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Dilemma: Practice manager needs support

Staff costs are increasing due to rising pay and extra workload. Despite falling profits, the practice manager wants to employ an additional secretary to release the present secretary, who may leave if they do not have the chance to expand their role into that of a deputy practice manager.

How do you handle the various concerns?

There are advantages in hiring an additional secretary

Dr Fiona Cornish

Dr Fiona Cornish

Falling profits and increasing workload are affecting us all and staff costs are one of the big expenses. This scenario sounds like a headache but there could be some advantages of saying yes to the additional secretary.

It would offer a chance to take on a young dynamic secretary with excellent IT and data handling skills. You could then change the roles of existing staff to areas of their strength. As general practice is turning into data collection rather than medicine, a new young whiz kid could be an asset with QOF and the other increasingly tedious requirements we are obliged to do to attempt to prevent profits falling further.

You could consider asking the existing secretary to do secretarial work half the time, and deputy practice manager work (perhaps in specific areas such as staff rotas and CQC requirements) for the rest of his or her hours. The new secretary could them do secretarial work half the time, like his or her colleague, and data-handling work for the rest of his or her hours, with a view to increasing income from the QOF and QIPP work.

Before rushing into employing the new secretary, you need to find out why the existing one is threatening to leave. Has he or she been offered a job elsewhere with a higher salary? Has he or she fallen out with any of the staff she works closely with? Is he or she ambitious and capable with more to offer than just secretarial work?

Personalities and conflicts always enter these issues. Find out what is going on. Emphasise that professional behaviour requires members of staff to get on with everyone at work and personal views must not impinge.

Dr Fiona Cornish is a GP in Cambridge and president of the Medical Women’s Federation.

Make the practice manager a partner

Dr Vicky Blackburn - online

It is hard for practice managers to balance the needs of a developing business and the bank balances of the partners. One way of insuring that this balance is maintained is to make the practice manager a non-clinical partner in the business, so that he or she has a financial interest in keeping costs low and profits high.

In any case, the practice manager should present the business case for ‘over-spending’ on clerical/admin staff, to the partners. This scenario highlights the need for every practice, like a business, to have a short term (one- to two-year), and longer term (five-year) business plan with projected costs on staffing. Decisions on staffing also have a ‘personal’ component. Highlight the need for partners to be aware of the potential strengths and weaknesses of their staff.

As a partner I would want to know how likely is the secretary to leave without promotion, how would he or she cope with promotion and what impact promotion would have on other staff.

The knowledge of how these individuals work and their role in the team is key. The cost expressed within a robust financial plan, would also help me formulate my decision.

Dr Vicky Blackburn is a GP partner in Gloucestershire and has a regular phone-in on BBC Radio Gloucestershire. She is also a member of a private GP service based at a local private hospital and regularly participates in the local out-of-hours service

Run a cost-benefit analysis of both scenarios

Dr Seamus Dawson - online

In the current climate any proposed increase in practice costs should be backed up and justified by a strong business case. Before making a decision to hire or not, the GPs should establish the full costs and benefits to the practice of employing the additional secretary and weigh this against the implications of doing nothing. Once you have the full facts in front of you the correct decision should become clearer.

The additional costs to the practice will not just be the new secretary’s salary. There will also be any pay increase to the current secretary for taking on new duties. Employer’s National Insurance and superannuation contributions should not be ignored. In addition to the payroll costs, one off costs such as furniture and computer expenses that should be included.

After establishing the additional costs the benefits to the practice should be identified. Releasing the current secretary from his or her present duties may allow new sources of income to be identified and pursued. Spreading the workload over another staff member could also reduce stress and pressure on the workforce and reduce days lost to sickness. And if the GPs choose not to employ the additional secretary there is a possibility the current secretary will leave - doing nothing may lead to further reductions in profit due to missed claims and opportunities.

Remember your accountant can help you identify the costs and benefits before taking any action.

Seamus Dawson is principal at Bridge Chartered Accountants a member of the Association of Independent Specialist Medical Accountants.

Readers' comments (2)

  • It would offer a chance to take on a young dynamic secretary with excellent IT and data handling skills.
    BEWARE of age discrimination!

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  • Does the Practice (Business) need a Deputy PM?
    If the decision is yes after an evaluation, make the necessary arrangements to recruit (internally and externally). If No, leave things as they are. Everyone seems to be trying to justify a change that might not be good for the business.

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