Are you anxious about your practice’s future? Negative thinking will only mean sleepless nights, so take positive action. Examine the challenges the practice may face in 2010 and beyond, and start planning how to meet them successfully.
Take time first with your partners and then the full staff team for a look at the practice’s activities. A useful technique is SWOT analysis: identifying the practice’s strengths, weaknesses, opportunities and threats. Avoid concentrating on shorter-term objectives such as this year’s quality score. Look ahead to challenges such as partners retiring or the practice outgrowing its premises.
Produce an action plan for strengthening business and patient services. A rolling five-year plan that you revise at, say, six-monthly intervals will keep you on track.
Managing the practice
If the GPs end up resolving minor organisational issues, either the practice manager is not doing their job properly or the partners are not delegating enough. The best managers are really business administrators with accounting, premises management, human resources and IT skills. They command high salaries but are worth the money if they free GP time for clinical care, commissioning, quality issues and developing patient services.
Consider offering partnership to key staff members, such as a nurse practitioner responsible for quality activities or the practice manager. Making them profit-sharing partners will increase their commitment and lessen the chance of their leaving. This is a big step: get advice from your solicitor and accountant.
A well-paid team is more likely to help you implement change. Consider moving staff to Agenda for Change pay and conditions to bring them in line with colleagues directly employed by the NHS. Ensure job descriptions are accurate and annual appraisals take place. Promote skill-mix by offering training.
Base salaried GPs’ packages on the review body recommended pay range (£50,332–£76,462) and the Model Terms and Conditions (see www.bma.org.uk).
If you anticipate difficulties with a GP-owned surgery in persuading retired partners’ successors to buy into the premises, consider moving to leased premises. If the premises need updating or are too small, leasing or the LIFT scheme may have greater attractions than saddling yourselves with large mortgages.
Small practices are less able to afford top-class managers or offer a wide range of services. Explore whether sharing a practice manager and administrative staff with nearby practices will increase efficiency and cut costs. Likewise, can two or three small practices jointly provide more patient services than each one alone? Consider moving onto the same site or even merging to form a larger partnership.
By commissioning services as part of a locality group or consortium, GPs rather than the primary care organisation (PCO) may be able to take the lead in the local health economy. Be wary of PCO offers of staffing help. Better to hire a manager whose loyalties are not divided.
Primary care marketplace
A consortium of practices, whether a social enterprise or profit-making company, is likely to be better placed than an individual practice to tender successfully for contracts, for example, to take over a vacant practice, against private organisation concerns. Your bid must be realistically priced and prepared to a high standard.
Prepare for 2010 checklist
- Are you monitoring expenditure and income effectively?
- Can you increase practice earnings from NHS and non-NHS work?
- Is the partnership agreement up to date?
- Does the practice have a capable business manager?
- Are your staff paid at or above Agenda for Change pay levels?
- Do salaried GPs have a fair pay and incentives package?
- Is the practice on top of recent employment law changes?
- Are you deploying the staff team efficiently?
- Can the practice offer more services via GPSI partners?
- Are there areas where the GPs or staff members need refresher/extra training?
- Are the surgery premises fit for future needs?
- Do you have a patients group to advise the practice?
- Does your practice have strong links with local GPs?
- Have you assessed the potential competition from the private sector in your locality?
- Have you fostered a good working relationship with your primary care organisation?
- Have you planned how to cope with partners’ (and salaried GPs’) retirements in the next few years?
- Have you investigated setting up a provider organisation and bidding for APMS contracts?
- Does the practice have realistic goals for the next five years?