R H Practice Managers: Jack of All Trades or Masters of Many? If we jump into our time machine and nip back to 1950 to visit a GP, we will likely come across a male GP working from their home supported by their wife who worked as a receptionist, assistant and anything else that was needed – that might explain the basis for your job description! OK, that’s a huge generalisation, but practice managers, as a role, didn’t exist.
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he Royal College of General Practitioners wasn’t formed until 1952. GPs were initially simply paid capitation fees. It wasn’t until 1966 that new terms of service, 'the family doctor charter', were agreed.
Andy Briggs Andy spent 25 years as a practice manager and managing partner in a large semirural GP practice, during which he met the challenges of the ever-changing NHS environment. Active within practice manager groups, practice based commissioning and CCGs, he now works within the system supporting practices to meet the new challenges of extended access and Primary Care Networks.
The charter bought about changes in the way GPs were paid under a system that became known as the “red book”. The red book enabled GPs to claim up to 70% of the cost of ancillary staff plus 100% of premises costs. GPs who took on the care of patients outside of core hours were paid additional fees. The charter was a turning point for general practice allowing GPs to improve their premises, employ staff and come together to form partnerships. This change, little more than fifty years ago, created the seedbed from which today’s practice manager role grew. The introduction of general practice fundholding (GPFH) in 1990 required organisational and inter-organisational management at a higher level. IT wasn’t very prevalent. When I joined my practice in 1993, computers were
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“dumb terminals” used mainly for prescribing and repeat prescriptions. Patient notes were still handwritten and lists of patients awaiting operations were based on T-cards. IT crept in and two systems ran sideby-side for many years. Claims for reimbursement and items of service were paper-based requiring capable systems to capture the activity and process the paper forms for payment. Once payment was received the payments would be reconciled against the claims. GPFH and increasing organisational complexity saw more managers being recruited. Many developed from existing administrative staff, hospital administrators, ex-forces or bankers, some were nurses. The breadth of background and experience within a group of practice managers has always appeared to be an immense strength. For many, the role of practice manager was “a Jack/Jackie of all trades”. The speed at which the role of practice manager changed has been at the same pace as the changes to the
