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Merge two practices

Larger practices appear to have it all. Enough staff and IT to hit QOF targets and enough partners to cover holidays without locums. So what should small practices do? Well, one solution is to merge.

Easy to say, but is it easy to do? And would it really suit you?

When proposing a merger, make a list of how partners and patients benefit. A larger practice will mean more staff, creating opportunities for specialist nurses and IT managers. It will also mean more equipment and more support for doctors. On the other hand you lose that small, friendly team – something to bear in mind.

If you decide that a merger really is what you want, these are the seven steps to merger heaven.

1 Envisage the new practice. The partners should meet to discuss how they imagine the practice will be. It is likely you know the practice you're planning to merge with. You may even be friends. But do you share the same philosophy? Or is your approach fundamentally different? One practice may cut overheads to increase income; the other may accept a lower list size with more staff to provide a high level of care. These things must be thought through.

2Are the businesses compatible? Ask an accountant with medical experience to look at the books of the other practice. If one has substantially higher earnings or another higher staffing levels, how will you agree?

3Work out the cost. Even if the accountant sees financial advantages, the merger itself will be expensive. It is likely you will have two surgeries. Are you going to buy into each other's buildings or keep ownership as before?

4Work out the logistics. There will need to be one computer and one phone system. And how do you overcome the problem of two managers? Only one may want to manage this new, large surgery. Alternatively they could have different roles, such as staff and finance. Ideally there should be a new manager with no experience of either surgery.

5Consider terms of employment. Staff pay, holidays and conditions need to be brought into line. There must be a new partnership agreement for the GPs.

6 Anticipate running difficulties. Every practice has its own culture. The larger practice could impose its culture on the smaller, giving the impression of a takeover, especially if the manager was from the larger practice. Both sides can be critical of the way the other practice cared for patients before the merger. This can cause anger and resentment.

7Let go of the past. The new practice has to have a new name and a unified approach. And every member of the practice from the cleaner to the partners must feel ownership. The old practices are dead – long live the new one.

Peter Moore is a GP in Torquay, Devon

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