This is not an entirely new issue, I remember being asked this very same question whilst giving a presentation as far back as 2018.

I also note that others within the wider NHS community and public have recently also raised this subject in relation to specifically Hospital Managers which has resulted in a petition to create a new regulatory body to hold NHS Managers accountable.

I am not entirely jumping on the band-wagon of the current drive – although am in agreement. It is in fact, some more recent experiences that have enforced what I have always known… a good manager can ‘make‘ an organisation whilst a bad one can ‘break‘ an organisation.

There are far too many self proclaimed and professed “experts” in the profession and industry, some who have never actually worked a day in a practice, or wouldn’t know the first place to start when it comes to reconciling CQRS Claims or navigating the PCSE Portal.

I remember a time when practice managers used to joke, “that the easiest way to become a practice manager was to marry a doctor”! Fortunately those days are long gone – or are they?

My own background is engrained within practice management and I continue to be heavily involved in the role. My journey began a long time ago, back in 1995. Whilst studying business at college an opportunity for some part-time data entry work arose at a lovely small practice. Yep in the days before docman and scanners, the GP would use a highlighter pen and highlight the key terms within clinical correspondence and yours truly would manually enter this information on the patients clinical record. Vamp Medical the system was at the time, which went onto become Vision/INPS. Computers were still not widely used, receptionists still used to book patients using a manual handwritten diary, pulling the Lloyd George notes before each clinic, notes would still be made into the paper records and acute prescriptions would still be handwritten.

I then began helping out the practice covering the evening reception, this progressed onto becoming an administrator and joining the practice full-time. I would frequently deputise for the practice manager whilst he was away on annual leave. After working in this capacity for a few years, I considered a career in medicine, but the thought of studying for a further 8+ years wasn’t very appealing for a young twenty something year old. So utilising the skills and experience I had obtained within the general practice environment, I thought that Practice Management might be the best route for my future.

I searched and researched what training was available for aspiring managers and the go to seemed to be the AMSPAR course, however through local contacts and networks I became aware of a 2-year PGDip in Management for General Practice (1 year certificate and 2-year PGDip) and decided to enrol myself. Unfortunately the course ended with my group being the first and last cohort we were extremely fortunate as at the time UK General Practice was going through its most profound changes at the time with the implementation of the New GMS GP Contract 2004. So in already a very short space of time, I had experienced the end of the Golden-era of General Practice: GP Fundholding, Strategic Health Authorities, PCG’s and then PCT’s and since that time QOF, CCG’s, CQC, NHSE and the current flavour of the month (well until March 24) PCN’s, ICO’s ICS, ACO’s!

Having learned about the New GMS GP Contract whilst at University, I soon developed an interest and expertise in QOF and found myself helping and supporting several practices. This gave birth to the next chapter in my career PCMS Ltd….

Seeing that there was a need for practices to be supported with management, I discussed an idea with a colleague and fellow practice manager…

“what do practices do when a GP is off”, “book a locum” he said

“and what about when the nurse is off”, “hire an agency nurse” he said

“and the receptionist” “well usually we cover with other receptionists”

“And what about when the Practice Manager is off” “Pandemonium” was his answer. And that was the idea behind what is now PCMS Ltd. After mulling over the idea for several years, I eventually took the plunge and set up PCMS Ltd (Primary Care Management Solutions). A company that would provide practice management support to GP practices. At the time nothing like this existed, now everyone seems to be an expert and there a few companies offering ‘similar’ services but these services tend to be more high level consultancy… flashy charts, spreadsheets, presentations and reports. But most lack the real life experience of what practice management involves.

The companies first job back in 2008, was to provide training to a newly appointed practice manager who had no prior experience, but came from a HR background. Soon afterwards in 2009, the company was providing support via the Londonwide LMC cover 32 CCG areas, providing remedial support to practices. In 2012, the company pivoted organically and morphed into a consultancy come recruitment company, but again specialising in practice management.

Unlike other industries, sectors and business that will have a departmental lead or departments for Finance, HR, Governance, Marketing, I.T… within practices a Practice Manager is all of these things. There are not many roles that are as diverse and that expose a manager to the sheer breadth and volume of areas that Practice Management does… including Public Sector Bureaucracy.

So back to the reason why now?

There have been many horror stories of a few rogue PM’s who by virtue of the trust that is afforded within the role abuse the position, such as the recent case of a Practice Manager in Leicestershire who stole a whopping £184,000 from the practice they were working at.

