In a webinar at the Management in Practice virtual festival 2020 (23 October), Jennie Dock, practice manager at Hedge End Medical Centre, Southampton, shared tips on how practices can adopt new services to boost their income, including what they should consider before taking that leap.
Offering enhanced services is an ‘obvious and easy way to generate income’, but practices should not assume they are all going to be profitable, Ms Dock said.
Practice managers should consider a range of factors, including the additional cost of clinical staffing, equipment, premises and consumables, such as prescriptions, which may or may not be reimbursable. They would also need to think about the burden this will have on admin and any legislation they would need to comply with, she added.
Ms Dock said: ‘Staffing costs [regularly] increase and quite often the income associated with the enhanced service doesn’t. So, it’s important that you review the service to ensure your budgeted costs are exactly or very close to what the actual costs are. And be prepared to cease the service if it’s not coming up to what your expectations were.’
Being active in research can be profitable as well as clinically rewarding for practices if it is well-managed, Ms Dock said.
She pointed to the RCGPs ‘Research Ready’ tool – a quality assurance programme for all research active practices in the UK – which offers insight into what would be expected and the support costs that will be available.
There are different levels of research that practices can undertake, Ms Dock said, and they are usually paid a retainer when they sign up. Practices would also typically be funded on a per-patient basis, and all the extra costs should be covered.
‘You may be able to do this across your PCN, which means you can share the admin and the clinical burden, and have a better chance of recruiting the right patients – and so there may be economies of scale there,’ she added.
‘Once you’re more familiar with the process, you’ll be able to upgrade your accreditation, and once you reach the highest level, the income [available] becomes quite significant. But the governance hoops are much harder to jump through there, and the documentation that comes along with it is less user-friendly.’
Having students in the practice also brings benefits, Ms Dock said, and there are many types – including medical, nursing, non-medical prescribing, physician assistants and GP fellows.
She suggested that practice managers first consider the amount of supervision time that will be necessary for the students, and to make an assessment of the associated financial costs.
‘In our practice, we have blocked out appointments for supervision. It’s not just the tutorial time, it’s the time to prepare the tutorials and write up the outcomes and any portfolios that the student has as well. You’ve got to think about whether the student is observing, which takes less time, or whether they’ll actually need teaching.’
The advantage of training students is that practices are benefitting from the additional capacity, and ‘if they like working with you, they might stay after they complete their time as a registrar’, she added.
Private services can include occupational health services, such as workplace assessments, sickness, absence management and immunisations or cosmetic and minor surgery.
Before rolling out these services, practices should look into the regulations involved, and also consider what the local demand is like – whether that’s individuals or companies, Ms Dock suggested.
‘Look at who the competition is – whether there is another local surgery or private provider doing this already – as if you’re too close, it might not be worthwhile, unless you’ve got an advantage over them.’
Practices should also consider other factors, such as additional premises cost, consumables, VAT, indemnity cover, staffing cost and whether they need to recruit from outside, she added.
The Directed Enhanced Service (DES) contract already includes the enhanced care in care homes specification, but practices can still offer additional services in the field of care homes, Ms Dock said.
Her practice currently offers the nursing homes on its books a ‘GMS plus service’, which involves additional perks, such as clinicians visiting non-bed bound residents for appointments, rather than those patients having to travel to the practice. During pre-Covid, there was a physical ward round, but it is now done remotely for the most part, she explains.
The practice prices the service by working with the care homes to determine how regularly they would want the visits, she added, with some of the smaller homes possibly requiring a monthly round, and larger homes twice a week.
‘We offer it by informing them of what is in the standard contract, and what’s not. The service is good for the practice as well as the patient, because it just makes the care of the residents much smoother than it would be without the ward round.’