Management in general practice: the challenge of the new General Medical Services contract.

BACKGROUND Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. AIM To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. DESIGN OF STUDY In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. SETTING Three general practices in England, chosen using purposeful sampling. METHOD Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. RESULTS Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. CONCLUSION The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the management of performance in this role.