Now there is a question and a half. It would be interesting to ask GP PRACTICES which one factor is affecting their income the most and if honesty prevailed I think it would be quite a shocking revelation. Lets consider some of the possibilities.

REDUCING NHS INCOME

Reducing income is obviously a key factor as GP PRACTICES find that annual pay increases are replaced by reducing points in the Quality Framewore, more and more tricky ENHANCED SERVICES to get to grips with and a disappearing MPIG. Practice Staff receive minimal or no cost of living increases yet the demand for GP SERVICES increases. The PMS contract budgets are tightened as the MPIG is phased out and the ability to earn extra money from providing NHS SERVICES reduces year by year. How many PMS practices still use their growth money and has it kept track of inflation? Practices take on what some might argue are ridiculous enhanced services that are basically trials of an untested scheme.

INCREASING PATIENTS DEMAND

There always is a turnover of patients in a medical practice but there is also an increasing AGEING POPULATION and the problems dealing with growing ETHNIC COMMUNITIES. The workload of practices has increased as the Quality Framework promotes patient reviews for asthma, diabetes etc. More staff are needed to review patients and to take bloods. It might earn more money but it also costs money to provide these services.

MANPOWER CHANGES

Research suggests that fewer GPs now work a five day week. Instead a four day week is more common and for a variety of reasons many doctors now work in their surgeries less than four days. Reasons cited include FAMILY FRIENDLY HOURS, preparing for or taking EARLY RETIREMENT  and son on. But the logic  of the situation is that it becomes more difficult to replace a PART TIME GP with another part time GP. It is not clear that the take up of SALARIED GP posts is the solution and many practices employ expensive LOCUM GPs to cover gaps in service provision.  But there is now an increasing trend to find different ways of providing ‘face to face’ or ‘voice to voice’ services. Surgeries offer EXTENDED HOURS in the mornings, the evenings and at the weekends. Is this just a device to deal with the numbers demanding services or is it an attempt to provide a better standard or quality services. Practices are using NURSE PRACTITIONERS to deal with minor illness, triaging telephone requests for appointments, using online services to allow patients to request prescriptions. But again this all costs money and a pat of butter can only be spread over a small amount of bread.

POLITICS AND INSPECTION

The advent of CLINICAL COMMISSIONING GROUPS, PATIENT PARTICIPATION GROUPS and of course the CARE QUALITY COMMISSION added to that online services, practice web sites and NHS ‘111’ Service and the NHS Choices web site. GP Practices are faced with a deluge of requests, demands, pressures and requirements unrivalled in the past. GPs are expected to take part in the activities of a CCG and some reduce their sessional commitment at the surgery to one day per week.  Practices are required to run a PPG, and Practices are expected to raise their standards to meet the requirements of a Care Quality Commission Inspection and to practice ‘safely’. It all takes time, time costs money. And don’t forget INFECTION CONTROL inspections, and annual reviews by your AREA TEAM, of NHS ENGLAND. Its no good saying you should have been doing it all anyway, POLICIES, PROTOCOLS and PROCEDURES but of course many were not and some still are not. What then is the real cost of all this politics and inspection? The time attending meetings and the time preparing documents all costs money.

AVOID GOING INTO THE RED

So there are numerous reasons why a GP PRACTICE will be under a financial pressure and clearly Practices need to be more well managed than ever before. Practice Managers need considerable support to do a good job from their practice employers and externally from CCGs, NHS England and support networks such as PRACTICE INDEX and FIRST PRACTICE MANAGEMENT. All have a role to play, It is rare for a practice to become bankrupt but as pressures grow on GP FINANCE it is inevitable that some will fall over – I hope it is not your PRACTICE.

Robert Campbell – September 2016

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