A new wave of practice managers that hold increased strategic responsibility for the future direction of their GP practices are opting to become non-clinical partners.
As practice managers take on roles that are more akin to chief executives of small-to-medium sized businesses, a growing number are becoming partners and taking a share of the profit, as well as sharing liability.
The change is in response to the fast changing healthcare landscape that requires practices to be run and developed in a more corporate way, says Louise Johnston, managing partner at Unity Health in York, a seven-partner practice (including herself).
‘The involvement that is required from practice managers is much more strategic compared to five to seven years ago,’ she explains. ‘The climate has altered dramatically. Services are being threatened and patients are now our customers. We see practices actually being shut down. So we have to ensure our services are sustainable.
‘More and more practice managers are from outside the health arena from private industry backgrounds, offering a skill set enabling them to adopt a different mindset and run the practice almost like a business, seeking out new opportunities and new ways of delivering services rather than meeting bare minimum contractual requirements.’
The move in employment status and giving up a secure salary may be a risk but that creates a big incentive to deliver results, Ms Johnston says. It also allows the GPs to focus on clinical care.
Philip Horsfield, whose background was in retail, joined the partnership at the Village Green Surgery in North Tyneside in 2010 after having started as practice manager in 2006. He says the decision felt right given the strategic contribution he was making to the practice.
He has purchased a proportion of the building, holds a percentage profit share and carries the same liability risks as the other seven GP partners. Through a deed of adherence, elements of the partnership agreement that related to clinical practice were replaced with criteria relevant to his practice manager role such as finance, HR, or health and safety issues.
Mr Horsfield says partnership has given him increased discretion. ‘I have complete trust from the GPs and have autonomy to get on with the job, increasing efficiencies, setting strategic direction and having long term vision,’ he says.
‘I look after the finances with little input from the GP partners. The move put me on a more equal footing and gave me a vote at the table although we have always worked very amicably together."
From the practice perspective Mr Horsfield explains that it ensures continuity since partnership status means he is unlikely to take up an appointment elsewhere.
Mr Horsfield also sits on the executive committee at North Tyneside CCG the remuneration for which goes straight into the practice pot.
‘If I was an employee I would have to justify giving a certain number of hours to do that work. This way I can take it on without worrying about that. Though it is extra workload since I’m not directly earning from it.’
Martin Eades, managing partner at Priory Medical Group which is made up of nine surgeries located around York and has just over 200 staff including 17 GP partners, 35 salaried GPs and two GP associate partners, says having a financial stake in the practice is a natural progression for those who are bringing commercial acumen and strategic thinking to the role.
‘I began as business manager but was quickly operating, to all intents and purposes, as a partner by contributing to the development of the practice, as well as working with the team to help make it more attractive to patients which has resulted in increasing our patient list,’ he says.
‘As managing partner, which I took on in 2012, I helped oversee a merger with another practice which was very financially advantageous to us. My eye is always on understanding the big picture, making sense of new policy from the DH and assessing how that affects us.
‘I also spend a lot of time relationship building with commissioners, other practices, other sectors, and agencies, carrying out due diligence. It is a very different role to a practice manager working in a smaller practice simply because the requirements are different.’
At her practice Ms Johnston has developed a management team that includes a finance and payroll manager, nurse manager, patient services and facilities manager, and a data manager that oversees the day-to-day operational running of the practice.
She says this has given her the time and capacity to think more creatively and innovatively about future direction and take a proactive role in pursuing non-GMS opportunities.
For example, she has been integral in setting up a clinical network made up of all primary care providers in the Vale of York CCG area to explore how they can work closer with stakeholders including the local hospital, councils, voluntary sector and social care agencies to deliver more integrated care through additional contracts.
Lynne Abbess, partner and head of professional services at legal firm Hempsons says the trend for non-clinical partners is still fairly unusual but is becoming more prevalent in larger practices with a substantial turnover.
‘The GP partners in these larger practices may appreciate they can no longer operate the business and need to bring someone in to do it for them,’ she says. ‘The management partner will usually be operating at chief executive level, with admin staff reporting to them, which will leave them to take a view across the business as a whole.’
So, what factors do practice managers need to consider if they are offered a partnership?
Ms Abbess advises: ‘You should satisfy yourself on the due diligence and to the extent any part of it represents unknown territory, check it out. Above all you should ensure it’s the right business for you to play a part in as a partner, rather than as an employee.
‘For example, are the partners organised in their approach to the business? ‘Becoming a partner means you will be jointly and severally liable, so if something goes wrong you are all held accountable, whether you were directly responsible or not."
The financial issues are also important to consider, says Ms Abbess.
‘Will you have to buy into premises - or is there a partnership loan for which you will become liable? Are there are any claims pending against the practice either externally or from staff?’
It is also important to ensure the role the management partner will play is clear at the outset, says Ms Abbess. ‘Are you going to be treated as a proper partner or will it just be a title? What will the nature of your relationship be with the other GP partners? All of these issues need to be seriously considered before agreeing to any change."
Ms Johnston admits that to agree to bring in a non-clinical partner required a significant cultural shift on the part of the GPs at her practice since they had only had experience of clinical partners. ‘They took a year to consider it. There was a lot of discussion. But they have been very supportive,’ she says.
This seems to be the common thread between all these practice managers – the GP partners involved have had to embrace change, but are forward looking, supportive and have built strong and trust-based relationships with their practice managers.
‘I think we will see more managing partners in place in the future to help run practices as viable sustainable businesses,’ Ms Johnston adds.
‘However, I would also like to see other professionals represented at partnership level too, for example, from the nursing side. We have multi-disciplinary team working and partnerships should reflect that.’