With the outlook for practice profits gloomy, it is important for GPs and practice managers to review all areas of practice expenditure.
Putting practice staff costs at the top of the list of costs to review is sensible as the payroll is likely to be your biggest overhead cost.
Don’t be tempted put off your review. The DH’s proposed GP contract changes which are planned to start in April could mean difficult times ahead.
Review each area
Practices should review each group of staff separately. Check if there are ways to save money by reducing the number of people you employ in each area, or to increase their cost-effectiveness by changing the way they work. Below are some things to consider.
- Can reception cover be provided using a smaller number of staff working more flexibly?
- Is it necessary to employ reception staff full time? Can they work part-time or for ‘zero-hours’? Under a zero-hours contract, the employee agrees to be on standby to work when required (not for fixed hours each week).
- Is there scope for the receptionists’ tasks to be performed more efficiently with existing IT and telephony equipment? For example, would telephone and online consultations and booking appointments and ordering repeat medications via the practice website reduce the volume of patients at reception?
- Can the number of secretarial/admin staff be reduced and cover for unusual or unplanned admin needs be met by using agency ‘temps’?
- Do they have enough expertise to make full use of your existing IT systems’ functionality to complete tasks more quickly?
Practice nurse team
- Can the nurses and healthcare assistants be employed on part-time or flexible working contracts?
- Can any under-utilised working time to be ‘sold on’ to external users (for example, to local schools or employers) under sessional or secondment arrangements?
- Do your nurses get Agenda for Change (AfC) pay rates? Is this specifically agreed in their employment contract? If AfC rates are not specified, it may be possible to remove the link to national rates of pay when their salary levels are next reviewed.
- Are the practice nurses doing admin tasks that can be performed less expensively by other staff? Would freeing up nurse time enable their deployment to other income-producing activities?
- Can the costs of revalidation be reduced? For example, by sharing training resources with another local practice?
- Are your salaried GPs appropriately productive? For example, do they routinely fail to complete their booked list on time during surgery sessions? If so, a performance review may be required. This can range from an informal inquiry into the reasons for any underperformance, to a formal capability procedure that may potentially result in dismissal. What is appropriate action in each case will depend upon the specific circumstances but it must be proportionate and reasonable.
- If a salaried GP fails to achieve revalidation within a reasonable timeframe, the practice can consider dismissing them on the grounds of their 'capability'. Promptly implementing the dismissal procedure, which is both complex and lengthy, may avoid extended periods of unproductive (and expensive) 'down time' with the GP not working but still on the payroll.
- If you employ team members who work more or less independently – counsellors are a good example - can they become self-employed contractors rather than remaining on your payroll?
Putting together a plan, which is reviewed annually, for managing the future costs of your staff is a prudent step.
If your practice is close to or shares a building with other practices, one way to control costs might be to share staff between you by employing them to work across your practices.
This would require careful planning and you would need a written agreement setting out each practice's liabilities. There would also need to be appropriate risk management procedures and policies.
Practices may also need to consider the impact of staff (and GP partners’) leaving or retiring if such departures are imminent.
Will you need to replace team members to avoid income losses? Or can their work be redistributed around the rest of the team?
If contractual documentation for your staff has not been reviewed recently, you need to check it complies with current employment law.
If you do alter staff members’ duties and hours, they may need new job descriptions and the practice may also need to agree revisions to their terms and conditions of employment.
- Sean Reynolds is consultant solicitor in the employment team of specialist healthcare firm Hempsons