GP Practice Managers, behind closed doors
Updated: Jun 21, 2019
Human Resources Management
The world of work is changing fast, and HR needs to change with it. So, the form and function of those who are the practice HR lead needs to adapt at the same lightning speed.
The unfortunate predicament for practice managers is their support comes from GP partners, who quite honestly know nothing about HR, or how to comply with employment law. Some practice managers are left managing one of the most important areas within the practice, in isolation, many lacking the tools required to deliver performance management, and in worst case scenario disciplinary or grievance management.
More often than not, I hear practice managers conversing about the staffing “issues” they are faced with, and when they try to manage poor performers, such individuals can prove toxic, especially if they have protected characteristics given to them by partner(s) within the practice, maybe they have worked at the practice longer, maybe they appear more loyal to partner(s), maybe they do more direct work for partner(s), and this can prove quite difficult to manage, because if such individuals are not content with their direct management line, they will often skip their manager and seek direct feedback from partner(s) and then use this against the manager.
Most practice managers are left to find (write) policies, purchase templates, and update these time and time again, and this is repeated several times within one local demographic, with out sharing of good practice, tools or tips between managers, let’s hope that the movement of Primary Care Networks will enable some form of centralising of such support functions (HR, finance, IT).
In my experience this indicates that HR needs to move up the value chain, and fast, with a deep understanding of commercial and strategy, and those who are of varying generations need to pause for thought and then to give their breadth of experience to lead whatever tomorrow’s people functions within primary care will look like, an example of this is the diversity in role, but also the need for flexibility and to remove the culture of hierarchical dominance from GP partners in the running of their business and the management of their employees.
In a recent survey conducted of practice managers on LinkedIn, managers reported spending an average of 7 hours per week sourcing locum cover staffing, an average of 7 hours per week actually covering staff sickness, or shortages themselves, and an average of 12 hours per week managing staff related admin, an average of 11 hours attempting to improve staff processes. Which indicates that the working week is completed just in these tasks above, and of course, there is all the other items, which is why in a recent Cogora: State of Primary Care Report 52% of managers surveyed confessed to working beyond their hours daily, and a further 36% confessed to working beyond their working hours several times per week, most of which is expected by GP partners, to be unpaid.
Governance and the age of Compliance
Practice Managers are the focus point when it comes to governance, not just with data protection, and the roll out of GDPR in May 2018, which created vast volumes of work. But there is governance around patient care, and patient safety, staying up to date with feedback such as friends and family test scores, reporting and acting on significant events, providing enough resource for reporting and clinical auditing to be met.
All of these contributing towards the deliverables of CQC regulators, keeping up with changes in mental health act, equality objectives, keeping up to date with duty of candour, keeping up with prescribing management, PGD’s etc, and ensuring that one is kept up to date with all recent items within CQC. On that note, the mere mention of CQC has managers worried, what with the new inspection scoring two years ago, the new regime of telephone calls and 22 questions to answer from this year, still has an impact on todays' managers, who are constantly second guessing whether they are up to speed with employment law, estate matters, clinical governance, patient safety, patient engagement etc.
I have in the last few weeks heard concerns from many managers about the recently announced changes to the K041b form, again managers concerned at the time frames required for submitting such vast yet important information in the new format.
Technology and the age of digital transformation
You’d have to work hard to find an organisation within the NHS that isn’t going through a digital transformation right now, and I worry for Primary Care that they are holding back on the digital transformation we are supposed to be enabling, because many do not have the right mindset, and I have to confess that this resistance does not often come from Managers, but GP’s.
Most managers I have encountered within my 7 years in Primary Care are quite tech savvy, though there are many out there who are not, we will all relate to that practice manager who prefers to make notes on paper, keep HR files in cardboard sleeves, in filing cabinets, who complete every aspect of their role by printing it out first, the type of manager who will never allow the NHS to fulfil its desire to be paperless, and they type of manager, who will be some what concerned when the implementation of the no fax machine policy comes into play in April 2020.
But for now managers, are having to get to grips with being data controllers, given access to multiple portals containing significant amounts of information, and in many cases managers are responsible for maintaining and updating systems such as practice websites, waiting room digital display screens, NHS apps, e-consultations, online bookings/prescriptions and medical records, electronic prescribing changes with pharmacies, and not to forget maintaining their all important capacity of being able to fix GP printers and pathology label machines, which constantly allegedly never work when the GP requests.
Finally, even Brexit is affecting the workload
It’s no surprise that for certain sectors, the implications of Brexit and worries over migration policy are the stuff of nightmares. Accusations made against non-clinical staff of favouritism, racism, etc are on the rise, just because staff are triaging patients and signposting them accordingly, in order to manage a system which is under increased pressure. The volume of complaints are on the rise, where there seems to be mistrust of the public, and real lack of understanding and education of a system pushed to the brink, and yet still trying to cope with more complex needs, that just clinical.
Within Primary Care the increase in recent abuse cases is representative of austerity and uncertainty of a nation, According to the Royal College of Nursing Employment Survey 2017 by Rachel Marangozov, Clare Huxley, Chiara Manzoni and Geoff Pike 54% of primary care nurses have experienced abuse from patients, service users or relatives in the last 12 months.
Practice Managers are working hard to retain their EU staff, and making sure that there is still a workforce who is made to feel welcome, in times where just within Primary Care nursing teams, 79% feel that staffing levels at their place of work are insufficient to meet patient needs.
meet patient needs.
Worry no more, if you can relate to this blog, most managers will with one point or another.
If you are affected by any of this, we recommend that you reach out, and seek some expertise, and assistance from Your2020Vision Ltd: https://www.your2020vision.co.uk/service