Don’t sleepwalk into failure

shutterstock_212260888Don’t sleepwalk into failure warns Nicki Rowland, managing director of Practices Made Perfect and Nick Danby of Face2faceCPD.

The role of practice managers has changed enormously over the past few years. In the last decade increased regulatory demands have ensured that process and protocols are a top priority for practices, which in addition to the growing need to attract new patients, keep existing patients happy, ensure the appointment book is full and that the practice is profitable, have all placed an enormous burden on beleaguered practice managers.

The root of the problem lies in the fact that historically the role of practice manager is one that has evolved, rather than being very clearly defined. Now, in a climate where the new CQC inspection framework demands that practices are ‘well-led’, there is an inevitable tension arising between the role practice managers are being asked to fulfil and the skills they possess to do the job well.

Characteristics of a practice manager

If we look more deeply into the reasons why this might be the case we can pinpoint certain general characteristics that embody the role of practice manager.

In many cases the job is given to the longest serving member of staff with little regard to the individual’s skills or aptitude. Often this results in a person taking charge of individuals who were formerly their peers and this always creates a challenge. In such a situation, when the manager is faced with having a difficult conversation with a member of staff, they are often ill-equipped and can lack the necessary gravitas to carry this out. This results in many managers employing avoidance tactics that ultimately leave the issue unresolved. This can escalate into resentment within the team and before you know where you are the whole management structure has been undermined.

Many of the practices currently failing CQC inspections are stumbling over the ‘well-led’ key line of enquiry, which in our opinion is due to a fundamental misunderstanding of what the CQC wants a practice to demonstrate in this area. Practices simply do not understand what is required, and furthermore, what they need to do to demonstrate compliance. This is not because the CQC is asking practices to meet impossible criteria, but rather because they have made changes to the standards that we believe will make practices more successful.

Ultimately principals need to remember that by the letter of the law, as the provider they are responsible for CQC compliance of their practice. Even though a practice manager might be the registered manager, the buck stops with the principal, regardless of the organisational structure. Furthermore it is our recommendation that anyone who is the registered manager for CQC purposes should not accept this role until systems are in place that can ensure full CQC compliance. A new manager should not take responsibility for inherent deficiencies in systems that they are not given the power to change.

Recently we were in a practice in which a practice manager had been employed to take care of CQC compliance. The incoming manager had inherited a very disorganised system, yet the principal’s expectation was that the system would be streamlined and running perfectly in a matter of weeks – which in our opinion was simply unrealistic. This lack of support and understanding meant that the practice manager could not possibly meet expectations and from the outset the relationship and the organisation of CQC compliance was doomed to failure.


Identifying a good practice manager is very difficult, and although to fulfill the role a person does need to possess certain qualities, they also need to be given the freedom to make changes to systems and their authority within the practice needs to be recognised. The ideal practice manager will have skills in leadership, management, strategy and be highly organised. Sometimes basic knowledge and experience of business and finance is also valuable, but most of all they need to understand the need for accountability and have the drive and gravitas to lead the whole team through the inevitable changes that are part of a modern-day practice

The role of practice manager can be stressful, but if an individual doesn’t possess the skills to perform the role then stress levels are inevitably raised. This is where access to good training becomes crucial and we encourage all practice managers to have the confidence to demand training as their right. We understand that no manager wants to appear unsuitable for their role, but often in their desire to please, many managers limp through at great personal expense without adequate training, leading to increased stress and often failure, as managers take on tasks for which they are unqualified. Ongoing education is part of professional development and everyone deserves to have appropriate training for their role.

Our feeling is that one way of elevating the position of the practice manager would be to introduce mandatory registration; this would raise the profile of this sector of the profession and give them the kudos they deserve. The lack of mandatory registration seems to raise a fundamental contradiction in the practice in which the non-registrant ie the practice manager is responsible for the training and actions of registrants.

Practice manager courses

High quality, relevant training is the key to overcoming some of the issues raised by practice managers who may be poorly equipped to perform their role. The course we run consists of a one-day seminar, which highlights the skills that practice managers need and provides an introduction to training in these areas. Alternatively we also operate a more detailed programme, which runs for five single days and includes details of the hard and soft skills required to run an effective practice. This accredited course will be timetabled with a two-week interval between each day’s learning so delegates can put their newly-learnt skills and processes into operation.

The combination of hard and soft skills is absolutely critical, particularly in a dental practice environment where the dynamic between the team members often requires excellent people management skills. This practical, rather than theoretical approach, in our experience provides the type of training best-suited to meet the needs of practice managers.

We meet with dentists and practice managers every week and we urge them to be more aware of the internal and external factors that are affecting their practices. Equipping practice managers with the skills necessary to do the job for which they are employed is the key to effective management and is a policy that should be adopted by all practices.

Nicki Rowland and Nick Danby are partners in the DPAS Dental Plans Business Bites programme and their services are available to DPAS client practices. For more information visit, call 01747 870910 or email [email protected].

Over the past 10 years, Nicki has worked in practice with her husband, Gary, during which time she has nurtured her team to achieve exemplary standards in both clinical and customer service. In 2012, Nicki was awarded Practice Manager of the Year by ADAM (Association of Dental Administrators and Managers). Nicki established Practices Made Perfect by Nicki Rowland as a practice management consultancy and training organisation. Nicki believes success lies in innovation – accomplished through the introduction of not just new products and technologies, but better services, different business processes, and exciting and inspirational initiatives.

Following a successful career spanning 15 years in engineering and as a technical sales director for major blue chip company GEC, Nick became national customer care director for Royal Mail. In 1997 he moved into the training and professional development field with Dale Carnegie – a world-renowned international consultancy and training provider – in order to share his practical skills and expertise with other businesses. He became a qualified professional instructor and quickly established himself as a leader in the field of personal development, with a particular focus on senior executives and leadership and management development. In 2002 Nick became a co-founder and director of Blue Sky Plc, a personal development company, which he sold in 2007. Following a six-month sabbatical in Australia, Nick returned to the UK, and started Face2faceCPD. Through his networking Nick has forged successful partnerships with several major blue chip companies in the UK and Europe and also as far afield as the Middle East and Australasia. Nick currently holds non executive directorships for a number of SMEs.


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