- Posted Wednesday October 31, 2012
Roles are different, why should training needs be the same? FPM’s Steve Morris explores the issues...
Different practices see different roles for their manager. Different managers are awarded different degrees of authority. Changing needs in general practice may cause the partners to look again at their management staff and the skills they have – are these sufficient for the new order, or do these need to evolve as well? Is their vision for the future one of radical change or is this still waiting to be kick-started into 2013?
Much depends in on the culture of the practice, historical experience and the extent to which individual partners want to be involved in the management role. Interestingly - in terms of the role - it is often the case that individual partners in one practice see different roles for the same manager! It is often down to the competent manager to both kick-start change, decide on their development needs, carve out their niche, and develop their own skills. A sort of DIY approach.
In the larger practice - say four partners and upwards - the practice may define the Manager’s role as “Ensuring that all the non-clinical aspects of the practice are managed so that the partners are free to concentrate on clinical issues”. This means:
- Managing and motivating the people
- Managing patient services
- Building a team atmosphere
- Managing the finances and improving profitability
- Managing the resources, buildings, computers and equipment
- Looking at the longer term vision for the practice
- Managing change
Individual Managers either take or are given different degrees of authority to manage the practice against the above specification. The different roles a Manager might have are usefully described as ranging from “Administrative Manager on the left of the continuum through to “Strategic Manager” on the right hand side. Many managers on the right hand side are proactive leaders, change agents and forward thinkers, (Chief Operating Officer as sometimes described) and at the other end, whether by personal (Manager) choice, or by employer wishes, or a combination of both, many "Practice Managers" are more comparable with the term administrative assistant. There are very many who fall somewhere in-between.
The point to stress then, when considering the training needs of PMs (and this particularly applies to Primary Care Organisations (PCOs) who may be looking at PM training, is that there is a huge diversity in the skills in existence and a huge diversity in the role and responsibilities held by PMs.
Identifying Training Needs/Appraisal
Against this background of what exists, what happens to people who want to improve their ability, and to carry out the role to a higher standard? How do they go about identifying their training and development needs and how do they fulfil that need?
It is not unusual in other occupations for training and development needs to be identified at an appraisal session or what are called “one-to-one sessions” with a manager.
However the fact is that less than 50% of PMs have any sort of formal or meaningful appraisal or review. Why is that? Partly because GPs as employers do not see any value in it, and partly because it may be seen as low priority. There may be a perception that it is not beneficial, or a good use of effort, or that it is seen as just “going through the motions” to tick a QOF box.
A few years ago the NHS Executive commissioned a report on the training needs of Practice Managers to;
- Help clarify the principal aspects of their job description
- Decide what existing skills they have
- Decide what they do not have
- Look at what is needed
- Decide how and where the deficiency can be filled
The FPM website (accessible to members) contains a useful Toolkit – the Practice Manager Core Competency Framework Toolkit. This is designed to help you to self-assess where you are on the Administrative – Management – Strategic incremental scale. Take the test. Get each of your partners to rate you independently as well. It could be an eye-opener.
What Sort of Training?
When looking at the training needs of PMs the most usual way to do this is across a PCO area. Managers will need training and development on four levels:
- Networking - keeping in touch and sharing day to day problems with other PMs
- Knowledge training - Employment law, Pensions, Data Protection, Health & Safety at Work
- Skills training - Delegation, Time management, Negotiation, Presentation
- Personal development or management development opportunities - Action Learning, Self Analysis, Career Development
There is a huge difference between what a manager wants to carry out and what a Manager needs to carry out as we have found out while working with PMs in the training field. All are well able to recognise what they need but it takes a strong person to acknowledge this publicly (with the PCO or employer), seek approval from the employer, find funding from scarce resources and then find an appropriate programme locally or if appropriate, on the Internet.
Who Provides PM Training?
The existing provision of PM training is very largely that which a group of Managers within a PCO area organise for themselves, or - as mentioned earlier - that which some forward-looking PCOs will themselves put on for Managers.
There are few specialist providers of training targeted at practice management. FPM is a market leader via our wholly-owned training subsidiary Thornfields@fpm – you can access the wide range of courses available via our dedicated Thornfields@fpm website.
Should providing PM training be a role of the PCO? Perhaps it should but it needs PCOs to decide that they are in the business of providing training, and not many PCOs seem to feel they are in that game; those that do, do not yet have the resources at their disposal to provide this. Often scarce training funds and protected learning time are directed at GPs and nurses, with managers coming in a poor third, if at all.
Should PCOs take greater responsibility for commissioning PM training? We suspect that a survey among PCOs would bring a mixture of views although many PCOs would definitely recognise that it was part of their wider brief. Again because of scarcity of resources – people as well as money – few PCOs have invested in this area.
Funding PM Training – Who Pays For It?
There is a real problem about getting funding for PM training; there are three main funding sources:
- GPs as employers
- The PCO as an organisation interested in this area either as commissioner or provider
- Drug Companies historically, who have a vested interest in being involved, although these are now heavily regulated to prevent conflicts of interest.
General practice income for staff training is rare, and certainly not within normal contract streams. The sad fact is that many GP practices see training as a cost rather than an opportunity and few have a formal staff training budget set aside, although many GP partners will respond positively if approached.
Training is a charge on the bottom line profits and therefore if someone else (e.g. the PCT) will not pay for it, then often it will not get funded. And anyway there is another underlying point at play: why should a practice fund the continuing development of a Manager, who might then get better qualified and then move on!
There is also some provision made by PCOs for staff training and a direct reimbursement arrangement on a participant-by-participant basis is inplace in some PCOs.
In other PCOs a delegated amount of money is given to a practice for “staff training” including Receptionist and Secretarial staff and Nurses but these amounts are usually small.
Alternatively, the PCO may hold a nominal budget, and allocate an amount to each practice to bid against, or may elect to hold training budgetscentrally and deliver courses themselves centrally until the budget is used up.
The Competency Framework
What about the competency framework (referred to earlier) – will that help in this field?
We believe it is a very useful tool and one that some PM groups, PCOs and individuals may use as a development tool. But this framework is not attached to anything, in other words there is seemingly no compulsion to take it forward. It ideally needs GPs as employers to see it as a useful thing to do.
GMS Contract - Impact on Training
What the GMS contract does is to increase considerably the need for PM training. The contract has changed the complexity of the management of the practice, the nature of the marketplace and the make-up of medical practice provision, and this is compounded by QOF, the CQC, commissioning and legislative change. On this latter point for example one of the options which the GMS contract has opened up is to allow PMs to join into partnership with GPs, without the restrictions on access to the NHS pension scheme.
Wherever a Manager stands on the continuum set out in the framework in the contract documentation (from Administrative Manager to Strategic Manager), there will be new skills to be acquired. Things that immediately spring to mind are:
- Using Spreadsheets
- Scenario Planning
- Change Management
- Business efficiency
- External meetings and working within external teams
- Negotiation skills
The way forward for PM training is not easy because of the unresolved questions about funding availability, employer and PCO support and the provision of suitable local programmes. But as ever there are always ways through these problems. It just needs time, determination, individual drive and the commitment of Practice Managers to work together.
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.