Creating a locum practice manager scheme

Nottinghamshire Local Medical Committee has developed a ‘Roving Practice Manager (PM)’ service that is free to access by all 124 practices in the Nottingham and Nottinghamshire ICB area.

Under this scheme, practices can request that a PM be deployed to them on a short-term basis to provide intensive expert support or advice on a particular difficulty/problem they face. This could include issues such as staffing shortages, financial problems, being given a poor rating from the CQC, practice mergers among others.

It is run by the Nottinghamshire General Practice Phoenix programme, which delivers all our LMC workforce-related schemes.

The ultimate aim of the service is to enable practices in Nottinghamshire to feel supported, develop resilience and thrive in the current high-pressure climate we work in.

Why it was set up

A ‘Roving PM’ scheme was first inspired by a role that I had had experience of when working as a practice manager between 2005 and 2011. A colleague had been employed by the then primary care trust to visit or call practices to help with IT queries and reports.

Later, after working as a ‘locum’ practice manager (working on short-term assignments in different settings), I realised practices often needed help with cover for an absent/sick practice manager; support with handover processes as one manager left and another was hired; and project work in preparations for mergers or CQC inspections. So, the idea for an ad hoc PM service similar to the one for IT seemed logical.

When was it launched and how is it funded?

In early 2019, the LMC was successful in bidding for £120,000 of CCG practice resilience monies to fund the service. We managed to launch the Roving PM scheme in September of that year.

The service is completely free for practices. However, after three years we are now close to the point where will need more funds or need to consider self-funding, part-funding or asking practices to pay for this support themselves.

How the Roving PM scheme works

As explained, a separate arm of the LMC, the General Practice Phoenix Programme runs the programme.

Practices that need help can get in touch directly to request that a PM be deployed to them. However, our practice liaison team, which is a small team of personnel providing direct practice support within our LMC, may also identify practices they think could benefit and signpost them to the scheme.  Any new practice managers are immediately made aware of the service.

The service works to match the right practice manager with the practice requiring support. Once a practice contacts Phoenix, an initial assessment takes place to decide on the urgency of the request and what help is required. A RAG (Red, Amber, Green) rating is then agreed. The next steps are Identifying an appropriate PM and linking them up with the practice.  

Cases are assessed according to the information submitted by the practice but the PM also checks on the needs of the practice at their first visit. A job plan is produced by the service manager and the PM reports back on a weekly basis. There is no set maximum or minimum engagement time though clearly our aim is to make an impact and spread the funding across as many practices as possible.

Benefits and outcomes

We have sought feedback and attempted to understand the cost and time benefits for participating practices.  A survey carried out in March 2021 showed that 100% strongly agreed that they would recommend the scheme to others. More than 85% agreed that the length of time the Roving PM was allocated was useful. And 100% agreed that their practice made practical improvements as a result of Roving PM.

Some testimonial received from practices, include:

‘This is a fantastic scheme which gave us access to an experienced PM at the right time. They were friendly, supportive, and got on well with our team, we would recommend it to anyone.’

‘The scheme has improved practice resilience as we have been able to use our own resources and staff instead of external support.’

How we recruit our Roving PMs

Locum PMs are hired on ‘associate’ agreements meaning they do not become employees and they are effectively self-employed. We conduct informal interviews, carry out DBS checks and take up references before approving PMs to work with us.

Candidates are given an induction where they learn about:

• the history and background to the scheme
• why the Roving PM scheme is needed
• the relationship with the commissioners (ie the ICB)
• conflicts of interest and confidentiality
• expectation setting and feedback
• proactive support they are offered (such as mutual support on WhatsApp; meetings; and support from the scheme manager).

Top tips and lessons learned

We have learned a lot in the three years of running Roving PM. For anybody considering running a similar initiative, this is my advice:

• Write a project plan and be clear about perceived benefits, process and how you will check that it is working.
• If seeking external financial support, be bold with financial bids. It’s better to have your bid reduced than underplay what you needed.
• Identify who is running the scheme and agree a plan with each candidate PM upon deployment. Does any variation to the plan have to be pre-agreed?
• Use local intelligence to ensure that those in need are offered help. Do so sensitively, many GPs are reluctant to seek help and admit failure or defeat.
• Take care to consider any conflicts of interest and encourage individuals to raise these themselves to ensure that the service is run ethically.
• Keep seeking sources of funding to prevent the cost from being passed onto practices. Have a ready-made proposal for any late-year underspends and non-recurrent funds.
• Review progress regularly and communicate successes of the scheme to the Roving PMs to give them confidence and share learning and ideas to improve performance when out in the practices.

Michael Wright is Chief Executive of Nottinghamshire Local Medical Committee