I’m a practice manager, I should be on a register.

April 16, 2016

I’m a practice manager, I should be on a register

Were you around during the BC epoch? That’s BC as in Before Compliance. Things were simple then. A dentist filled and pulled teeth. His (it was always a he) nurse took appointments, she (it was always a she) handed over the instruments and washed them ready for the next patient.

Then along came increased regulatory and financial demands and more demanding patients. To cope, practice managers were born, developed or created. Their workload increased thanks in no small part to the birth (and subsequent re-birth) of the Care Quality Commission (CQC). Now practice managers not only had to cover reception during lunch times, nurse staff through their personal traumas, work out which sides of the page credits and debits go on but maintain a raft of policies to demonstrate compliance if ever two suited and booted men and a woman decided to visit and ask about ‘chloes’ (whatever they are).


Self development

Noting that most of their team hung proof of qualifications on the practice walls and were always slipping away to attend courses on the pretext of maintaining their CPD records, the smart practice managers found courses they too could follow – usually in the evenings or weekends. They gained qualifications in finance, personnel management (or HR as they preferred to call it), business skills, auditing, customer care, marketing, PR and a host of other things too esoteric to mention. They wallpapered their offices with certificates but one thing was always missing. They didn’t have a number. All the other team members (except the lowly receptionists and cleaner) had a number. Practice managers didn’t.


No number, no cry

On 30 September 2013, the General Dental Council (GDC) brought into effect its revised Standards for the Dental Team. The document set out principles, standards and guidance by which dental teams should work, including principles of patient consent, complaints handling, patient confidentiality and ethical advertising all issues normally handled by practice managers.

In Standards, the GDC required those members of the team who are GDC registered to have a duty of care to ensure that those staff not registered are knowingly working within the ethical standards expected of the dental profession. Pardon me? So those wielding GDC numbers, even though by dint of their brief employment period they are obliged to sit on the wobbly chair in the tearoom and make sure there’s always sufficient fresh milk, have the power to condemn to the naughty step a practice manager who sits on the right hand of the practice principal and not only knows which sides the debits and credits go on but why.


“Ah ha but…”

I hear you cry, “…practice managers don’t deliver dental care.” Oh, don’t they? Let’s consult the oracle. Wikipedia refers to dental care as ‘the maintenance of healthy teeth and may refer to: Oral hygiene, the practice of keeping the mouth and teeth clean in order to prevent dental disorders’. Bother. I’ll try another oracle. The Free Dictionary states that dental care is ‘the practice of the dental profession collectively’. Gotcha!

I have more. The CQC uses Key Lines of Enquiry (KLOE) to assess compliance with legally binding fundamental standards. ‘Is your practice safe, effective, caring, responsive and well-led? Is the question asked. What does ‘well-led’ mean? At first glance, this is the leadership and management part of running a practice. However, on closer inspection the well-led KLOE involves much more. Tasks such as COSHH risk assessments, Legionella management and clinical records audits sit within the well-led KLOE and are often within the role of practice managers. Perhaps a practice manager without a clinical background would delegate these jobs – if they could. In a small practice, without the luxury of superfluous clinical time outside the surgery, it’s more likely practice managers learn how to do them.


Summing up, M’lud

Many practice managers are not GDC registered but lead a team of people who are. Within a practice, a practice manager is the person with the broadest spectrum of responsibilities (many of which are clinical) but often a limited clinical knowledge. A practice manager ensures their GDC registered team members meet their on-going CPD requirements but do not have to do so themselves.

Registration would make a lot of sense. It would require all dental professionals to work in a systematic, accountable and streamlined way. In its Standards for the Dental Team, the GDC states: ‘You must work within your knowledge, skills, professional competence and abilities’ but many practice managers work outside these requirements. Despite the additional cost of registration, it would introduce the necessary legislation to support practice managers and ensure that they are ‘a fit and proper person’ (CQC Regulation 19) for their roles.


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More soon, Nicki x