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Predicting disaster and planning for it

Two misfortunes are looming on the general practice horizon, so be prepared, says Dr John Couch

Within the last year many practices were asked by their PCT to produce a disaster plan for the scenario of their practice premises burning down. While this remains unlikely, the exercise was extremely useful as it brought sharp focus to areas such as fire protection, data back-up and communication with patients. My partners and I now have copies of the plan on our home computers.

Disaster planning is common throughout industry and can be a useful tool when other misfortunes become apparent. Sadly for general practice there are at least two of these on the near horizon.

The first concern is that of growth money for PMS practices and MPIG for GMS. As both primary and secondary care enter an era of cost cutting, the White Paper specifically tasks PCTs with reviewing PMS growth funds for value for money.

The implication is that if clear benefit to patients cannot be demonstrated then reductions may be made. Next there are rumours that the rising level of private APMS involvement in primary care may eventually give PCTs an excuse for cutting MPIG. This would be a major financial blow to most GMS practices.

Rather than waiting for these tsunamis to arrive, practices should consider what they would do if a significant reduction in NHS income occurred. It is inevitable that some cut in partner drawings would occur, so how could this be ameliorated?

An increase in income from other areas would certainly help. Look to maximise all other NHS income such as the QOF, enhanced services and practice-based commissioning. Do not forget GPSI work, explore the possibility of setting up PBC provider groups to maximise your skill base and as always look out for opportunities for increasing private income. Consider training needs sooner rather than later.

Practices will also be forced to look at internal cost cutting. All expenses must be reviewed meticulously. Sadly, if there are large income cuts, this must include staff levels and the painful possibility of redundancies.

The second threat is that of extended opening hours. Whether we like it or not APMS bidders are already being encouraged to provide these and many will agree in order to secure a successful bid. There are also predictions that out-of-hours providers and walk-in centres may be allowed to offer routine appointments to patients.

If this happens it may not be long afterwards that our list sizes start to shrink as many working patients re-register.

Although we fought to get rid of our OOH obligations it could be business suicide to ignore this threat. If you do decide to change sooner rather than later, plan how this can be achieved. Some staff and partners may be willing to work to 8.30pm if they start work later that day.

Offer rewards and inducements for Saturday morning work. Discuss this openly with your whole team. I will discuss this topic in more detail in a subsequent article.

While it is unlikely I will have to retrieve the 'practice burns down' plan from my hard disk I have a sneaking suspicion that the plans for the doom-and-gloom scenarios I have mentioned will be actioned within the next few months. Will you be ready?

John Couch is a GP in Ashford, Middlesex

Disaster planning

What to do in the event of a significant reduction in NHS income

• Maximise all other NHS income such as QOF, enhanced services and PBC

• Do not neglect GPSI wor

k• Explore possibility of setting up PBC provider groups

• Look out for opportunities for increasing private income

• Consider all training needs as a matter of urgency

• Review all expenses meticulously

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