Managing a merged practice

Just the same as being a Practice Manager but bigger – right?

Undoubtedly, the skills associated with practice management remain critical following a merger between surgeries. The accounts still need doing, the CQRS (Calculating Quality Reporting Service) battle is ever the same, pressures driven from patients, commissioners, GP partners, staff, facilities, regulators, to name just a few, really don’t disappear and in some ways become a greater challenge.

Members of the team expect to walk into work on Monday after the merger and for everything to have changed but it all actually looks broadly similar to last Friday. Some of your patients will develop a keen interest in how their surgery works and what it will mean for them in terms of access to services. You may also have practice managers in your local area giving you a cheery wave and a “rather you than me” look in their eyes.

In terms of managing a merged practice it is a multi-faceted role but there are two aspects that require the most attention. One is to manage the implementation of robust processes across all locations and the other is to manage a culture change. The key for the manager responsible for delivery is recognising how your actions and decisions impact on processes and culture. The only way to maintain your own sanity in a merger is to ensure you are taking the approach of running a marathon and not a 100 meter sprint.

The position of the lead manager (job title completely irrelevant) may well be occupied by an existing practice manager and if so, they must be selected via a formal recruitment process to establish the skills required are in place at a well-developed level. To select the manager who has been around the longest, or puts their hand up first may produce some results…However, are they the right person to take a position of professional responsibility for delivery of business objectives? Can they support the GP partners and help to set the strategic direction of the organisation? Do they possess all of the required business and leadership skills to manage some very complex issues whilst driving a programme of organisational development and culture change?

Well-led merged general practice organisations will deliver financial performance improvements, better quality of care for patients and will be both a provider and employer of choice but this will not happen overnight. A consistent and sustained effort is needed to ensure that the organisation has a well-developed identity and a culture of “yes we can do that” rather than “that’s too difficult, we can’t”. We can take our rightful place at the STP top table (or whatever the next iteration is called) with colleagues across the health economy, rather than wait for the crumbs to fall. We can shape the vision and deliver the objectives at the patient point of access.

The lead manager in a merged practice cannot focus on the minutiae but must take action to quickly develop an internal team of people who are empowered and trusted to deliver within their area of expertise. There is no room for “we’ve always done it this way” or “I’d like to keep doing this my way”. Merger works when everything happens in “our” and not “my surgery”.

Change in management language can also help partners and teams to work in a merged way by consistent reinforcement that people may work at separate sites, but we are all working for the greater good of the entire practice.

The role is challenging, with an intense workload and carries the fundamental requirement to continuously look forward and not rely on the rear view mirror for answers. That’s not to say that history has no importance; it has got the organisation to where it is now after all.

The skills needed to be evidenced are those associated with leadership of organisational change, operational management, people development, bravery and with enthusiasm in abundance.

So, merged practice management is like being a practice manager but bigger? I’ll leave that one for you to decide!

Sarah Longland is a highly experienced commercial and NHS senior manager with over twenty two years’ experience in HR and general management positions in both commercial settings and more recently in General Practice.

Currently a Business Manager of Sutton Coldfield Group Practice, Sarah has also worked as Head of HR within BADGER GP out of hours’ services in Birmingham and most recently as General Manager of a 10 surgery super partnership in Birmingham.

Sarah has for the last 2 years, alongside her role as a practice manager, supported the merger of a 32 practice GP super-partnership partnership in Birmingham and held a board position with them as Interim HR Director, up to and since merger. Sarah has facilitated mergers in general practice at both a strategic and operational level and is now supporting another merger in North Birmingham.

She has also presented to the BMA General Practitioners Committee on the subject of the corporate GP partnership model and its benefits to patients and partners.


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