What are the biggest challenges of General Practice Management?

Tracy Green Head of Primary Care QCS

With over 13 years experience of managing and leading GP Practices, where do I begin...?

As you can imagine I shall start with the enormous challenge that COVID-19 has bought over the last year. As with all health and social care providers, this put tremendous strain on practice managers to make sure that practices were covid secure, clinicians were split between hot and cold clinics, PPE was sourced and delivered, patients were involved and updated, innovation was implemented maybe years before the ideal time and of course they were the go-to people to make sure that all team members were looked after, risk assessed and deployed accordingly.

Then came the vaccinations which were so welcome but also created new challenges. These have been commissioned at Primary Care Network (PCN) level meaning that many larger clinics have been set up in places such as sports halls bringing many teams together from various practices to deliver this incredible service. The challenge does not stop there as there have been vaccine shortages, short dated vaccines, media messaging prior to information being shared with vaccination centres and there have been delivery issues causing clinics to be cancelled and changed at short notice.

Are you tired yet? Well that was the additional work!

Practice Management can be a lonely place to be as the role reports to the partners, but practice managers also manage upwards and run the GPs business for them. Whilst the CQC Registered Manager is usually, but not always a partner, the practice manager tends to be the lynchpin in the organisation ensuring that policies are in place and being followed, audits are carried out and evidence is being gathered to demonstrate compliance with the CQC whilst keeping a diverse team engaged and productive.

I liken Practice Managers to CEOs of small businesses who hold an NHS contract. As any small business, there are many areas to manage including recruitment, retention and development, finances, strategy, premises, contracts, HR, IT, and of course patient satisfaction. The NHS contract is the main income for the practice, and this can sometimes bring its own headaches. Private work is minimal, and the patient expectations have grown exponentially at a time when employees are struggling with their own mental health through periods of lockdown, and family issues such as home schooling due to COVID-19.

Finance is very different in general practice. There are claims for so many services that it is imperative for practice managers to hold a detailed list of all income and expenditure. Anticipated payments are made on a monthly basis and then reconciled at year end based on the practices report submission and the clinical system is used to run searches to claim for these funds from a number of places including NHSE, the local Clinical Commissioning Group, the council and now Primary Care Networks. Deadlines for claims are generally tight and some commissioners are more lenient than others so if a practice is late with a submission, you run the risk of reduced income; no one wants that.

Practice Managers are unsung heroes who are having a really tough time. Please be kind to them, check in and ask them how they are while they are looking after everyone else.