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Making the most of your practice manager

Your practice manager is one of your most valuable resources in making a success of PBC. Practice manager Jose Tarnowski and GP Dr Shruti Patel offer top tips for maximising their PBC role

Your practice manager is one of your most valuable resources in making a success of PBC. Practice manager Jose Tarnowski and GP Dr Shruti Patel offer top tips for maximising their PBC role

1 Audit their skills and look at a minor team restructure

Enlightened PCT chief executives are referring to practice managers as ‘de facto commissioning managers' for their practice.

The practice manager role, now more than ever, needs to focus outside the practice to make the most of opportunities presenting themselves.

Without doubt, practice managers already have some of the necessary skills to take on this role, but there are things you can do to help them realise this and help equip them with the additional skills they will need for PBC.

• Suggest they liaise with other practice managers to see what they are doing or even set up a local practice managers' forum to share knowledge and ideas.

• Consider freeing up their time by outsourcing some of the back office work (our practice has outsourced payroll) and/or promote another team member to office manager, operational manager or assistant practice manager to keep the practice ship sailing smoothly.

• Consider sending your practice manager on training days offered by the PCT, such as data analysis tools training.

There is a trend for practice managers to be made partners these days and this reflects the central role they now have in developing the business of general practice.

2 Recognise number-crunching as their central role

PBC requires a great deal of data gathering and analysis to allow practices to manage indicative PBC budgets. Practice managers are well placed to take these tasks on as they are familiar with using and analysing data that underpins both clinical care and the business. Commercial tools are now emerging to assist in this work – such as

Dr Foster, EMIS's Qute tool and so on.

Specific tasks for the practice manager include:

• Understanding the PBC indicative budget – how it's made up, what's included and excluded and how the tariffs work.

• Implementing processes within the practice to manage and analyse data, including data validation for budget management and referrals analysis to identify areas where new care pathways might be developed. Such processes might involve using other staff as data clerks or analysts in support of the practice manager.

• Presenting key information to clinicians at practice meetings.

• Work related to whatever PBC LES or DES the practice has signed up to.

3 Triaging PBC information is another key role

Your practice manager can act as both a filter and an information scout. We are bombarded with material from the PCT and elsewhere and practice managers can triage this. Also, because practice managers have been engaged in identifying new and more cost-effective ways of delivering GMS/PMS services, they have a good sense of how

to keep their practices moving forward.

They can also check useful websites. Obvious ones to check regularly are the National Association of Primary Care and NHS Alliance (both also hold regular conferences covering PBC) and also the Improvement Foundation, but don't forget local ones such as the PCT website and the LMC. Our LMC has been particularly on the ball in warning of potential PBC pitfalls to avoid and identifying opportunities for PBC to develop and expand primary care.

4 Use them to gauge the picture of local health

PBC requires understanding local demographics and identifying patients' needs. The PCT's public health department has detailed information on morbidity, deprivation and so on that can be shared with practices to help them understand the needs of their population. The practice manager has a key role in seeking out and pulling together such information to add to what the practice team already knows about the population they serve.

5 Get them to highlight which patients might get involved

Patient involvement is crucial to PBC, particularly for getting business cases for service change approved. Conversations about what patients think of the practice and other local services are more likely to take place in reception rather than the consulting room. The reception team and practice manager can therefore gain a good idea about which patients might be willing to become more involved in a patient forum.

Our practice has set up a Patient Practice Partnership and this has been a good sounding board for PCT proposals (both sensible and controversial ones). The PCT is likely to be receptive to arguments put forward by patient groups and patient group support for PBC proposals can therefore be very powerful.

6 Educate the whole practice about PBC via your manager

Staff are much more likely to feel empowered and have a sense of job satisfaction if they understand why they are asked to do something and appreciate the context in which the practice now operates. Your practice manager can lead this process. A presentation on PBC and the changing context of primary care was given at our June practice meeting – not just about what was happening in our area but about wider NHS changes. Staff commented how interesting they found it, both as members of the public and as staff.

Empowerment makes staff feel valued.

In our experience, staff members joining the NHS now have a good induction but this has not always been the case. Those who have been working at the practice for a number of years may well need updating so they are also up to speed on the changing NHS.

7 Use them to get all GP partners on board

GPs are much more likely to do something if a suggestion or request comes from one of the in-house team rather than from the PCT. Practice managers can also have a clearer ‘helicopter view' of why the GPs should get involved in PBC and how it's likely to benefit the business and the patients. This could mean encouraging GPs to attend PBC training or support events, or simply to give protected time to PBC and organising locum cover to ensure this happens.

8 Putting business cases together is a bread-and-butter practice manager role

Many managers have already been here either developing services for PMS growth or bidding for modernisation funds back in the days of primary care groups.

The practice manager can work up ideas for services to be provided in the practice or respond to bids put out by commissioners for service provision. They can draw up the business plans, cost them accurately and make sure all bases are covered.

Identifying opportunities for the practice to expand on what it provides to patients using the funding mechanisms of PBC will extend the practice's business base and secure its future. This may need to be done as part of

a group of practices if a service is too big to be provided by a single practice. In our area, practices have formed larger groupings for the provision of ‘out of hospital' services.

9 Get them to build good relationships with the PCT

GPs may have been seen as the ‘bad cop'

in the past but your practice manager can easily be seen as the good one.

Tips for harnessing good relations include: encouraging your practice manager to devote time to developing good working relationships with the PCT team who can help move PBC forward; taking up opportunities for the practice manager to attend training or support sessions that the PCT offers; and inviting relevant PCT staff to practice meetings or practice manager forums where it is felt they can help with specific issues.

10 Recognise which tasks are not the practice manager's role

Once your practice manager is handling your PBC strategy and on first-name terms with the PCT commissioning lead, don't lose sight of your own PBC role as a GP.

The GP role is about coming up with the clinical ideas for care pathways and for common-sense, cost-effective and clinically effective ways of dealing with patients.

Another fundamental GP role is working up ideas in collaboration with secondary care colleagues so that there is cross-sector clinical support for service models that make sense for patients.

And if your PCT is not providing enough appropriate support for PBC (finance, data provision, training and support) then you need to be raising these issues with other stakeholders such as the LMC.

Jose Tarnowski (pictured left) is a practice manager at a practice near Bristol and a former NAPC co-opted executive member Dr Shruti Patel is a GP board member of Woodspring PBC cluster

collating and analysing data on local health needs is an obvious role collating and analysing data on local health needs is an obvious role collating and analysing data on local health needs is an obvious role

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