Similarly, being a Practice Management Consultancy, PM Locum Agency and providing recruitment services to practices we have come across some cases (more recently) which also raise concerns about the need for better regulation and monitoring for the profession. We have GMC regulations for GP’s, NMC for Nurses, HCPC for allied health, CQC for practices, but a role that is so vital and carries such importance… a person with no formal training and or qualifications can walk right into. A recent practice we have been working with, wanted to do just this, following the departure of their PM they requested support in recruiting a replacement PM, the practice itself had significant challenges within the partnership as well as some ongoing serious HR issues. The practice wanted to appoint a manager who had no prior experience. Naturally we advised them against this and have successfully placed an experienced PM to the post, fortunately so as they soon had a CQC inspection announced.

Practice Managers hold a pivotal role in ensuring the smooth operation and effective management of the GP practice. While healthcare professionals are regulated to maintain high standards, there is a pressing need for regulations within NHS GP Practice Management, specifically for Practice Managers to promote excellence in patient care and overall practice efficiency.

Ensuring Competency and Qualification:

Practice Managers play a critical role in overseeing various administrative and operational aspects of GP practices. They handle finances, human resources, patient records, and liaise with various stakeholders. Regulating Practice Managers would require setting minimum competency standards and qualifications to ensure that only skilled and qualified individuals assume these crucial roles. This would enhance the professionalism and competence of Practice Managers, positively impacting the entire GP practice.

Safeguarding Patient Data and Confidentiality:

Patient data confidentiality is paramount in healthcare settings. Practice Managers have access to sensitive patient information, making data security and protection of utmost importance. With regulations in place, Practice Managers would be held accountable for ensuring compliance with data protection laws and safeguarding patient confidentiality at all times.

Enhancing Quality Assurance and Patient Safety:

Regulation in GP Practice Management would help establish clear guidelines and protocols for delivering safe and high-quality patient care. Practice Managers would be responsible for ensuring that healthcare professionals adhere to best practices, and effective systems are in place to monitor and evaluate patient care outcomes. This would result in improved patient safety and overall healthcare quality within GP practices.

Promoting Ethical Conduct and Professionalism:

Regulation would instill a sense of ethical conduct and professionalism in Practice Managers. With defined standards and codes of conduct, they would be obliged to act with integrity, transparency, and accountability in their decision-making processes. Such ethical behavior would strengthen the public’s trust in the healthcare system.

Standardising Practice Management Procedures:

Regulations would help standardize practice management procedures across different GP practices, promoting consistency and efficiency. Implementing uniform processes would streamline administrative tasks, reduce errors, and improve overall practice performance.

Conclusion:

Regulating NHS GP Practice Management and requiring Practice Managers to meet specific standards and qualifications is essential for achieving excellence in patient care and ensuring the efficient functioning of GP practices. With proper regulation, Practice Managers would be equipped to handle the challenges of the healthcare landscape, safeguard patient data, and uphold ethical standards.

Ultimately, these measures would enhance patient safety, boost public confidence in the NHS, and contribute to the delivery of exceptional healthcare services.

Let us know what you think. Are you a practice manager or a GP, would you be in favour or against regulation for the profession?

Remember to share, like this post and keep an eye out for series two of this blog where we drill down into what regulation could and or might look like?

Sheraz Khan MSc PGDip MGP ILM ICM is the CEO at PCMS Ltd, managing partner at two GP practices London, practice management consultant and CEO @PCMS Ltd. He has more than 20 years’ experience working in primary care. He holds a diploma in Management for General practice a Master’s degree (MSc) in Primary Health Care from Kings College University London and a certificate from the Institute of Leadership and Management. Sheraz has worked with PCT’s, CCGs and now ICB’s, GMS/PMS, Private and APMS practices assisting in practice development issues, remedial and resilience work, and continues to work with GP federations and PCNs around formation and operational processes. He has experience in all aspects of healthcare management however specialises in personnel development, performance and man-management, employment law / HR and estates and facilities developments within primary care. Sheraz Khan has an interest in patient and public involvement and engagement strategies as well as systems and process improvement. Sheraz Khan is also a practice manager mentor to several trainee managers as well as being a specialist advisor to the CQC (Care Quality Commission).

PCMS Ltd, Practice Index Ltd, First Practice Management, Practice Business Magazine, Londonwide LMCs, Institute of General Practice Management, PMA, Care Quality Commission, NHS England, British Medical Association, General Medical Council, Stephen McCaffrey