ANNE CRANDLES

Practice Management Adviser
Boroughloch Medical Practice, Edinburgh

Times are tough and we all have to cut our cloth accordingly. Bob Senior’s article in the Autumn 2010 edition of Management in Practice makes no bones about this and offers lots of sensible advice.

While making “efficiency savings” is, unfortunately, a current necessity, great care is required when deciding what to sacrifice to balance the books. I am thinking specifically of the small, apparently easy wins and how the consequences of these decisions could return to haunt us.

Training
Training is an excellent example. By cutting back on staff training, not only do you save on course fees, you also avoid the associated opportunity costs, since there’s no need to find someone to cover the vacant shift and you can see that your member of staff is in the practice, working, rather than swanning off on some half-baked “jolly”.

This is all well and good until your one and only phlebotomist leaves and no one else can do that extra bit of venepuncture (three times a week)! Which of course impacts on those all-important, income-generating QOF points.

“Extra mile” services
It might be tempting to cancel the weekly breastfeeding support group and osteoporosis exercise classes. But remember – these will be valued way beyond the cost of a few nappy sacks and the odd exercise ball. If you do give these the chop, the practice up the road may decide to provide a similar service in their waiting room. Imagine the impact on your global sum when the patients vote with their feet.

Furniture, fittings and stationery
Reception staff are often told they only get one chance to make a good first impression – but so too does the state of the place. Cutting back on fixtures and fittings or that annual lick of paint will soon create a less loved and more “lived in” look.

And, bare in mind, white notices with black print are not only boring, but people with learning disabilities, epilepsy and visual impairment also find these difficult to read. Surely a ream of mixed coloured paper will not be the undoing of this year’s profit margin?

Staffing
Hopefully, you have not had to face staff redundancies. But perhaps you have considered using the hint of shorter working hours – or worse – to make everyone sit up? You might secretly think that the staff could talk a little less, work a little harder and make fewer mistakes.

Beware! This is not the way to sort out performance issues and can destroy staff’s goodwill, which you may come to rely heavily upon in the very near future. It is worth noting that the well-known management technique the “Fish Philosophy” places great importance on allowing staff time to “play” as a way of promoting high levels of team morale and exemplary performance.

Which brings me nicely to …

Christmas
Even if you were merely contemplating making cuts to the practice Christmas night out, the M&S Vouchers or whatever you normally do over the festive season – STOP! Don’t do it. The staff you still have will have been through a tough year too – they are working harder, covering staff gaps, putting up with even shorter tempers but still managing to smile at the patients. This applies to the tea and coffee supplies too.

There is no denying we need to be more cost conscious, but not at the expense of staff morale and practice standards. Please – don’t throw the baby out with the bathwater!