Editorial Comment

What is Bankrupting General Practice?

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 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.


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.


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.


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.


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





Editorial Comment

Improving Surgery Premises

Published on the Practice Index web site, in the last few days here is my latest extended piece of writing looking at Improving Surgery Premises.



Editorial Comment

Primary Care Support England – Petition

GP Surgery Manager supports the Petition set up on to bring Parliaments attention to the failure of Capita to provide an acceptable system for transferring medical records when patients change doctor and failing to set up salaries for GP Registrars.

Practice Managers Comment -” It really is shocking!! They’ve lost patient records – patients are complaining to NHSE. Complete and utter shambles. The van driver who brings and takes the records has told me that their vans aren’t big enough, so they can’t fit everything in. The depot has a room completely full of records, which don’t get touched due to insufficient staff and small vans”. 21/9/16

Add your name to the Petition using the Link below:

PSCE Petition

Ask your colleagues, doctors, nurses and practice staff to add their names too – 100,000 names needed for a debate in Parliament, but 10,000 names will provoke a Government response.



Editorial Comment

GP Practice Staff Pay Survey

In collaboration with the Practice Index web site,, we are running a ‘new’ Pay Survey which looks at comparative pay and conditions offered to GP Practice Staff. As have other practice management web sites, we have looked mainly at Practice Manager salaries in the past but on this occasion we are looking at all Practice Staff. It would appear that the NHS Agenda for Change System is not widely used by Practices, and the old Whitley Council grading and pay system may be used to a greater degree. However, there is also anecdotal evidence that Practices more and more use their own pay scales. This leads inevitably to disparity between practices. Some examples have come to light in the salaries offered to Data Clerk and Health Care Assistants. Some practices offer a clerical pay grade, whilst others offer a higher pay grade. GP Practices are independent employers and can of course offer what they like. However, in the scheme of things all Practice Staff are entitled to join the NHS Pension Scheme and there can be problems recruiting new staff if pay grades in general practice are not comparable to colleagues in other practices or other parts of the NHS.

If you want to take part in the Survey you can do so by using the Survey Monkey facility on the Practice Index Forum, if you are a member ( You can also download a word version on that site and forward a completed survey to  A copy of the survey form is also attached here for your use.

Pay Systems Survey 2016Survey



Editorial Comment

Up and Running Again is no more. It has been replaced by in the hope that it will attract more interest. The kingfisherpm site was free to access and offered comment and training material for practice managers from a very personal perspective. The promise is that the new site will continue to be a vehicle for comment and ideas as well as provide training documentation for its readers. Thank you to James and George at the Practice Index web site for their help and support keeping this site alive and kicking. Robert