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At the heart of general practice since 1960

I am facing big losses following a PMS review. How can I make savings?

Two experts advise

Glyn Rawlings-cropped-330x

All expenditure should be reviewed. It takes time but will produce savings.

Salaries and locum costs are by far the biggest expense. The practice will need to assess whether it has the correct clinical skill mix, if locum costs could be reduced by moving work from GPs to nurses, pharmacists or HCAs, and whether reception and administration can be shared with other practices or outsourced – for example, accounts, payroll and HR.

The practice should also review its personally administered drugs income and costs. Look at what is being paid for each item and the amount being reimbursed for these. Can costs potentially be reduced through local buying groups?

In terms of cutting administration costs, practices should shop around for deals and not be afraid to ask current suppliers to price-match other companies, for example, on computer consumables. 

On premises, the practice needs to examine whether savings can be made on overhead costs and whether there are ways of generating income from better use of the premises. However, practices do need to be aware of the premises regulations.

Glyn Rawlings is specialist medical accountant with Rowleys Medical Accountants, Leicester

Sheinaz Stansfield-cropped-330px-online

It is vital to consider your options for financial stability and cost- effectiveness. Review your current income on at least a monthly basis and ensure you are claiming and being paid for everything you do. Robust monitoring systems need to be in place to enable this and partners must be actively involved in this process. Review your current expenses and identify potential areas for efficiency savings: items such as drugs ordering, stationary and utility bills are a good place to start.

One option is to stop doing anything that does not add value to the patient journey. Any services that are not part of your core GMS contract, but may have been negotiated as part of your PMS contract, such as acupuncture or minor surgery, could be negotiated for continuation through commissioners as an enhanced service.

Also consider getting involved with your CCG or health and wellbeing board, which will enable you to identify future sources of income, for example when services are going to be recommissioned. Where possible, get involved in service redesign and procurement as this will give you the skills to bid for future services when the PMS funding is redirected.

Identify skills or interests currently unused within the practice and which your CCG or local authority may be commissioning, and consider bidding for completely new contracts. These may be joint ventures with other organisations, for example, dermatology, minor surgery, employment medicals or screening/health checks with the private sector. Sign up for local websites that advertise contracts.

Develop joint ventures or federate with other practices to enable robust back-office and HR processes. Natural wastage and skill sharing across practices would be a better way to manage costs rather than opting for redundancies that are costly, take time and must be avoided to retain organisational memory and continuity for the practice.

Sheinaz Stansfield is a practice manager in Gateshead, Tyne and Wear 

Readers' comments (3)

  • option C: give up your contract, preferably with two fingers up.

    Work as a full time locum and get paid more for doing less work.

    Alternatively emigrate to Canada or the antipodes.

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  • Harry Longman

    Declaring an interest before we start . Ours and yours. Enabling GPs to be 20% plus more productive translates into the level of savings, within weeks, that you need. Look at Oak Tree Didcot who lost £170k PMS funding, on the GP Access case studies page http://gpaccess.uk/case-studies/practices/ Lots more, repeatably. Don't give in to cynicism and despair, it's in your hands. And it's lonely in Borroloola.

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  • It's important to remember what PMS funding was given for.
    Firstly for delivering the NSFs, remember them?
    And secondly for delivering improved ACCESS.

    Most practices took on extra nurses for the NSFs and extra doctors for the access.

    The NSFs went into the QOF and PMS practices had a reduced QOF to recognise they where already partially funded.

    The PMS payment is to pay for extra access. If NHS England don't want to pay for this, then you need to lose the doctors it is funding.

    Unless you want to turn your practice from a business to a charity case. It's your decision; not nice, but there it is.

    The other question is what is your CCG doing about it?

    They should be concerned that the poorer access that will result will impact on patients, increase A+E, increased referrals and admissions.

    If they are concerned then they should, with NHS England, come up with the money.

    If they are not concerned, then why should you be??

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