What's on managers' minds this week

Published: 15/07/2004, Volume II4, No. 5914 Page 10

Senior primary care trust managers interviewed for HSJ's previous Inside Track on primary care said the main thing that concerned them was 'everything' (page 14, 1 April). This time it is general practice managers, who feel no less overburdened.

They wonder how they are going to fulfil all the requirements of the new GP contract, particularly when recruitment shortages are everpressing. But unlike their PCT masters, practice managers feel they have no power to influence government expectations.

A lack of influence on healthcare planning was the key frustration cited in a survey of practice managers carried out at a recent NHS Alliance conference. One representative said: 'They feel that they have got no direct influence on policy, unlike the British Medical Association, NHS Confederation or even the alliance.'

But grass-roots practice managers best describe how this affects them daily.Moves towards practice-based commissioning would be more successful if they were fully involved in decisions, one suggests.

She says: 'We are aware of what needs commissioning.We can say: 'You are wasting money there.'' Laughing, she adds that practice managers would know how to cope with waiting lists.

The alliance and the Institute of Healthcare Management have launched a network for practice managers, which she welcomes.

'We want to have a collective voice, we want the Department of Health to understand how much we understand about general practice.'

All practice managers speaking to HSJ complain that PCTs fail to understand how general practice works and to interpret government rules properly.

Differences between practices and PCTs over what types of services should be paid for by PCTs under the new GP contract are well rehearsed. But practice managers also reveal challenges caused by PCT variation in payments - for example, for employers' increased pension contributions this year and for general salary rises.

Variation in PCT moves to adopt Agenda for Change is also causing concern.Where some managers relish the opportunity to attract staff with higher salaries, others fear the dent it will put in practice pockets.

Another complaint is about the need to provide extra information, says a practice manager from the North West. 'We are constantly being asked to collect more data just so we can justify payments, yet There is no extra investment in staff.'

He adds: 'The number of people in primary care organisations has increased just to analyse our data. Statistics can be very interesting but when you're at the coal face every day There is other things to deal with.'

He would like more freedom to run his practice: 'The flavour of the moment is choice. I think we offer too much choice.'He describes regular patient demands for same-day access for appointments that must fit in with their hair appointments.

Another criticises PCT responsibility for IT.Her PCT will not pay for encryption of external data so community staff can no longer access this information. Equipment replacement is also a challenge.

'I've heard of some practices that have been waiting three weeks for a new printer; some have just gone out and bought one anyway.What would happen if a PC were to break down in a consulting room? We would not be able to record any quality and outcomes framework [necessary for the new GP contract] data.'

But the real key to practice manager empowerment would be proper training, one says. 'I would like formal training on the contract by people who know what they are talking about. I have been to courses [run by local medical committees and PCTs] and they haven't had a clue.'

As managers come from different backgrounds, she adds: 'We want recognisable training that everybody would want to do.'