Experts outline five key issues that GP practice managers should approach differently to maximise success in the coming year.
1.Make improving finances a team-wide effort
Now, more than ever, it is essential that GP practices have robust strategies in place.
Many practices still rely on year-end accounts to monitor their results despite there being some fantastic software that can be used to set and monitor forecasts, as well as create bookkeeping efficiencies to ensure any problems are identified and dealt with in a timely manner.
It is imperative that practice managers and GP partners:
- discuss and agree their goals.
- arrange for rolling budgets and cashflow forecasts to be set. I recommend a minimum of 12 months.
- monitor forecasts versus actual results monthly, which should then be evaluated and acted upon, including making any necessary updates to future forecasts.
Cashflow forecasts can give practices the time to plan for any likely dips in cashflow and avoid any unnecessary overdraft or short-term loan charges. (Be aware of any PCSE/NHS issues affecting cash balances, such as GP superannuation and VAT on rent reimbursements).
Meanwhile, budgets enable practices to act quickly if any income is missing or costs increase and then plan for any changes needed to ensure the practice remains profitable.
Over the past few years, the impact of increasing national living wage rates and inflation compared to practice contract uplifts have meant an erosion of the value of the contract and, ultimately, an erosion of partner pay.
Last year’s Autumn Budget only added to these pressures, therefore it is essential to look at how to maximise profits. Here are some areas to consider:
Income
Communicate and educate. First, your team, so all staff know the impact of their actions on finances – for example, coding and claims. And second, your patients. Encourage them to support the practice by getting all the vaccinations and immunisation they need (e.g. flu) as well as access online material or alternative providers to avoid unnecessary attendance where appropriate.
Monitor and evaluate (and take action where necessary). Act on financial forecasts compared with actuals, use of time and resources, and profitability of individual services.
Collaborate. Be aware of what is happening in your local area/PCN/federation and collaborate to maximise access to Additional Roles Reimbursement Scheme (ARRS) staffing and any other available funding.
Challenge notional rent reviews and services you may be asked to deliver with no income attached or lack of profit.
Expenditure
Review costs. When looking to cut costs, be careful not to reduce quality or impact patient care. Instead, focus on efficiencies and streamlining processes. Business cost consultants can review costs such as utilities and insurance to help secure the best deals with no fee.
Also, review loan rates but watch for early repayment charges.
Staff. Plan annual leave well in advance to keep the cost of cover to a minimum. Also, cross-train staff where possible so they can cover for others. Ensure the right person is in the right job, making full use of ARRS.
Calculate the cost of the impact of National Insurance changes to the staff budget. And when people leave or retire don’t automatically replace them but first review what the practice needs.
Drug/vaccine profitability. Plan for the flu season to minimise waste. Raise your team’s awareness of what is claimable (particularly which sutures/skin adhesives and skin closure strips), as well as the cost of what they are purchasing compared with the available reimbursements from the NHS. Consider alternative vaccines to avoid scenarios such as the reimbursement you receive is less than the cost.
Finally, be aware of the dispensing fee sliding scale. In order to maximise dispensing fee income, ensure patients are spread across dispensing practitioners to benefit from the higher amounts per script. This applies to non-dispensing practices too.
Kay Botley is head of healthcare at Duncan & Toplis and a member of the Association of Independent Specialist Medical Accountants
2. Think like a PCN
After being part of and leading a PCN for over five years I can honestly say (despite it going against the grain of popular opinion) it is completely worth it.
Admittedly, there have been tough times but overall I have seen first-hand the benefits, including better outcomes for my staff and patients.
The first and biggest benefit has been financial. For better or worse, the direction of travel for new income into practices is via PCNs – whether that be ARRS, enhanced access, Covid, flu or care home beds funding.
The second benefit has been increased joint working, integration and improved relationships between between member practices. We have five in our PCN, and over the years, we have learnt to trust one another and lean on each other for support, boosting our resilience and helping us make a success of countless tasks and projects.
Individual practices now need to ‘think like a PCN’ in order to survive and thrive in the current healthcare climate.
