Our guide to some of the priority challenges for the next 12 months and advice from the experts on how practice managers and GPs can tackle them
Maximising practice income and curbing costs
Practice managers and GP partners are facing unprecedented financial pressures and uncertainties as costs continue to rise and the current negotiated GP contract terms approach renewal in April 2024.
You can take several steps to navigate these challenges successfully. These include:
- Develop accurate financial forecasts that anticipate both revenue and expenditure. Regularly reviewing and adjusting these forecasts will help practices adapt to changing circumstances effectively. Few practices use this as a working document, too many rely on the end of year accounts (produced six months after the end of the year) to manage the business, which don’t provide an up-to-date financial view.
- Look at making efficiency improvements. Identifying areas where operational efficiencies can be achieved can lead to cost savings without compromising patient care. Streamlining administrative processes and reducing unnecessary costs are important aspects of this. For example, document workflow, medicines management and lab reports can all benefit from a thorough review.
- Engage in proactive contract negotiations with local commissioning authorities such as integrated care boards. Advocating for fair terms and requesting additional resources to support patient care can make a significant difference. This ensures practices are funded for all the work they are doing. Working alongside your LMC to achieve this can help make this feel less threatening.
- Take a forward-looking approach to tech. Invest in health tech solutions that enhance efficiency and patient care, such as telehealth, electronic health records, and remote support.
- Optimise staff roles and responsibilities to ensure maximum productivity. Considering flexible staffing models that match demand fluctuations are essential aspects of workforce management.
- Leveraging the power of PCNs can help practices pool resources, share costs, and collectively address population health challenges.
- Encourage patient participation in practice services and raise awareness of self-care options. This can reduce unnecessary appointments and improve patient engagement.
- Continuous learning is vital. Staying updated on changes in healthcare policy, reimbursement structures, and contract terms by attending training as well as engaging with professional networks is important for success.
- Finally, build financial resilience. This can be achieved by maintaining a financial cushion for emergencies or unforeseen challenges and exploring funding options like loans when necessary. By proactively managing finances, embracing innovation, and advocating for fair contracts, practice managers and GP partners can adapt to the evolving healthcare landscape and continue to provide high-quality patient care.
Daniel Vincent, former practice manager and co-founder of Primary Care Workflow Solutions
Keeping general practice staff happy – while not being able to afford pay rises
Many practices are struggling to keep up with pay growth because uplifts to the global sum have been inadequate and other non-staff related costs, such as energy, have risen inexorably. How can practices motivate teams in the absence of pay rises?
There is perhaps a disconnect between how people value pay and keeping people motivated.
The psychologist Maslow created a model to help understand what motivates and fulfils humans. His Hierarchy of Needs pyramid has at the very bottom physiological needs, so the basics such as breathing, food, water, shelter, clothing and sleep, which we need in order to survive.
For many, pay is what provides these needs and has on an impact on the affects the next level of needs in the hierarchy, which include safety and security.
If employees are unable to meet their basic needs through their salary, then the absence of pay rises and the ability to meet these needs will be devastating. For those individuals, hardship funds and no-interest loans may be the best way of supporting them, along with access to employee assistance in the form of financial management and debt counselling. Providing gift cards for food and utilities can also help and may be tax efficient.
For employees who are not struggling to meet their basic needs, you may be surprised to learn that while pay is still important, it is not the be all and end all. The HR organisation, the Chartered Institute of Personnel and Development, has conducted research into the value of job factors such as:
- Wages
- Job security
- Promotion
- Good working conditions
- Interesting work
- Management loyalty
- Fair discipline
- Appreciation
- Help with problems
- Feeling involved
In a survey it carried out, when managers were asked what factors they feel are most motivating, they said wages, job security and promotion. They cited appreciation, help with problems and feeling involved was least important.
When employees were asked the same question, they listed appreciation, feeling involved and being given help with problems as being the most important factors for motivation. (wages came in in at number five).
This rings true with the work I do with practices around engagement. So, if you want to reward and value your staff, start with appreciation and communication making sure that they feel involved and can ask for help with problems. Here are some easy wins that are often requested by employees:
- Notice when people do things right as well as when they do things wrong
- Have regular team meetings as well as one-to-one meetings.
- Notice and say thank you when people go the extra mile
- Check in with people when the team is short staffed.
- Say good morning and goodbye at the end of the day (how many times do GP partners leave without saying anything because their minds are elsewhere?).
- Ask members of the team about what they have done that makes them proud.
- Ask them about what they are dreading and try to help them.
Liz Willett, Chartered MCIPD, Head of Business Partnership at Kraft HR Consulting Ltd
Getting the balance of ARRS and practice staff right
As we enter 2024, a significant departure from the norm is evident as many GPs grapple with job scarcity. It’s a turn of events we would never really have predicted.
This challenge stems from a multitude of factors including rising costs, insufficient funding, and a heightened reliance on Additional Roles Reimbursement Scheme (ARRS) staff.
One pressing concern revolves around the uncertainty of ARRS funding post April 2024. While it seems logical for it to continue until at least April 2025, no official confirmation has been given.
