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
