Episode 7: The Pivotal Role of the Practice Manager

What happens to a GP practice when the person who holds everything together suddenly isn’t there?

In this extended episode, James takes listeners inside the unseen world of the Practice Manager — the quiet stabiliser who keeps the rhythm of the practice steady while pressure builds from every direction.

Drawing on years of experience across Scottish general practice, James explores why the PM is the true operational heartbeat of a practice: managing finance, staffing, compliance, systems, culture, and day-to-day risk so GP partners can focus on clinical care. Through real stories and lived examples, he examines what happens when that role is undervalued — from burnout and turnover to sudden operational collapse.

The episode also tackles some of the toughest realities facing practices today:
• why recruiting a strong Practice Manager has become so difficult
• the pay paradox and the true cost of under-investment
• how poor induction sets PMs up to fail
• why empowerment and trust matter more than micromanagement
• and how losing a PM can destabilise a practice faster than almost any other change

Looking ahead, James places the Practice Manager firmly at the centre of the next phase of Scottish general practice. With the £531m Scottish Government funding package now reshaping the system, the next three years will bring significant workforce growth, expanded access ambitions, digital transformation, tighter governance, and increased reporting requirements. Every one of these changes will land operationally with the PM.

This episode makes the case that Practice Managers are no longer just running today’s business — they are about to become the transformation leaders who will determine whether new funding delivers real benefit on the ground.

Supportive, honest, and future-focused, this episode is essential listening for GP Partners, Practice Managers, and anyone invested in the sustainability of general practice in Scotland.

Episode 6 – Keeping the Momentum
Mini-Series 2: Making It Work

Starting is one thing. Sustaining? That’s where the real work lies.

In this final episode of the Making It Work mini-series, James Johnstone explores what it really takes to keep change alive in your GP practice — long after the project buzz fades and real life takes over.

Because just like a patient who stops their inhaler when they start to feel better, practices often let go of the routines that made them stronger. Slowly, the old problems creep back in.

This episode is about preventing that relapse — keeping your improvements breathing, your systems stable, and your team motivated.

In this episode:

• Why most improvements slip back — and how to spot the early warning signs.
• Turning short-term projects into embedded habits.
• Building visibility, ownership, and accountability into your systems.
• Using celebration and feedback to keep motivation alive.
• Guarding against drift through reviews, induction, and “symptom spotting.”

You’ll hear practical ideas and examples drawn from real practices — from five-minute huddles and “Friday fixes” to creating visible change logs and celebrating the wins that matter.

Because sustaining improvement isn’t just about efficiency — it’s about trust, resilience, and creating the headspace to lead rather than firefight.

James breaks down the tools and mindsets that help you:
✅ Make change stick.
✅ Keep staff engaged and proud of their progress.
✅ Build a culture where improvement becomes the everyday habit — not the occasional project.

Reflection prompts:

• Which of your recent improvements are already starting to slip?
• Do your team know the impact of their efforts?
• Who owns your systems, and how do you keep them alive?

As James puts it: “Momentum isn’t something you find. It’s something you maintain.”

This episode closes the Making It Work mini-series, following:

• Ep 4 – Finding the Wins That Matter
• Ep 5 – Working Smarter, Together

Together, these three episodes guide you from finding your first quick wins to embedding lasting systems that free your team to focus on patient care.

Next time, we shift from stability to growth — helping you move from inward focus to outward leadership as a future-focused GP Partner.

💬 Connect & Learn More
James Johnstone is a Primary Care Transformation Manager and Business Consultant. Through his consultancy, freemeup SOLUTIONS, he helps GP Practices tackle operational challenges, enhance efficiency, and strengthen financial performance — freeing GPs to focus on the business behind the care.

Connect on LinkedIn
🔗 Visit www.freemeup.co.uk
📧 info@freemeup.co.uk

🎧 Follow freemeup in practice for practical insights on running the business of General Practice — clearly, confidently, and sustainably.

In this episode of freemeup in Practice, James explores one of the biggest hidden drains in General Practice — misalignment. When the wrong people do the wrong work, GPs drown in admin, staff feel underused, and patients face unnecessary delays.

Through real case studies — from duplicated diabetic reviews to underused pharmacists and referral bottlenecks — James shows how shifting tasks safely, trusting your team, and embedding care navigation can unlock extra GP capacity without adding clinics or staff.

You’ll learn:

• How to spot signs of misalignment in your practice.

• Practical steps to delegate with safety nets.

• How to sustain alignment through culture, clarity, and trust.

• The emotional payoff when everyone works to the top of their role.

👉 Challenge of the week: Identify one area of misalignment in your practice, shift it for two weeks with a clear safety net, then review it with your team.

If you want support in spotting patterns or embedding systems that last, that’s what James does at freemeup SOLUTIONS.

Follow, review, and share the podcast with colleagues — and keep showing what happens when the right work lives on the right desk.