ABSTRACT
Introduction Effective primary care is internationally recognized as being essential and core to sustainable healthcare1 and has been firmly established in the NHS since its inception in 1948. Primary care is defined as the first contact of a patient with a healthcare provider, usually a GP, dentist, optician or pharmacist in a given episode of illness, and over 90 per cent of the contacts with the NHS are provided by these services. Primary medical care in the UK is provided by general practice and the volume of activity provided amounts to over 300 million consultations a year. The nature of general practice has changed over the years through a series of reforms and, indeed, at the time of writing, the NHS is undergoing a further radical reform. The nature of the reforms since 2004 has led to general practice being delivered through a number of different contractual routes and this has led to an increase in the heterogeneity of providers in the primary care medical market. The range of these heterogeneous providers varies from singlehanded practices to ‘corporate’ providers managing and running a number of practices. Hence, there are practices of different complexity, different skill mixes and varying levels of management support. Policy driving care closer to home and the need to contain costs have led to a further layer of complexity, with some practices offering services beyond those considered to be traditional general practice. These include services previously considered to be within the scope of secondary care, but with the advent of health practitioners with special interests, there has been a shift into primary care. The changes have seen an expansion of the role of practice managers, as well as nurses, and healthcare assistants. The changes have also seen a change in the profile of employment status of GPs, with an increase in the proportion of non-principals and those holding a salaried role rather than as a GP principal, which historically was the most prevalent model of delivering general practice.2 The breadth of the practice manager role can be seen by a review of the competency framework published with the new General Medical Services (nGMS) contract.3 The exact role will vary depending on a number of factors, and will encompass operational, tactical and strategic
components to varying degrees. It must also be remembered that essentially general practices are small businesses and therefore the role of the clinician in management in general practice will be wide and varied. The exact role will depend on a number of factors, including the size of the practice and the level of support from the practice manager, with whom the medical manager will need to have an extremely close working relationship. The role may also be either the responsibility of one clinician (e.g. an executive partner) or, as is often the case, it may be distributed among several GPs or partners.