Not all things can be, or should be, done at the PCN level, but it’s worth always considering where your project or task fits best. Is it at practice, PCN, federation or ICB level?
I advise you to challenge your previous instinct to make things fit at practice level because we perceive that to be the most profitable or useful to patients when, in reality, it might not be.
For example, flu vaccines were always administered at practice level before, but in 2020, we changed that and now deliver the service as a group. Since we purchase the vaccines as a PCN, we can secure a bigger discount from the supplier. Not only that, delivering the service at scale at external venues frees up space in our practices and is more efficient since vaccines can be administered in a quicker timescale.
Patient satisfaction has also increased due to there being more appointment availability, easier parking and so forth.
On the other hand, we explored the possibility of undertaking clinical research as a PCN but decided against it. It continues to be a practice level activity due to the intricacies of some studies and the reluctance felt by each practice to ‘give up’ the control of eligibility searches and invites to their patients.
This demonstrated that not all work should automatically be taken over at PCN level.
However, we need to start thinking on a broader scale and using PCNs for the purpose they were set up for – support general practice.
Ryan Smith is strategic manager at Kenilworth and Warwick PCN and GP IT chair at Coventry and Warwickshire ICB
3. Accept that profit isn’t a dirty word
General practice has to be profitable. That statement and the idea of having to follow such a fundamental business principle shouldn’t make you uncomfortable.
NHS England is fairly clear on general practice being a business and says: ‘GP practices are independent businesses that are contracted to provide services for the NHS.’
So if we can accept this, we can also accept that every practice has to be run on solid business principles, one of which is making a financial gain.
Far from being a dirty word, it’s crucial for practice managers to recognise that making a profit is a necessity and provides a number of benefits:
- It ensures sustainability and the continued long-term delivery of high-quality patient services.
- It improves resilience, making you better able to navigate unexpected financial challenges.
- It helps build a stronger workforce; a financially stable practice is more attractive to new recruits and is better able to support growth and development.
- Quality and innovation are easier when profit allows for reinvestment in practice and quality improvements.
What are some of the business principles that will build practice profitability?
Good financial management
While business is not just about making a profit, you won’t be in business for long if you don’t, so it pays to be on top of the practice finances. Some of the key things are:
- Chase every bit of viable income
- Manage expenditure as tightly as possible
- Regularly review and renegotiate contracts
- Monitor and report on your finances each month
- Make the finances a constant part of the conversation
Strong business governance
The key is to make sure this is a part of how you operate so it doesn’t slow you down or distract you. Strong governance can be considered to be built on the seven pillars of:
- Organisational structure
- Effective leadership
- Regulatory compliance
- Financial management
- Risk management
- Information governance
- Stakeholder management
Make sure your governance is strong for each pillar and you’ll work more efficiently and safely. You’ll avoid problems that can cost significant time and money and you’ll reduce the risk of issues, complaints and disputes.
Measure what’s happening
If you don’t measure, you can’t be sure what is happening. Your set of business key performance indicators (KPIs) should arguably be your most valuable information. In addition to determining your progress against your goals, an effective dashboard of KPIs supports the practice by:
- Making decision-making better and easier, with real information available to guide you
- Improving control, with problems anticipated before they happen
- Reducing conflict since accurate information removes the need for guesswork and assumptions.
By embracing profitability as a key objective, practice managers can ensure the longevity and quality of primary care services. It’s not just about making money; it’s about adopting solid business principles to create a sustainable foundation for general practice.
Gary Hughes is the founder of Leadership in Practice and Portfolio Careers in Primary Care providing leadership and management development to primary care.
Know – and demonstrate – that looking after your own wellbeing isnt a luxury, it’s a basic
As managers in general practice we hold a pivotal and often isolated role, ensuring things run smoothly for everyone else in the practice.
And in today’s fast-paced environment, especially for managers, the pressure to be ‘always on’ can be overwhelming. Whether you’re leading a team, running a department, or managing a whole practice, the constant demands can take a toll on your wellbeing.
This role can be intense, we face high workloads, complex decision-making, and constant responsibility. So, while ensuring the success of the organisation is important, looking after yourself is equally crucial.
