We Employing additional staff in new, special and unusual roles in general Practice always begs the serious question as to who pays for it. For example, in a Practice that was a ten mile round trip to the nearest hospital pathology department I always thought that it was an important service to offer phlebotomy at the surgery. But this post was not funded by the Practice. It was initially funded by the GP fundholding initiative and after the demise of fundholding the hospital continued the service until the hospital accountants stepped in to stop the service. After that funding was intermittent as PCGs and then PCTs offered various degrees of funding for a phlebotomist.
The basic Practice budget allows for reception staff, medical secretaries and practice nurses and you could argue that is all that it is for. Any additional posts come from either the Practice or any special funding initiatives that have taken place over the years. Newly appointed Practice Managers may not be aware of the history of funding ancillary staff. Fundholding practices received growth money and this was used to fund posts such as a salaried GP or a nurse practitioner. There were also savings but the money would be a one off income not a permanent one. There have been other funding initiatives. But what if that money is clawed back. Who pays then. Beware too of the cost of redundancy and the rising cost of pensions. Be aware too of the potential employment tribunal costs of terminating staff unfairly!
Practices of course are free to use their budgets as they see fit, but to make a long term commitment to fund say a nurse practitioner instead of a GP still assumes that the fund will be consistently available. What if the list size is falling? What is QOF income is reducing? What if MPIG has bitten harshly. What if the scope to increase Enhanced Services Income is minimal and unreliable? I have to say that having run five medical practices over 25 years I do wonder why Practices get into financial scrapes and do not cut their cloth accordingly. That said there are disasters that beset Practices, such as theft, and fraud. Since 2004, the staffing element of the budget never matched the original cost once you factor in superannuation. The need for Locum cover presents a major headache for those trying to balance the books. Cutbacks in budgets, the MPIG and changes to QOF all add up to a financial nightmare.
I also found that moving to privately built premises which were under a lease to the Practice became a burden. The leasing companies seem to keep a tight reign on maintenance costs and insist on their own contractors providing services, whereas Practices that own their own premises would be unlikely to set up high cost maintenance services for their buildings. So when it comes to funding ‘new’ staff posts one can understand the desire to employ two health care assistants instead of a nurse practitioner. But let the buyer beware.
Here are ten keys points to bear in mind:
Is funding guaranteed for the post or posts you propose?
Have you assessed the actual full costs, including superannuation, national insurance, professional fees and medical indemnity?
Are you getting value for money?
Would the money be better spent on something else (Opportunity Cost)?
Are you going to be tied in to a long term commitment that is difficult to get out of?
What happens if funding reduces or is withdrawn?
Beware of ‘flavours of the month’!
Listen to your accountant not the CCG idealists!
Always have reserves and know you can pay the bills, particularly Inland Revenue?
Beware of GPs too keen to take high drawings!