I have worked with seven totally different practices during my working life and have met managers from over 100 other GP practices. Each practice has its own way of doing things and it’s own problems. Each has its own way of keeping financial records.
Running appointments systems and managing the number of doctors and nurses to keep on top of patient demand would require its own book to discuss although I have found the the general answer is that the doctors will run their practice appointments the way they want to and engage more help only if they are not too much out of pocket. So keeping hold of the purse strings is extremely important but is it done well?
This leads then to the financial management of a GP practice. What I have found is that the way practice accounts are kept can be a revelation. Bearing in mind that there are excellent payroll packages on the market that are relatively easy to use, such as Iris or Sage I wonder why some practices still farm out this work to accountants or payroll specialists or still do it manually (Yes I found one practice).
More surprisingly I found in a number of practices a lack of adequate practice accounts. Twice I found handwritten journals only partly completed. In another I found spreadsheets again partly completed and no breakdown or record of NHS Income.
Where Sage, Iris or Quicken software was used it had not been set up to record and categorise all income and expenditure. These practices were still highly dependent on the annual accounts being prepared by their accountants. In one case I found that the accounting software had been used to limited effect with no proper category allocated to income and expenditure. In fact dormant or defunct categories had been used for income no longer paid and categories for new payments had not been created. The fact that information about NHS payments made to the Practice could be downloaded from Open Exeter had not been utilised.
In simple terms I would expect the practice accounts to be kept with such level of detail that would match the categories shown in the annual accounts. At the end of the financial year a back up of the accounts could be provided to the accountants. However I have tended to find a reluctance to buy working accounts software by accountants.
As a final thought the extent to which a practice manager handles and prepares practice accounts would surely help determine the salary he or she receives!