After more than 20 years as a Practice Manager across three very different NHS practices, I finally retired earlier this year. Having spent years contributing articles and shaping policies for FPM, I once imagined retirement would leave me restless—struggling to fill the time I once devoted to work. But, as many before me have discovered, life quickly finds ways to fill the gaps.

After more than 20 years as a Practice Manager across three very different NHS practices, I finally retired earlier this year. Having spent years contributing articles and shaping policies for FPM, I once imagined retirement would leave me restless—struggling to fill the time I once devoted to work. But, as many before me have discovered, life quickly finds ways to fill the gaps.

Initially, I considered continuing with articles and commentary, but I soon realised that without first-hand experience, providing meaningful insight would be challenging. Even the idea of part-time work briefly crossed my mind, but in truth—I’m thoroughly enjoying retirement and have little desire to return to the NHS in any formal capacity.

This final regular blog is an honest reflection on my career—the successes, frustrations, and the ever-changing landscape of primary care.

Starting Out: A Baptism of Fire

I entered the NHS with no prior knowledge of its inner workings—an experience best described as a baptism of fire. The reality behind the reception desk is far more complex than most realise.

GP practices, I quickly learned, operate as small independent businesses, increasingly hiring Business Managers to oversee finances and daily operations. My own path into management happened unexpectedly—through a conversation with a doctor while serving as a magistrate.

Like any business, finance is the lifeblood of a practice. Navigating NHS financial systems—Capita, PCSE, GMS statements, CQRS, and countless other income streams—was an ongoing challenge. Errors, delays, and missing breakdowns created constant stress, demanding vigilance to ensure practices received the funding they were owed.

Has this improved over the last 20 years? Marginally. But the inconsistencies remain, and perseverance—along with strong relationships—remains key to resolving financial issues.

Systemic Change Without Strategy

The role of a Practice Manager has only grown more demanding, largely due to the NHS’s lack of a long-term strategy. Over the years, we’ve moved from PCTs to ICBs and now PCNs—different names, same challenges.

Patients don’t care about bureaucracy; they simply want timely, effective care.

Meanwhile, repeated NHS restructures have wasted vast financial resources on redundancies and rehiring, with little evidence of accountability or long-term planning.

IT: Still Not Fit for Purpose

NHS IT systems have long been a source of frustration—lacking resilience, frequently crashing, and failing to meet the evolving needs of modern healthcare.

With only a handful of suppliers, practices have limited alternatives. Deviating from NHS/ICB-approved systems often requires self-funding, making change difficult.

That said, some advancements—like Accurx—have streamlined patient interactions. A new clinical system is currently being trialled, and it will be interesting to see if it drives improvement. If nothing else, it may push the dominant providers to enhance their systems and improve reliability.

A Communication Crisis

For years, the NHS has struggled to communicate the many changes in Primary Care to the public. Patients often assume practices implement policies for their own convenience rather than to improve care.
Now, as a patient myself, I see the value of these changes firsthand. Yet without transparency and education, Primary Care continues to shoulder blame for systemic failures like appointment shortages and long waiting lists.

Rising to the COVID Challenge

The NHS was woefully unprepared for COVID—but despite the chaos, we rose to the challenge, delivering vaccinations and adapting to new demands.

Each of us has stories of resilience, teamwork, and moments of patient appreciation. Whether the NHS has truly learned from the pandemic remains to be seen. One can only hope we are better equipped for the future.

The Future of NHS Work

Primary care delivers the vast majority of NHS services, yet receives just 6–9% of the overall budget—a percentage that continues to decline. This imbalance is unsustainable.

Encouragingly, the Labour Party has suggested reviewing this funding structure, recognising the true value of primary care. Time will tell if meaningful change follows.

Retention of Practice Managers is another growing concern. Nearly 50% are considering leaving due to burnout, rising patient expectations, and workload pressures

Practice Managers juggle HR, staffing, finances, complaints, CQC readiness, payroll, pensions, appraisals, QOF, and more—making it no surprise that some practices struggle under extreme demand.

We serve on the frontline, often facing abuse for issues beyond our control, walking a fine line to appease everyone. It was a constant juggling act, and at times, upsetting someone was inevitable.

Memorable Moments

My career has been filled with highs and lows, many of which I’ve blogged about over the last 15 years.
From navigating the fallout of a suspended partner to stepping into sole leadership after a partner’s passing, my experiences stretched me in ways I never anticipated. Looking back, some challenges—such as holding a practice together solo for 12 months—were more stressful than they were worth.

Most patients I encountered were appreciative, but the difficult few are often the most memorable. Two individuals once pursued a discrimination claim against me, escalating it to the Queen’s Court in London. After a thorough review, the judge dismissed the case due to lack of evidence—yet the process remained a deeply stressful ordeal.

Other standout moments include managing the aftermath of a theft that flooded the building. Despite the chaos, we reopened after only a morning’s closure—an achievement in itself.

What I’ll remember most, however, is the camaraderie—the friendships and mutual support among practice managers, partners, and staff that made the job worthwhile.

Looking Ahead

The NHS will always be under pressure. Even doubling its budget wouldn’t eliminate all challenges—it cannot be a bottomless pit. Money must be spent wisely, with a long-term plan in place. Unless we look 10 years ahead and work cross-party, constant shifts in direction and policy will continue to undermine the system’s foundation.

We need to move beyond headline announcements without tangible plans for execution. As I write this, a new government initiative proposes several Urgent Care Centres to alleviate pressure on A&E and general practice.

It sounds promising—but when will it happen? Where is the funding coming from? Who will staff these centres? These are the questions that often go unanswered. Headlines without substance remain a frustrating norm.

Final Thoughts

Looking back, my career in the NHS has been both rewarding and demanding. Practice Managers are the glue that holds primary care together, and we truly make a difference.

That said, I won’t miss the relentless stress, shifting goalposts, or the never-ending challenges of managing people, finances, and egos.

For those considering retirement—do it while you can. The NHS will carry on, whether we’re there or not.