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Expand your practice to secure its future

Attracting new patients, merging, bidding for NHS contracts and diversifying are key ways to future-proof your practice, says Nick Nurden.

Increase your list to benefit from economies of scale (Image: iStock)
Increase your list to benefit from economies of scale (Image: iStock)

In the current climate where practice profits are being challenged and GPs are working under increasing pressure, expanding your practice may seem like a crazy idea. But doing this can help the practice remain sustainable and secure its future.

With the requirements placed on GPs now, keeping your practice small is becoming increasingly unsustainable. This applies particularly to practices in England: they are already subject to heavier monitoring by PCTs, which are soon to be replaced by the NHS Commissioning Board (NHSCB) and clinical commissioning groups (CCGs), and they will also need to meet Care Quality Commission (CQC) standards from April 2013.

Growing the practice’s list is one of the few ways we have to increase core income. Being larger gives the practice economies of scale and by diversifying you help to spread your risk more effectively.

There are four main options for growth:

  1. Attract more patients
  2. Merge with other GP-owned practices
  3. Tender for vacant practices.
  4. Diversify by offering new services.

Attract more patients

While you cannot advertise an NHS practice directly, there is much you can do encourage new registrations. If you are providing good care existing patients will do a lot to promote the practice by word of mouth.

Practices can also become more involved in the local community and provide a range of health promotion facilities and activities. This will help you to engage with a broader section of the community and develop links with local media – they are normally open to a good story and are a great way of getting some free publicity.

Merge with other GP-owned practices

Merging might be a good way for your practice to gain economies of scale.

If you can find one of two other local practices with which you could work more closely and which share a similar ethos to your practice, merging is worth considering as a way to meet current and future challenges.

If GP-owned practices are to remain competitive against commercial operators, we should work in partnership with our near neighbours rather than competing with them.

Even if you do not want to formally merge into a larger partnership, you could perhaps consider some joint initiatives, or sharing some functions such as HR or IT with your neighbours.

Tender for vacant practices

If a practice is without a GP contractor (for example, because of retirements) the NHS in England is required to put it out to tender – not just to other GP practices but to other healthcare providers including independent sector companies. PCTs are also offloading practices that they may have been managing directly through tendering.

Bidding for a contract is hard work and a fairly cumbersome process but it is possible for practices to succeed at this. The main note of caution with this is making sure that you do not underestimate the challenge and costs of absorbing a new practice.

Diversify by offering new services

Look for other opportunities aside from core general practice by, where possible, offering enhanced, specialist or even any qualified provider (AQP) services: patients prefer using these at their local practice rather than going to hospital.

Practices in England will need to keep in mind the conflict of interest issue, but the emerging CCGs will present significant opportunities with the increased development of GPSI services. There are also opportunities under the Transforming Community Services (TCS) programme to take on the direct management of some existing community services.

 Planning practice expansion
  • Business plan: If you are planning to grow make sure you have a business plan. You need to know where you want the practice to be in one, three and five years’ time.

  • Space to grow: Ensure there is enough capacity in your premises and that you are using it as efficiently as possible.

  • Skills mix: Do you have the right mix of skills (both clinical and non-clinical) in the practice team?

  • Smart working: Re-organise to accommodate as much growth as possible by working differently rather than by taking on more people. You can grow your services with little or no capital investment and there are few risks involved until you reach the point of needing extra staff.

  • Innovation: Make sure your plan includes looking for ways to work more efficiently and move towards developing a flexible and responsive workforce with increased skill mix. Look for innovation in the way you are delivering care and identify aspects not adding value to patient care that can be dropped.

  • Manage change: Carry the practice team with you by having a clear vision and through effective motivation and leadership.
  • Growth is an important part of securing your practice for the future and helping you create the type of organisation that will be better structured and run to cope with the continued funding challenges and increased pressures that will be placed upon us in coming years.

  • Nick Nurden is business manager at The Ridge Medical Practice in Bradford
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