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CAMHS won't see you now

Let’s hear it for practice managers

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I recently asked over 30 practice managers if they could each tell me one thing that would help them or that would make their work just a little more bearable.

The key themesin their answers were related to funding, financial claims, reporting and over-complicated bureaucracy. 

All the managers agreed on the urgent need to simplify claims and remittances and to tackle the cash flow crisis: local authorities were routinely taking at least three months to pay for work undertaken by practices. GPs in many practices had been required to reduce or to stop drawings for a period, or in some cases to introduce new capital to deal with increasing practice overdrafts.

There were many calls to ditch over-complex and fragmented computer software, which was making payments and reporting systems byzantine and time-consuming. Several managers told me that they felt ‘trust has gone’ and global email addresses at NHS England meant no one seems to take personal responsibility or to be accountable for anything. I heard accounts of considerable time wasted on prolonged phone calls, being passed from pillar to post, chasing details or clarification regarding payments. 

There was a consensus view that NHS general practice was being brought to its knees by payment chaos. 

A number of the managers reported concerns about high levels of stress amongst their practice doctors and nurses. Practices were struggling to recruit GPs and nurses and many reported the rising costs of GP locums. 

I was surprised at the number of newly appointed managers. Long serving managers were leaving - their job was not what it used to be, long days dealing with mindless bureaucracy and overwhelming patient demand. Three managers, each with twenty years’ experience, reported that they had never known things so bleak, or seen morale in general practice so low. Practice nurses were off with stress and GPs were struggling to keep going - many have already emigrated, gone part-time or scheduled early retirement in the next year or two.

General practices are small businesses and as such are vulnerable to sinking when cash flow fails. The LMC are campaigning to get practices paid in a timely fashion. For instance, me and a group of these managers met the local director of finance for NHS England. We agreed we would develop an charter for the way NHS payments should be in the area, and that payments should be made within a month of the service being performed. 

Every week I meet practice managers and I feel humbled by their dedication and commitment. They are the linchpins of general practice particularly through the recent years of turmoil and chaos. They just want to be allowed to get on with their work, to do a good job and to have the time and tools to do it.

GPs so rarely know what being a practice manager involves, but we do know that we need them.

They are holding UK general practice together - often at significant personal strain and stress.

Anyway, a clear message from this chief exec: I really appreciate the fantastic work you do, I will stand by you, and I owe you a big thankyou.

The LMC Insider is chief executive of an LMC in England. He is also a practising GP

Readers' comments (7)

  • Vinci Ho

    Practice managers and practice nurses are unsung heroes . Loyalty and dedications.

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  • It is sad that with all that is going on, some practice managers choose to get involved themselves in clinical issues that is outside of their expertise, which then results in more work for them.

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  • Shurleea, sometimes practice managers have no choice - if none of the partners able/willing to take the issues on...
    I'd have thougt that very few of the things practice managers end up doing in the clinical field relate to the clinical aspects.

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  • I should have said, Practice Managers are absolutely indispensible - I remeber (with retrospective horror) when I didn't have one.
    That was many years (and GMS contracts) ago: bad then - but these days life would be impossible without a good practice manager!
    May I offer sympathy to practice managers coming into general practice and the NHS from other, more organised sectors?
    Previously there would have been an organisational/regulatory framework established: now in the NHS and general practice it seems that there is *no* framework for functioning, routine, PCT-type back-office sort of functions (pay, rations, advice on claims/bids/opportunities etc).
    I'm not sure that even the general practice practice managers will be able to make the system work much longer!

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  • I get many sleepless nights worrying about CQC inspection, I wake up having mini panic attack. When a job affects home life and health it's time to move on, so with much sadness I now look at ads for jobs outside general practice. Some job stress and problems to be sorted is normal, that's what we are paid to solve. But CQC and it's pointless drivel pushed by the ex-PCT morons who can't hold down a real job so like to swan about having power over practices as a CQC inspector, is the killer.

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  • Being in a practice manager role is horrible compared with my other roles in other sectors. The NHS is chaotic mess and 'paperless' is a complete joke. Keeping track of ridiculous claim and payment systems is bad but you can normally find a way through it using time one simply doesn't have. It's the clinical side of the administration that always surprises me. We do our level best but in this day and age we are still dictating and writing letters between primary and secondary care and use different IT systems? Completely bonkers. If it wasn't for the great team we have and a love of public service I would have run a mile (screaming) after my first couple of weeks in GP land.

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  • One sysem of claiming? Now we have CCG, NHS, Public Health, with all the departments therein. And what is CQRS all about? More updates than Jeremy Hunts policy's. Only PH could ask you to submit an invoice that they send you the details of what to invoice for!

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