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How our practices are boosting their profits

Three GPs tell By Ian Quinn about their differing approaches to generating profit for their practice

By Ian Quinn

Three GPs tell By Ian Quinn about their differing approaches to generating profit for their practice

Tailoring different surgeries to local needs

Dr Clare Gerada, vice chair of the RCGP – and the ninth most influential GP in the country, according to Pulse's 2009 movers and shakers poll – is a partner in a new breed of GP-led consortiums shaking up services and financial models.

The Hurley Group, a fast-expanding group of practices based in south London, has been busy tendering for new services, recently winning a bid for one of the capital's first GP-led health centres.

But Dr Gerada says the way the group has geared its different surgeries to meet local demands is the real reason behind its financial and, more importantly, medical success. At each surgery, salaried GPs are employed – working to a profit-related bonus scheme – to help identify local priorities and maximise revenue.

The empire includes the Sternhall Lane Surgery, a small, previously rundown inner-city practice in Peckham, which has changed beyond recognition since being taken over from the PCT. Its performance in public health areas ranging from flu to smears and even childhood vaccination have all dramatically improved. Dr Gerada says it is all down to changing the culture of the surgery to one geared to proactively face up to the community's needs, from the attitude of the lowliest member of practice staff to the salaried GP put in charge and handed an equity stake.

Less than a mile and half away the Riverside Medical Centre, based in Vauxhall's plush St George Wharf, deals with an exclusive bunch of patients. For these professionals, having extended hours services on Saturday to match their busy working lives was higher on the agenda.

‘These practices might as well be on a different continent,' says Dr Gerada, one of a dozen partners in the group.

The Hurley Group's latest project, after winning the tender to turn the Lister surgery, in Southwark, into one of Lord Darzi's GP-led health centres, is a new direction, and not without opposition from those who resent the ambition of GP entrepreneurs. But Dr Gerada says: ‘GPs aren't like the Royal Bank of Scotland.

GPs are not driven by money – they are driven by the chance to make change.'

Boosting list sizes – and QOF claims

A salaried GP in what is often portrayed as a crime and health black spot in London's East End might seem an unlikely role model for entrepreneurial GPs. But Dr Richard van Mellaerts has become an outspoken advocate for a new breed of GP for whom profit is no longer a dirty word.

He admits he and the partners at their Bethnal Green practice have spent increasing time poring over their budget sheets rather than treating patients, but argues modern GPs have no choice if they want to safeguard their futures.

He says tighter claiming procedures and an aggressive approach to recruiting new patients have turned his practice around financially in just two years.

‘We were a practice in trouble. We had difficulty recruiting. But we've turned it around by really concentrating on driving up our patient list, closely looking at what services we provide and how profitable they are, and improving our systems.'

The practice recruited 1,500 patients at a freshers event at Queen Mary's University London and has even employed a part-time, Bengali-speaking marketing officer to spend time mingling with patients in the waiting room. Beefing up its IpsosMORI patient survey scores has been a key focus.

‘We recruited three new GPs and have become very active in recruiting patients,' he says.

Dr van Mellaerts says eradicating sloppy procedures for QOF reporting has had a massive impact on the practice's bottom line. His practice audited both the EMIS system, looking for incorrect Read coding, and its claiming mechanisms.

‘We've tightened up our IT systems. We now have a watertight coding and claiming mechanism. Our claims in some cases have gone up threefold with no extra work. I think there are practices who are happy not to be so financially driven but it's going to be increasingly difficult for them to survive,' he warns.

Partnering the private sector

As the spearhead of Sainsbury's bid to become a major player in general practice, Dr Mohammed Jiva, secretary of Heywood, Middleton and Rochdale LMC, is a controversial figure in the profession.

As well as running his Manchester practice, Dr Jiva is the man behind PriMed Services, a company given a key role in the rollout of a franchising scheme that could see more than 200 in-store Sainsbury's surgeries up and down the country.

If the national rollout proceeds as planned, Dr Jiva will have helped create a new breed of supermarket GP and also come up with a new economic model.

Dr Jiva opened up the first Sainsbury's surgery last year, which with three other practices offers an extended hours service on Monday, Wednesday and Thursday evenings, plus a Saturday morning surgery. He says: ‘I have a community provider agreement with the PCT and a landlord tenancy with Sainsbury's. I am the one who has to account to the PCT.'

But in return, PriMed doesn't have to pay superannuation on GP wages and he sees it as an ideal way to boost income.

On top of that, his company will now be paid £100 a month from practices who want to take up a Sainsbury's franchise, with Dr Jiva responsible for vetting applicants. He has already held talks with GPs in London and Leeds who could be the first to walk with him down the supermarket aisle.

Dr Jiva argues passionately that GPs can use such controversial schemes as a way of keeping control over the future of radical new NHS services – and boosting profits.

Dr Clare Gerada: "GPs are not driven by money - they are driven by the chance to make change." Dr Clare Gerada: partner in a new breed of GP-led consortiums Dr Richard van Mellaerts Dr Richard van Mellaerts Dr Mohammed Jiva Dr Mohammed Jiva

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