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The business priorities practice managers can’t ignore in 2023

by Rima Evans
4 January 2023

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Primary care experts predict the most pressing issues facing practices this year – and share tips on managing them

First and foremost is that financial pressures GP practices experienced throughout 2022 are set to increase during 2023.

This is the warning from Andrew Pow, board member of the Association of Independent Specialist Medical Accountants (AISMA). Some of the key issues include:

Pay inflation. Practice staff are feeling the impact of inflation on their household budgets but NHS funding for GP practices will not cover inflation-linked pay increases. What staff in other parts of the NHS get paid adds to the pressure. If, for example, a PCN physio employed by a hospital trust receives a 4.5% pay increment, how does that compare with the pay of other PCN staff directly employed by practices?

Tip: Weigh up all the options. These are implementing across the board increments to all staff members at the same rate; differential uplift rates – lower paid staff members will feel the inflationary impact on their household budgets the most; and a combination of a lower inflation uplift with a one-off cost of living bonus.

Energy costs. As practices come off their fixed rate deals, energy costs will add further pressure. Even with government support (which will end in the spring) costs will be higher.

Tips: Consider an investment in energy efficient lighting that could save money in the long run. Run your practice as you would at home and turn everything off at night.

Interest rates. Rates have risen by 2.9% since December 2021. Any borrowing not on a fixed deal will be linked to the Bank of England rate so costs will have increased. Fixed rate deals will be above 7% going forward.

Tips: Consider using a broker to check out the fast-moving market. Maximise rental income and ensure rent reviews are done in a timely manner.

General inflation. Practice budgets are already being squeezed by the increase in general costs such as stationery.

Tips: Look at digital solutions to ensure in-house processes are as efficient as possible. Maximise income from claims including drugs reimbursements.

Gareth Thomas MSc, Business Manager at West Quay Medical Centre in Barry, South Wales and National Lead Wales at the Institute for General Practice Management, on:

Managing patient call volume

Media headlines have highlighted how patients have struggled to get through to GP practices by phone, especially from 8am each day. Examples of patients waiting up to one hour, then being cut off without speaking to anyone at the practice have been reported.  Patient experiences like this can be frustrating, cause complaints and place a strain on reception teams, especially in the morning as patients scramble to be first in the telephone queue.

This winter, pressures on patient access to GP services are already at a high and don’t look likely to wane. Surgeries will need to take proactive steps to manage this demand.

What can they do to make improvements? Some suggestions we have put in place, include:

  • Remove long ‘welcome’ messages on the answering system, and make the information you need to relay to patients more succinct.
  • When all routine appointments have been booked, play a queue message on your answering system (these play before a person is placed in a phone queue) informing patients that there are no routine bookable appointments left for the day in order to manage demand and patient expectations. Or, if the surgery is running a different appointment system that day, again let patients know.  
  • Consider increasing the maximum call queue numbers and announce to patients where they are in the queue.
  • Enable a patient call-back option and create a virtual queue (if available) to allow patients to opt for a call back without the need to hold on the line.
  • Review call data to evaluate call volume patterns throughout the day. This will allow you to plan the right level of staffing for meeting demand
  • Promote the fact that patients can register for online services.
  • Promote other digital tools including website/app to help patients to find information.
  • Consider using a live-chat facility.
  • Online triage systems can, of course help. However, they are not a panacea.
  • Send appointment reminders by text and provide the option to cancel, to minimise the number of appointments slots that are wasted.

Ash Higgs, Managing Director of MCG Healthcare on:
Recruitment and retention of staff

The immediate outlook for 2023 remains bleak with NHS figures showing a shortage of 10,500 doctors, 47,000 nurses and around 4200 FTE GPs. 

GP practices need to be prepared for the challenging times ahead – how can you attract and retain more staff and manage increasing patient demand within tight budgets?

When it comes to candidate attraction widen the focus

  • Consider permanent or longer-term contracts rather than temporary placements, which will save time and money. 
  • Think about  whether practice nurses can help your overworked GPs and successfully treat patients with less complex needs?
  • Ask practice staff if they have friends or colleagues who are looking for a new role, many practices pay referral fees to staff who refer a successful candidate.
  • Research free resources for advertising jobs such as your local LMC or PCN website.
  • Advertise roles on social media and encourage staff to share these with friends and followers.
  • Most importantly, create a clear, concise job description.

Develop a robust interview process

  • Identify essentials for the role, e.g. salary expectations, skills or hours required and discuss these with the candidate prior to interview.
  • Have the process mapped out: how many interviews will you hold?, who the candidate will meet?, in what timescale will you make a decision? Ensure all of this information is clear to the candidate from the beginning.
  • Prepare for the interview, ensure you have read candidates’ CVs thoroughly.
  • Be consistent across all interviews to ensure a fair and non-discriminative process.
  • Take notes throughout the process.

Sell the role and your practice

Due to a shortage of clinicians there are many jobs available, so ensure you are selling the role and the practice to potential candidates. Think about why they should choose your practice over others and what makes you unique. For example, refer to your practice culture, opportunities for career progression and use testimonials from current practice staff.

Post Interview, don’t delay

Don’t keep interviewees waiting for a decision, make sure you contact them within the previously set timescales to let them know if they have been successful or not. Moving fast at this stage can be crucial if you don’t want to risk losing your first-choice candidate.

Liz Willett, Head of Business Partnership at Kraft HR Consulting Ltd on:

Changes to HR and employment-related law

2023 looks set to bring in some important changes to the employment law landscape. They include:

  • strengthening employees’ rights to request flexible working with proposals granting employees the right to request flexible working from day one of employment, rather than from 26 weeks;  

  • Proposals to extend protection from redundancy to an employee from the moment that they declare pregnancy to six months after the end of maternity leave under the Protection from Redundancy (Pregnancy and Family Leave) Bill. 

  • Legislation to repeal the whole of the UK’s retained EU law from the end of December 2023, except for the legislation that the Government chooses to retain.The Bill currently affects around 2,400 regulations across 21 Government departments and may change rules around working time, trade unions’ ability to mobilise strike action, TUPE and part-time and fixed workers’ rights.

In addition to these forthcoming changes, there are some legal developments that have affected  good HR Practice with regards to holiday entitlement and recording of working time.

Employers are required to record employees’ working time to ensure that they are paid according to the National Living Wage and ensure that they are taking their breaks.

For seasonal, term-time only employees or employees on casual contracts, holiday pay for the 4 weeks of leave under the Working Time Directive should be calculated on the average pay over the previous 12 weeks where they have worked.  This is important to bear in mind where staff do regular overtime or work for PCN vaccination or out-of-hours contracts and are paid for this through the practice payroll.

Bank holiday entitlement is also going to be necessary to consider in 2023.  A new bank holiday for the King’s Coronation has been announced for May 2023.  If you allow staff paid time off for this additional bank holiday in addition to their normal entitlement of eight days, you should ensure that people who don’t usually work this bank holiday get a pro rata amount of time to take off too.


Hear about how to grow the business’s profit; managing patient access; and retaining staff at your PCN at our Management in Practice event in Birmingham in May. Register here for free.