Editor Rima Evans recounts the main events of the year, heavily focusing on the impact of underinvestment in staff pay – as well as practices’ achievements

Money, money, money.

Not so funny for practice managers given the unrelenting squeeze on finances and under resourcing surgeries have had to endure in 2023.

Having to do more with less has taken its toll on staff pay, which has been a dominating concern over the past 12 months.

As early on as January, there were warnings that the NHS – primary care in particular – could not compete with major supermarkets/retailers in the pay stakes and were losing staff to the likes of Aldi, Lidl and Amazon.

The imposed GP contract in England, which failed to keep up with cost pressures and inflation did little to ease GPs’ and practice managers’ battle to recruit and retain staff. 

The Association of Independent Specialist Medical Accountants (AISMA) sent out the warning in May that staff cost pressures are acute across general practice and eating into practice profits, making it more of a struggle for surgeries to take on additional staff or award pay rises they felt their staff deserved.

The surprise Government decision to provide additional central funds for a 6% pay rise for salaried GP staff in England, announced in July, didn’t prove to stretch quite as far as hoped.

For many practices, the additional uplift to the global sum to cover the pay increases still left a funding gap, prompting the BMA sand RCN to issue a joint warning that the 6% rise for staff was unaffordable in alot of cases and couldn’t be fulfilled universally.

In Wales, managing rising costs and wage bills have been exacerbated by a breakdown in negotiations around the GP contract, announced in October, making budgeting and forward planning tough as a result of practices’ uncertain financial position.

Practice managers outlined their fears that the lack of an uplift, which effectively rules out pay rises for many of their teams, will lead to a ‘haemorrhaging’ of staff to other better paid sectors.

Unfortunately, greater pay challenges lie ahead for practices in 2024, when the minimum wage increases by 9.8% in April.

However, the Institute of General Practice Management (IGPM) has pledged to work with the BMA to make staff pay a priority issue in the next round of contract negotiations.

Disappointment on the pay issue hasn’t stopped practice managers and GPs continuing to roll up their sleeves, keep calm heads and steady nerves and cope with a multitude of challenges thrown their way.

Over the past year, these included (but are not limited to):

1.The changing of the start date for the flu and Covid vaccination campaigns in the Autumn

This was not just once but twice (and at the eleventh hour) – coupled with a chopping and changing of Covid jab payments. In England the fee went down then up, in Wales it went down, again at the very last minute. The BMA said the ‘mismanagement’ of the situation caused widespread confusion for GPs, practice managers and their teams but despite the chaos had been able to deliver clinics as planned.

2. Managing the switch on to allow patients automatic access to their GP records via the NHS app

It became a contractual requirement for practices in England to go live with this by October 31 under the Recovery Plan, despite strong concerns voiced about the workload involved to implement the programme and reservations about the safety of vulnerable patients having full record access.

An update from NHS England in early December showed that more than four in five practices (81%) have now implemented this, with 23.5 million people now able to check their consultation notes online. The Government has set an ambition of 9 in 10 GP practices offering patients access to their records through the NHS App by March 2024.

3. Absorbing the extra strain in the system as a result of strikes over pay from other parts of the NHS

The irony of this is not lost here. While GPs and staff expressed solidarity for industrial action held by nurses, junior doctors, ambulance drivers and others, practices nevertheless had to plan carefully to cover the extra work that came their way as secondary care and emergency services were disrupted. In January, for example, surgeries in London were asked to provide clinical cover during a walkout of ambulance service staff.

The outcome of GP contract negotiations in 2024 will shape how willing GPs are to take collective action themselves…  

4.Meeting demand from patients and the requirements of the Recovery Plan

The Recovery plan, launched in May, aimed to ‘tackle the 8am rush’ and improve access, said the Government. A key plank was funding to help practices transition from analogue telephone systems to digital solutions that would ‘put an end’ to patients having long waits on the phone when they contact their surgery (and yes the view was widely expressed that new phone lines don’t amount to much if acute staff shortages mean there is no actual person to answer the calls).

In November, data showed that in the 12 months to October 2023, 358 million general practice appointments, including Covid-19 vaccinations, were delivered. This amounted to an increase of 50.9 million compared with 2019.

5. Continuing to innovate

Nowhere is this showcased more convincingly than at the General Practice Awards, which includes the accolade of Practice Manager of the Year. This year the winner was Norfolk-based business manager Caitlin Clarke for her work in dramatically reducing patient wait times on telephone lines as well as boosting recruitment and staff wellbeing.

But there were also numerous other examples featured in Management in Practice in the past 12 months, including this rural practice that helped to develop a healthcare hub at a farmers’ market to engage with hard-to-reach patients; a practice in Somerset that helps its patients tackle the cost of living crisis; and a Bristol surgery that increased the length of GP appointment times with patients – only to find it improved GPs’ work life balance.

There’s a lot to review and reflect on – and be proud about.

I wish you all a happy, exciting, healthy (and well-funded) 2024.

The rest of this newsletter features highlights of our most popular news articles, blogs and practical guides from 2023.