Part 28d: Management skills in the primary care team.

Nursing in general practice in the UK has seen many changes since its inception. At the start of the 20th century, GPs had very little to do with nurses, and district nurses were mistrusted because they worked for the local medical officer of health. In the 1970s, however, GPs began to employ practice nurses because there was an increasing demand for primary-care nursing services that district nurses, with their existing workload of home visits, could not meet. The 1990s then saw a huge surge in the number of practice nurses, in response to a new contract between GPs and the Government for the supply of medical services that allowed GPs to claim reimbursement for health promotion and screening activities. Further changes in GP remuneration put more emphasis on the management of long-term conditions, care ideally delivered by nurses within the practice. The number of single-handed GP practices has declined since the publication of the Shipman reports on the activities of a homicidal GP.1 But most recently, a new contract for provision of General Medical Services by GPs, which became live on 1 April 2004, has meant that practices (rather than individual GPs) are rewarded for the quality, rather than the quantity, of their work. Thus a range of factors has led not only to more nurses in general practice but increasingly to a greater skills mix among the primary-care team, from healthcare assistant to nurse consultant or nurse partner. We also have completely nurse-run practices. As a result, nurses in general practice now need to take on managerial roles within their teams. In this article, our aim is to identify what makes a good manager, differentiate between management and leadership, and suggest how management skills can be further developed.

Activity Who manages you? What do you consider good about their style of management, and what would you change?

THE ROLE OF MANAGERS A manager is employed by an organisation to be responsible for, and accountable for, efficiently accomplishing the goals of the organisation.2 A manager's focus needs to be on coordinating and integrating resources, and in fulfilling his or her responsibilities will exercise the functions of planning, organising, supervising, staffing, evaluating, negotiating and representing. Good interpersonal skills are an important asset, but a manager also has the authority and power defined by his or her responsibility and accountability to the organisation. The manager's job is to: clarify the organisational structure choose the means by which goals are to be achieved assign and coordinate tasks, developing and motivating staff as needed evaluate outcomes and provide feedback. A manager's functions are vital, complex and often difficult. Those of nurse managers must aim to balance the different needs of: patients; the employing healthcare organisation; fellow employees; and themselves. Nurse managers need a body of knowledge and skills that is …