Integrity - dead, or just out of fashion?

FPM’s Steve Morris highlights some techniques that good managers know instinctively

Thankfully fraud by practice managers is unusual, but another major incident in Manchester, resulting in a jail sentence, highlights just how much the partners have to rely on the integrity of their staff and management. That is not to say however that there is some invisible line that managers draw, or partners do not cross, without demonstrating a lack of faith.

In my role with FPM I do from time to time get drawn into investigations or court cases (not this one) as an expert witness, as NHS fraud investigators or practice managers seconded into investigations often refer to FPM as the source of relevant knowledge and evidential opinion. One common theme in each of these cases (apart from dishonesty) is a lack of proactive communication and information both ways between the management team and the partners. I’ll explain what I mean later.

There have been a number of commentators relating to the Manchester case calling for practices to review their “anti-fraud” policies, which is all very well, but only a low-level protection, and likely to be ineffective if no other fundamental changes take place to the practice culture. Over the years I have spoken to a number of GP partners who have concerns over the management of their finances. Some just do not know if they have concerns or not, but do think something is not as it should be. It can be as vague as that. Not necessarily fraud, but just not knowing, and reluctant to ask.

Fraud is devious and designed to circumvent policies, but it is my view that all will be found out eventually. Many other concerns arise from simply “not knowing” and can be solved with proper communication, openness, and timely information, all without compromising those invisible lines.

Many practice managers appointed through the FPM Recruitment Service are senior managers with a wide range of skills and experience which cover the full spectrum of organisational and people management. They will apply their management skills equably in a well-considered way across the organisation to ensure the smooth running of the business and the integrity of their actions. They will ensure that they are clear about the parameters in which they work, and question and establish parameters where they are not. They work autonomously within their remit, and know instinctively when matters should be (not have to be) communicated upwards. They sound like paragons of virtue, but they are more common than many may think.

Communicate with your partners whether they want it or not.

It is their business. Agree with them that you will provide them with key information to look at if they want to, and ensure that you do this reliably. You will be surprised how many seemingly disinterested partners will eventually come to you with questions

Ensure they remain informed

It follows on from communicating. Even if you are acting totally within your parameters, there are still certain issues where you may think twice. These are likely to be the matters the partners should be advised of. This is where instinct and integrity come in and the concept of “proper communication”. Good managers will know this and others will need to persevere. Consulting and informing are key components of good team working in general practice, ensuring that those who should know, do.

Establish information flows to enable partners to know about their business

  • Monthly detailed budget and expenditure reports to the partners
  • Monthly detailed income analysis reports to the partners
  • Bank balance reconciliation and analysis
  • Quarterly financial forecasts rolling for the next 18 months
  • Minutes of team meetings to the partners and other teams
  • Risk assessments and strategic risk framework quarterly

Be open

  • Make sure the partners have access to all your records even if you are not there
  • Work hard to establish a culture where the partners can come and look at information for themselves if they want to
  • Be open and encourage partners to question you, to take more interest in their business
  • Escalate and agree any matters which involve you personally to one or more partners. Be “whiter than white” and make sure your partners understand why you are taking that approach.

You are unlikely to be there forever. Fraud or “just being unsure” is less likely to happen in a culture where openness, communication and consultation are normal and team working between the manager and the partners is strong, and this culture can carry on long after you have moved on. Drawing on the skills of colleagues is as important for the manager as it is for the GPs, and for the manager the support and appreciation you can gain from the partners for a collaborative approach to management such as this is invaluable

For you good managers out there, this is nothing new.

Steve Morris is a former business performance and risk analyst, and was a Practice Manager in Yorkshire for over ten years. He is General Manager, First Practice Management and specialises in finance and HR. He is a Fellow of the Chartered Institute of Bankers.

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