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10 ways to boost your profits

Dr Johnny Marshall, chair of the National Association of Primary Care, offers advice on how a practice can maximise its revenue streams

Dr Johnny Marshall, chair of the National Association of Primary Care, offers advice on how a practice can maximise its revenue streams

1. Enhanced services

The DH and NHS Employers have made it clear any growth in GP funding is likely to be in this area. Practices must calculate how much income they can expect to generate from each individual service and how much it is going to cost to implement. Remember that even where the cost of delivery exceeds the income, unless you can take cost out of the practice it may still be beneficial financially to deliver the service to minimise loss of income.

Review your current enhanced services to ensure you're maximising income and the advantage to your patients. Soft tissue injections are a good example where there is significant variation in charging between GPs and therefore scope for GPs to increase their charges.

Under the current Payment by Results tariff price, a joint injection performed in a hospital costs from £153 to £258, as opposed to a price of about £43 through a LES. Everybody wins.


There is pressure for the QOF to deliver greater value for money. This may result in existing clinical indicators being modified or removed and practices will need to carefully assess the workload required for each new indicator against the income it will generate. Investment in high-quality practice management to carry this work out may ultimately pay for itself. Or some practices may find the initial investment required daunting and could consider acquiring these skills at a lower cost by either sharing practice managers with other practices or subcontracting the service from them.

Remember that providing what will be perceived as a higher level of service through delivery of a greater breadth of indicators may have indirect benefits in how your practice is perceived by your PCT. Your trust's view of you may have an impact on future opportunities for investment in your practice and its ability to attract patients.

Make sure your disease registers record all patients with the relevant chronic diseases as this will improve both the service to your patients and your income, especially if you are already doing most of the work. This will require accurate coding, templates to help practice staff capture data as effortlessly as possible and careful monitoring of progress to maximise delivery.

3.Private fees

Start by making sure you are maximising revenue from the work you are already undertaking. Check your practice systems are identifying all the private work you

are carrying out and whether you are claiming and being paid for it. It can feel uncomfortable charging patients for non-NHS services and different practices will have different attitudes to how rigorously they pursue this. Ensure you reach an agreed position and stick to it. If you do not already use an IT system for this purpose, consider whether the investment in any hardware, software, staff training and running of the system is justified by the income it will generate.

Opportunities to secure revenue from other private sources remain, although some of them are getting more competitive with fees having fallen in recent times, as with medicolegal reporting. For some practices, participating in drug trials has been a significant source of income. It is hard to secure work unless you are operating across a large population and in a highly professional manner. This may be something larger practices could achieve in isolation but the opportunity might be better realised by collaborating with other practices or by partnering with a local practice already established in this area.


Although GPSIs have come under significant scrutiny recently over their training and governance, developing a new skill can provide both personal gratification and generate additional income. However, make sure you are clear on what the true costs are. There are circumstances where GPSIs have historically been remunerated at levels barely covering the cost of locum backfill and once training costs are taken into account are actually running at a loss.

5.Bidding for new services

Love or hate them, GP-led health centres represent an opportunity for entrepreneurial GPs to widen their sources of income. However, this is not something that you should enter into lightly, as you are likely to be required to invest significant time, and therefore money, in preparing a bid that may not be successful. If you prefer collaboration to competition then working with other practices in a federated way will allow you to benefit from economies of scale without losing your independence.

6.Staff skill mix

A practice's staff is its most valuable asset and greatest investment. In recent years many practices have undergone significant changes in personnel. Practice nurses have taken on an increasingly important and extensive role within primary care. GPs are the most expensive resource within practices and if tasks can be delegated to other health professionals then GP time freed up can be used to generate additional income. Or, if the circumstances are right, a practice could decide to retain less GP time.

Among the developing areas of skill mix are training receptionists to take on clinical tasks, such as venesection and ECGs, healthcare assistants taking on practice nursing roles and practice nurses taking on extended roles, such as Zoladex implants and the fitting of IUCDs.

7.Practice-based commissioning

Review what options there are for your practice to participate in practice-based commissioning and what resources the PCT has made available to support them. Individual GPs may be needed to contribute to service redesign and these opportunities can generate sufficient income to justify participation on a financial basis. Where practices have come together to form consortiums there will be a need for more formal leadership roles that could provide extra income to the practice.

PCTs that have not yet devolved commissioning responsibility to practices are going to need to secure much greater clinical involvement as a result of World-Class Commissioning, so look out for opportunities. There isn't a career structure in place to support involvement of GPs in commissioning at present and the rates of pay may not be favourable enough to warrant participation on a financial basis alone. But if you are prepared to negotiate and provide a high quality of support, you might find this a viable option. And by supporting your PCT, you may find it more willing to support you.

8.Expanding provision

If your practice can identify new ways of working that fulfil local priorities you may be successful in submitting a business plan to provide additional services. Make sure you understand what the local priorities are. If you are not already contributing to your PCT's operational plan for next year, make sure you at least know what is in it to understand where the opportunities lie. Ask your PCT to see it.

9.Buying groups

LMCs have been working on behalf of their practices to secure larger discounts on items such as flu and pneumococcal vaccines for some years. More recently some LMCs have been widening the breadth of what they purchase and have even started combining to increase their buying power further still. There have been reported savings of up to 25% on medical consumables and stationery.

10.Negotiate with suppliers

For those purchases that you are not able to make through a buying group, remember that times are tough so be prepared to negotiate with existing suppliers for greater discounts or extra goods for free.

Dr Johnny Marshall is chair of the NAPC and a GP in Wendover, Buckinghamshire

Dr Johnny Marshall: 10 ways to increase your profits Dr Johnny Marshall: 10 ways to increase your profits

Some practices are training receptionists to take on ECGs and venesection.

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