played a vital role in the successful delivery of the programme and in supporting our host practices.

“I feel very privileged to have coordinated and delivered such an innovative, comprehensive and forward thinking bespoke programme, that addressed both the practical and academic aspects of Practice Management.”

Programme Coordinator

We also had a practice manager who acted as a mentor to the trainees.

“I was very lucky to get a candidate who was exceptionally talented and who quickly became indispensable. We worked very well together and I was pleased that at the end of her training she was more than ready to take on a role as Practice Manager.”

Host Manager

Both the trainees and the coordinator were employed by the GP Confederation to ensure consistency in the experience and participation of trainees in the programme. The coordinator liaised between the practices involved, the trainers and the training providers. This built up a library of resources such as presentations and training schedules. They were also pivotal in getting the programme accredited with the Royal College of General Practitioners.

We are now doing an evaluation of the programme and are keen to roll this out to other localities. We have produced and delivered marketing materials and are waiting to hear from other areas keen to utilise our experience.

Success factors

The key to the success of this programme was the collaboration between the GP Confederation and the training providers, having shared resources and trainers, host practices, a co-ordinator to manage the process and a mentor to support the trainees over the 12 months.

The challenge we faced was keeping the programme practical and relevant, ensuring that what was learnt in the ‘classroom’ was easily applicable to being on the job. Also, the feedback from the participants, which we are looking to incorporate into the programme, was that they would have found it useful to see and play about with mock finance systems that were similar to the ones currently in use at practice level. This was because all practice finance systems are different and many of the trainees had not been exposed to practice finances previously or as part of their training.

This scheme provided City and Hackney’s Primary Care sector with:

• 6 new highly trained managers
• Locally trained managers following locally agreed protocols and pathways
• A benchmark for best practice in primary care management that can be adopted by GP practices  locally and beyond
• GP practices better able to withstand change.

We are delighted with the success of this programme and highly recommend it for any organisation or practice collaboration looking to skill up and succession plan for the practice manager role.

Read more about the salaried trained practice manager programme

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