Surgeries are now confronted with the intricate task of maintaining a balance between ARRS staff and other clinicians, including salaried GPs and locum staff.
The primary objective for practices should be cultivating a well-rounded clinical team. This approach not only enhances patient access but also ensures the critical element of continuity of care.
At MCG Healthcare, we have seen two distinct approaches to using ARRS funding. The first, which seems to lead to desired outcomes for patients, is when the surgery uses it to support GPs. For example, a patient with a musculoskeletal complaint sees a first contact physiotherapist instead of a GP.
The second, which almost always results in lower patient satisfaction, is the prioritisation of ARRS funded roles over GPs for financial reasons. This can result in patients seeing the wrong clinician, potentially compromising the overall patient experience. It’s also a false economy when patients need to rebook an appointment.
One way for surgeries to improve workforce planning is to audit their current patient data to determine how acute and how urgent patient visits are and then build the workforce accordingly around those findings.
Given the unpredictability of healthcare, practices should adopt flexible staffing models that allow for rapid adjustments based on demand. This could involve a core team of permanent staff supplemented by ARRS staff during peak times or to address specific needs. Locum staff can be employed to cover temporary gaps in staffing due to holiday leave, sick leave, or because of unexpected surges in patient numbers.
In addition, the importance of triage cannot be understated so patients are seen by the correct clinician or given the correct advice first time.
The overarching goal remains the creation of a healthcare system that is resilient, adaptable, and focused on delivering high-quality patient care.
Ash Higgs, MD of recruitment specialist MCG Healthcare
Increasing collaborative working to improve care
Transformation is driving collaboration and it’s not going to stop. Practices will be pushed further into working together as networks, federations, or hubs and not just with each other but also different agencies, organisations or parts of the NHS.
Meanwhile, at practice level multi-disciplinary working is delivering positive results.
Collaboration is key and will be an unavoidable necessity. However, it also presents an answer to many challenges.
Collaboration simply means working with others. Each collaboration brings its own benefits but the common ones for general practice include:
- Tackling workforce pressures. Collaboration allows you to address workforce challenges by sharing staff expertise, joint recruitment and staff development.
- Population health management. Working together with joint strategies, aligning services and sharing data can offer a more proactive approach to population health management.
- Managing limited resources. Shared resources, including premises, staff and technology can be a way to manage operational challenges and improve services.
- Strategic leadership. Collaborative leadership can provide a bigger, better strategic view, keeping things progressing while removing the burden of solitary decision-making.
Collaboration doesn’t always happen easily and there are some key elements needed to deliver success. These include:
- Creating a purpose and vision. This is essential, the ‘why’ you are collaborating and the ‘where’ you are heading. Its importance can’t be overstated and it will help parties engage and will keep you on track.
- Establishing trust. Focus on building relationships based on trust and be honest with what you can and can’t do.
- Communication. Communicate regularly, frequently, and face-to-face, when possible. There can’t be too much. Aim to make sure communication and information flows seamlessly and transparently.
- Making decisions and taking action. Don’t procrastinate or avoid decisions unnecessarily and make sure you are doing something. Collaboration without action is largely pointless.
- Reviewing progress. Schedule regular reviews to make sure your collaboration is on track. Share the progress and address any challenges together.
Collaboration isn’t just the latest trend, it might also be a lifeline.
Gary Hughes, former practice manager and founder/director of Leadership in Practice and Portfolio Careers in Primary Care
Embracing new technology
Hundreds of general practices in England will be able to unlock the power of cloud-based telephony systems in 2024, helping beat the 8am rush for appointments and making it easier for patients to get the help they need from the right professional.
More than 1,000 practices currently with analogue phone systems are expected to go digital by the end of March, joining the majority of practices who are now already using digital telephony. It’s part of NHS England’s Delivery Plan for Recovering Access to Primary Care, to help a national transformation to modern general practice.
The new systems will provide a swathe of benefits. Patients can request automatic call-backs without losing their place in the queue, hear recorded messages shaping their expectations, and use keypad or voice options to reach the right team member or service.
Here are five top tips to help practices and PCNs get the biggest benefit from these tools:
- Use cloud-based telephony systems to see, measure and understand patterns in daily patient contacts and how much capacity is needed on any given day, giving teams back a sense of control.
- Review staff rotas and clinics accordingly to better align capacity to need. For example, more reception staff on Mondays, adjusting the timing of routine and follow up appointments, or avoiding times when acute demand is highest.
- Enhance care navigation, so all patient requests by phone, online or in person are directed to the right care professional first time. This will make use of the full general practice team and other local health services, and support patients use digital options where appropriate, such as ordering repeat prescriptions.
- Update your practice website using national best practice guidance, making it easier for patients to use online forms to request care, relieving practice phones.
- Use recorded messages, scripts and national communication materials to explain new ways of working and encourage patients to use the range of expertise in the primary care team and use digital tools when appropriate.
Practices and PCNs can access nationally-funded practical support, resources and training to help them with all of the above from NHS England’s national General Practice Improvement Programme. Visit General Practice Improvement Programme and Care navigation training.
Dr Minal Bakhai, MBE, GP and director for primary care transformation, NHS England
