Feeling valued as a manager of a GP practice
A roadmap to feeling value
A primary trait of almost every practice manager I have met is their devotion to their team and their natural inclination to serve.
In my coaching work with practice managers, I have come to realise that the complexity of the role has changed over time. Managers tell me the role has progressed from one of team support and administration, to include rapid innovation implementation, increased governance reporting, managing burnt out teams and the new challenge of the new GP contract and the formation of PCNs.
As a close onlooker, the role is clearly not for the faint hearted.
Many of the managers I meet describe themselves as self-taught. Rarely have any received extensive training in change management, coach leadership, innovation, reporting, team pastoral support, complex network collaborative working etc. Even those with extensive educations in these areas hit the ground and realise that each practice is an evolved beast of its own origin. The core functioning (DNA) of each practice is uniquely different to any other practice — in an environment where individual practice performance seems under constant scrutiny/criticism and it is increasingly difficult to trust others or feel that your back is covered.
The description of the role in its entirety is beyond the scope of this article, being uncapturable in any generalisable sense.
Beyond the role itself is the complex dynamic of a practice and/or PCN.
Practice managers find themselves in a complex weave of politics and power, sitting in a business/health service hub where the owners and power (GP partners) also serve as the primary function of the business. In the context of an organisation, this is known as a particularly complex environment to try to effect any changes, nevermind rapid and large scale changes (as are increasingly demanded from the government and service demand).
Practice managers often find themselves trying to negotiate between a power base that seeks to serve its function — GPs — trying to see patients, get home as early as they can to chance to see their kids and avoid burnout or the loss of more peers — and the needs of the rest of the team, the patients, the CQC and the CCG (to name a few).
There is a great deal of chatter about the long hours of work of a GP, but little is said about practice managers.
Most that I meet, at least when I first meet them (as this is an area of need), work long days and are never far from their phones or email. 6am panics to patch up the service with a locum, when a staff member calls in sick, or annual leave email panics when the team has run out of coffee and nobody knows how to order it or who orders it.
Practice managers wear so many hats; parent, shoulder to cry on, captain, inventor, fixer, party organiser, fire fighter…
Yet the question that almost often prompts tears from practice managers I support is, “do you feel valued?”.
And in these tears is a signal to a great need for the practices as a whole.
Many times I am told stories of practice partners leaning too heavily on practice managers. Passing on all responsibility but failing to support when asked (often due to their own demands). Needing to be chased to deliver. Expecting the manager to have the answers, to fix the problems, to lead the team — but to not authentically be given the leadership power. Answerable to the GPs, the owners — the function of the business, the least able (in their role) to effect quickly what often needs to be effected.
It’s not a power struggle, from my observation. Practice managers regularly communicate to me how they have developed strategies to persuade, seduce, comfort and tiptoe necessary ideas through board meetings. A recent coachee commented,
“as long as they end up believing it was their idea, they will go with it. But, I then never take any credit for my work and all the blame when it goes wrong. It is exhausting.”
So, how to thrive as a manager in such an environment?
I will offer a brief ideas roadmap towards experiencing value — based on what I have seen coachees work with:
1. Recognise your role and how value is ‘felt’
Take time to consider what role you present with the team and what is valuable to you. Many practice managers I meet thrive on rescuing the team and keeping the ship afloat. The list of hats I provided above they recognise well, and perhaps can add more.
It is important to recognise that humans are incredibly poor at recognising a valuable thing or person. The philosopher, Marcel Proust, noticed that when the telephone was first invented he was in marvel at it as a miraculous wonder and within a very short period of time was enraged if it failed to work. A miracle turned into an annoyance, simply through the passing of time.
We take for granted that which serves us well.
You may have fallen into the category of someone who is essential and a miracle worker, but is just unseen — due to the demands that everyone has and the frustration they experience when they need something fixed and are so used to it being smooth, under your leadership.
In this instance, I would invite that you look at the hats you are wearing and try to notice the value you create. You are likely needed… really needed. In truth, it would be harder to replace you than perhaps any other team member — without some serious practice disruption.
Notice this — to be needed is such a great thing in life and does not always need appreciation. We are needed by our pets, children, parents as they age… and rarely do they explicitly appreciate us for our efforts. But we appreciate, in ourselves, that we can give to them.
This is not enough… but is your start… more below:
2. Recognise the system and what is encourages
The NHS is learning to become a compassionate employer. I would argue that it realises this itself. The messages of compassion and support are increasing, in an environment of staff retention and recruitment issues. The work is harder and the team are more in need than ever before.
You are in a role that is primarily built around serving others and meeting targets, relentlessly. The whole team.
As a leader, your own sense of unity with the team and your own self-development is often put last as you constantly seek to meet the needs of others.
Pause and reflect.
Your team is greater if it is closer and tighter. To achieve this, you need to create the space to lead — and part of that needs your own self-development.
The quickest and most impactful ingredient is time to think, reflect and plan. Lock your door, block the diary, divert the phone for an hour a week and reflect on what is going well, what is needed and how to get it.
Start by valuing yourself and your role as more than just hat swapping.
3. Arrive at leadership and move from management
Leading is a mindset not a job title. Every person in your team can lead in their role and in delivering the value they carry.
Your role invites you to be strategic and to place the team’s ability to deliver at the core of your strategy.
To achieve this you need to start passing some of your hats to others and supporting them to grow into their hats. Fixer, party planner, report writer, data gatherer, 6am fire extinguisher… these are all hats you can pass around.
Leading is about enablement of others and yourself.
This may take some work, or even leadership coaching, but is the cornerstone of your ability to access value and to feel valued.
4. Initiate a conversations audit
I have written a seperate piece on how to do this, as it is a tool in its own right.
However, for you as the leader of an organisation that needs to feel value — work on how you talk about value and where it is felt.
I can assure you, as I have witnessed through coaching, that many of the GPs feel devalued and a sense that they are on their own.
Their own partners seem a million miles away and that they have to keep pushing on.
Learning to enquire about value, to talk about what you value and to invite this as a culture shift is perhaps the best gift your team could give itself.
Learn to strive for this and to brave the conversations needed to get there. It will feel fluffy and odd, in the world of targets and pressure — but the ‘soft stuff’ is what we all really want and once our egos get past it, we treasure it and it becomes the glue needed to hold a team strong.
I have the greatest admiration for GP practices and their leaders. I hope that this admiration can be activated for yourselves and between your team members, and have seen these approaches to have an effect.
Find out about how we at aim-you can support your practice.