One of the best ways to secure a steady flow of income is to increase the size of your practice list. Dr Haider Ali advises how to do this
GP practice list sizes are increasing as the population of the UK continues to grow but the number of practices falls because of closures or mergers. Many GPs will be wary of deliberately expanding their patient lists as they struggle with workload. But for those looking to increase income, expanding your list size can be an efficient option. It can also help ensure your practice can survive amid these uncertain times.
So, what do practices need to do?
1. Consider expanding your practice catchment area
There are a few ways to expand your boundary area. First, you can widen your conventional boundary area. If you opt to do this, you have to register any patient within the area who applies to the practice, unless there is good reason not to (such as the patient having been abusive in the past). Changes to your conventional boundary need to be discussed and agreed with your CCG, so it may not be the easiest option.
An alternative is to expand your ‘outer’ practice boundary, which also requires the agreement of your CCG. Outer boundaries were set by primary care trusts and CCGs in 2012/13, but GP practices can still review and change them. Outer boundaries exist to allow current patients who relocate a short distance outside your practice area to remain on the list and continue to receive all services from your practice. It can be an easy solution for growing list sizes, particularly if such patients request to keep you as their GP. For those patients that fall into this category but don’t request to remain with you, you should simply ask them – it requires little admin work.
It’s also possible to accept patients from outside your practice area (including new patients who move into your outer boundary). Since 2015, all GP practices have been able to register new patients who live outside their area. Such patients can access all services provided by the practice, except home visits and any emergency treatment needed while they are away from, and unable to attend the registered practice. Practices are paid the same amount for these patients despite not having to offer these services.
Before deciding to take patients from outside your traditional boundaries, you should undertake some research. This includes considering each patient’s best interests and clinical requirements, such as for bedbound individuals or chronically unwell patients with ongoing urgent care needs and who are more likely to require face-to-face assistance.
You should also inform out-of-area patients they won’t be able to receive home visits from you directly – instead these are organised by the commissioner in the patient’s place of residence. In addition, check whether there are good local services for secondary care provision, and that you can communicate effectively with their teams to prevent any harm to patients. Finally, check whether the patient’s immediate family is registered elsewhere, and think through the implications of this for child or adult safeguarding.
2. Consider a practice merger
A practice merger is a way to instantly grow your list size. Two or more practices may merge or one practice may take over another.
As BMA Law Practice Mergers Guidance sets out, all those involved in a practice merger should consider certain factors before making a decision. These include who should be primarily responsible for coordinating the merger, the business plan (including the benefits and reasons for merging) and a patient consultation strategy. You should also make sure that the aims and expectations of each party match, so you are working towards the same objectives and can address any potential disagreements.
Your application may need to be approved by NHS England and your CCG.
It may seem that merging practices can be an efficient way to increase your patient list, but bear in mind there are extensive arrangements to make and factors to consider.
3.Target new housing developments
Housing developments offer a good source of new patients. Our practice carried out a social media and leaflet campaign in areas with new developments to highlight how our surgeries could offer a range of secondary care specialist services without the need for hospital referrals.
Look at how you can target such areas with promotional materials or other forms of content. Engage with new residents at local events or when out and about.
4. Approach students
Many practices attend student fairs, particularly if located in inner city areas, to gain new patients. University fresher and reading weeks have proved successful events for my PCN. My practice has also hosted sports day events in collaboration with an exercise facility, running stalls to discuss the health benefits of physical activity. While these were largely health promotion events, they also allowed us to market ourselves as an attractive primary care site with a caring team and a proactive focus on lifestyle medicine and wellbeing.
5. Revamp your practice’s digital presence
GP practices are increasingly taking to social media to promote services and attract new patients. If you haven’t already engaged with this, now might be a good time to start. If you already have social media presence, you should take the time to review and refresh your strategy.
Your campaign doesn’t have to be perfect but it does help to have authenticity and use your own voice. You might want to hire a social media manager to facilitate this – a move that worked for my own PCN. But this type of role doesn’t fall under the Additional Roles Reimbursement Scheme and may not be feasible for all, so find out if there is anyone in your team who has an interest or experience in digital marketing.
Consider highlighting those services more suited to younger patients on your social media channels, as they are the ones more likely to use these platforms. These could include family planning, sexual health clinics, gender dysphoria or hormone-bridging therapy clinics and LGBTQ-friendly provision, as well as more general services. You should also promote your patient focus groups to demonstrate that your practice listens and adapts to the needs of your specific population.
6. Introduce patient-friendly innovations
Satisfied patients make for good advertising, which can lead to more patients registering with you. So, assess what you can do to improve patient satisfaction. One option is to establish a patient participation group, or if one already exists take action to make it more successful.
A well-organised patient participation angle brings tangible improvements in areas that patients value and encourages a diverse group of patients to join in with discussion. This is useful for uncovering suggestions your team may not have considered.
Meanwhile, despite recent criticisms by some of the media and public, don’t forget that many patients and GPs still prefer remote consultations. This facility tends to appeal to patients who don’t have easy access to transport, have busy or unsociable work schedules and who have to juggle family demands. Demonstrating to prospective patients that you are adaptable and can accommodate out-of-area access can encourage more patients to join your list.
Ultimately, the most effective way of increasing your practice list is to provide excellent care and making sure your current and prospective patients know about it. This will involve adapting to new ways of communicating with your practice population and providing a wider range of services.
7. Make sure your team is on board
There are obvious advantages to increasing your practice list, in terms of income and additional capacity, to cope with the never-ending pressures and demands on general practice. However, it is important to consider the potential pitfalls and difficulties both to clinicians and the wider practice team. That’s why it’s crucial to ensure all staff are involved in the decision-making process.
As well as boosting morale, this approach will also feed through to your patients. Having a united, harmonious team will show patients that your practice offers a welcoming environment, which in turn will encourage more people to join.
Dr Haider Ali is a GP and sports doctor in Manchester
Key points
• Know your options when it comes to expanding your conventional boundary, expanding your outer boundary and accepting out-of-area patients.
• Any merger application may need to be approved by NHS England and your CCG.
• To attract more patients, target areas like new housing developments, perhaps via social media or leaflet campaigns.
• Develop a strong social media presence, or refine your current one.
• Take another look at how patient-friendly innovations are received.
This article was initially published on our sister title Pulse Intelligence. Read more articles about practice income and finance here.
