Published: 21/11/2002, Volume II2, No. 5832 Page 21
I was struck by how accurate John Edmonstone was (letters, 24 October) in his portrayal of practice managers, but would like to take issue with some of the general assumptions he made.
I agree that the role of the practice manager can be ill defined and can lack the status of being recognised as equivalent to a middle or senior level manager in the mainstream NHS, and this perception can only be changed from within the profession. I would, however, challenge Mr Edmonstone's assertion that the current problems in practice management are solely a result of the mindset of practice managers.
I would argue that GPs, as the employer, must share some responsibility for the situation.
Many GPs were reluctant to employ well-qualified, experienced staff to take a more strategic approach to general practice management, preferring to promote reception staff from within the practice, many of whom had no experience of working in other parts of the NHS. Many GPs confused the concept of management with that of administration, preferring the practice manager to deal with issues such as the bean-counting bureaucratic method of remunerating GPs from item of services payments, while dealing with finance, resource and strategic planning issues themselves.
Inadequate funding from health authorities has also contributed to this problem, with GPs as independent contractors to the NHS being reluctant to fund from their own pockets the higher salaries necessary to attract the right people into practice management.
With regard to Mr Edmonstone's proposition that experienced practice managers should work on more strategic primary care trust-wide projects, I agree and believe this sharing of skills and experience would benefit patients. Like many managers, I was hopeful such collaboration was one of the principal reasons for the establishment of PCT local healthcare co-operatives in Scotland, but there appears to have been little or no impetus from LHCC's to be innovative or develop new ways of working.
I see the skills required in practice management as being highly transferable to other parts of the NHS and am confident that as I pursue board-level appointments in the future these skills will increasingly be recognised as such.
Alistair Mackintosh Business manager Dr McNicol and partners Ayr