GPs are working longer hours, providing additional services and coping with increased patient demand, all at a time when funding is reducing. This cannot go on forever.
At a time of shrinking net income, GPs need to ensure that income streams are worth chasing. Is there the relevant resource available and is the cost more than the reward?
The loss of the organizational QOF points will affect practices differently, depending on size and current performance. I’d say the BMA estimate of a £19,800 loss is an average of what practices might lose, with some fairing better and some worse.
I think it likely that those losing the most will be practices performing well, whereas practices with high list sizes and offering low services will be less affected. Surely this is not what was intended?
Practices need to ensure that they maximise their QOF points by ensuring proper recording, particularly by locums and salaried GPs.
Partners must also constantly review their drawings to ensure the practice has enough cash for monthly expenditure, and to ensure they are not faced with a sudden request to pay drawings back into the practice.
Uncertainty about enhanced services income and the loss of the MPIG mean the future prospects for practice income are grim. At the same time many practice costs are rising. Hence practices need to review their expenses regularly and find ways to be more efficient.
For example, can patients be seen by a nurse rather than a doctor? What percentage of a GP’s time is being taken by only a handful of regularly attending patients and how can this be managed better? Staff costs are a practice’s biggest expense. Sadly, if a practice is overstaffed then changes need to be made.
I see many disillusioned GPs who regret that being much more financially efficient has to come before patient service. Many have taken early retirement and GP partners are becoming harder to find. Re-organising accounts and adjusting services is the only way forward. We may also see practices working together more closely via federations of cost-sharing.
Ken Craig is a partner at Rawlinsons Chartered Accountants