It’s important to believe that self-care is not a luxury but a necessity for managers.
A manager’s wellbeing directly impacts their ability to lead others. When managers are physically and emotionally healthy, they are better equipped to handle stress, make sound decisions and support their teams. In contrast, burnout or exhaustion can lead to poor decision-making, diminished empathy, and an inability to cope with the pressures of the role. In the long run, this can negatively affect the entire practice, leading to a decline in team morale, reduced productivity, and even poorer patient care.
It can feel selfish to value your own wellbeing. The opposite is true; by being kind to yourself, you will have more ability to support your colleagues.
Here are some practical steps managers can take to maintain their wellbeing:
1. Take a real lunch break
It’s easy to work through lunch, but taking a proper break is crucial for both mental and physical health. Stepping away from your desk, even for 30 minutes, helps clear your mind, increases productivity and reduces stress. Use this time to feed yourself with a healthy meal or take a walk outside to recharge. If nothing else, it will stop your keyboard from getting filled with crumbs!
2. Go for regular walks
Sitting for long periods is unhealthy, and staying indoors all day can make anyone feel sluggish. Scheduling short, regular walks during the day, even if it’s just around the surgery, can boost your energy and creativity. Walking not only improves circulation and reduces stress but also provides a moment to reflect and recalibrate. Best of all though, get outside and get fresh air. If it is raining take an umbrella, if it is cold take a coat – just get outside!
3. Set boundaries on holiday
It can be tempting to check emails or respond to Whatsapp and Teams messages when you’re on holiday. However, truly disconnecting is essential for mental recovery. Set clear boundaries with your team before you leave, letting them know that you’ll be offline. Turn off notifications and trust your team to handle things in your absence. There was a time when we couldn’t be contacted on holiday, back then someone else always fixed things by the time you got back.
4. Delegate and trust your team
Managers often feel the need to handle everything themselves, but effective delegation is key to reducing stress. Empower your team to take responsibility for tasks and trust them to manage without constant oversight. This will not only free up your time but also develop their confidence and skills.
By taking these steps, managers can lead by example, showing their teams the importance of worklife balance while maintaining their own wellbeing. Remember, a healthier manager is a more effective one.
Adrian Down is managing partner at Caythorpe & Ancaster Medical Practice, Lincolnshire
5. View digital skills as an ally, not an enemy
The latest figures from NHS England show that general practice delivered a record 38.5 million appointments in October 2024 (or more than 40 million if you include appointments for Covid-19 jabs). That’s the highest ever one-month total on record. Alongside this, primary care struggles with overwhelming demand and clinician shortages, and leaders warn that the pressure facing services is not sustainable.
So what’s the solution? It lies in harnessing the use of digital tools to reduce the strain. The shift from analogue to digital is something we all know is coming in the 10 Year Health Plan and, with over two-thirds of patients (68%) initially contacting their GP by telephone, it is clear that primary care has a fantastic opportunity to embrace the use of digital tools and AI in telephony, particularly as the majority of systems are already in place.
The integration of tech and AI should not be viewed as a challenge or a risk; it is a tool that can offer transformative benefits and address some of the numerous pressing challenges for patients, clinicians, and practice staff.
Although time is stretched for practices, by taking simple steps, such as reviewing telephone data regularly; embracing the support offered by their tech providers in optimising their systems; and allocating time for staff to build confidence in the digital tools they have available, practices can make some impactful changes.
Ultimately, integrating and optimising technologies such as cloud telephony, unified communications, and AI-enabled healthcare tools means practices can alleviate operational pressure.
AI-powered systems can enable more efficient call handling, prioritising urgent cases and directing patients to other appropriate services, such as pharmacy, without delay. This enhanced accessibility not only improves patient satisfaction but also fosters better health outcomes by ensuring timely care. Additionally, these streamlined processes reduce administrative burdens and repetitive tasks for staff, creating a more manageable workload and mitigating burnout.
Together, these advancements pave the way for a more sustainable, patient-centred approach to primary care.
Max Gattlin is commercial director at X-on Health
