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At the heart of general practice since 1960

Profile of a high

earning

practice

Very high earning GPs have been in the news of late, and one such GP is Dr David Pelta ­ here he describes how his practice is organised to maximise earnings

To achieve the best possible earnings, we decided right from the start it was imperative to use the most effective business methods and to have the best practice manager we could find.

Doctors are generally poor managers and it is with this in mind that we ensure the majority of our doctors spend the maximum amount of time dealing efficiently with medical problems. They have as little as possible to do with practice administration.

We have a purpose-built surgery, 24,000 patients, a PMS contract and six equity partners, supplemented by six salaried doctors (3.44 WTE), seven nurses, three health care assistants, a counsellor and a variety of administrative and reception staff.

Thus you can see that we boost our earning potential by having a high patient list. This means there is a heavy medical workload to be dealt with and all our doctors are working for much of the day seeing patients.

Work is done mostly in surgery as home visiting has declined enormously and a considerable number of requests are dealt with on the telephone.

Workload is streamlined where possible ­ one of the salaried previously retired partners works a full three days a week during which he does a majority of our medical

examinations.

Our practice manager decides the appropriate fees to be charged and whether work is taken on or not on a private basis ­ ie, she decides how to make the work cost-effective. So certain requests are refused as they offer an unacceptable payment.

Nurses triage a high percentage of acute requests as well as dealing with a number of chronic and routine conditions such as family planning, cervical smears, asthma and running a travel clinic.

The division of labour in the nurses' treatment room is important so we employ three health care assistants and a full-time clerical assistant enabling the nurses to concentrate on their professional work and not spend time on clerical work or chaperoning.

Workload analysis

The doctors have analysed their workload so that with luck there are minimal requests for short-term sick certificates as it is accepted by patients that we do not give them for under a week and will often give longer-term certificates to cover a period of illness rather than have patients returning for purely administrative reasons.

I might also add that two of the partners do have MRCP and one has FRCS which I think helps in competence of managing workload. We are a low referring practice according to PCT data and choose to manage many conditions in-house ­ for example we have our own endoscopy suite enabling us to carry out diagnostic gastroscopy, colonoscopy, sigmoidoscopy, colposcopy and laryngoscopy, all of which are good fee earners.

There are a number of areas in general practice that effectively lose income. Partners may wish to be involved in things like teaching, medical politics, PCT committees and so on, but these are all time and revenue losers.

Higher-income patients wish to be seen quickly and offered a good service at short notice, and if they are delayed because partners are undertaking some of the above then this is potentially a major financial loss.

Postgraduate education is essential, but since we no longer have to do nights or weekend work, it is not unreasonable that studying should be done in this time. For that matter, so can any of the other interest mentioned above.

Income is obviously dependent on earning all claimable fees, which is extremely well done by our management team. But in addition control of expenses is of paramount importance in maintaining our income. In this respect we keep a close eye on our staffing costs which should never be more than 35 per cent of income.

Doctors always wish to have more support staff, but staff must be productive. Our manager reviews jobs, measures achievement and rewards staff accordingly.

One example of keeping workload down is that we write very few letters. Referrals are templated on the computer and downloaded by the secretaries. If a post becomes vacant and it is perceived that the duties are not contributing effectively to the running of the practice, then a replacement will not automatically be recruited.

Give your manager discretion

Management of staff, repairs and decoration of the building, care and servicing of equipment and purchasing are all a very important part of the manager's job and in this practice we give the manager discretion to carry out this work without constant consultation with the partners.

Negotiating telephone, power and equipment costs, together with moving available funds in a beneficial way for the partnership, also contribute to our eventual profit levels. I am delighted to say we keep our building in an excellent state of repair and presentation, having cleaners in three times a day in patient areas, particularly toilets.

Accountancy bills are kept to a minimum as all financial procedures are fully computerised and the practice manager will deal with any day-to-day queries the doctors may have, thus avoiding unnecessary contact with the accountant. Remember professional time can be extremely expensive.

We have a full and thorough review of the accounts by the partners on a yearly basis. Bank charges are negligible and a high percentage of our payments and receipts are made by the BAC system.

Purchasing of vaccines, immunisations and other supplies is also a constant challenge to achieve best rates. Fortunately our large practice can achieve economies of scale.

The practice has a contract with a large local company for a wide range of occupational health services. Several small contracts were stopped as we decided they were not cost-effective, but we do run a small non cost-effective contract for the local hospice as a matter of goodwill.

We consider it is absolutely essential to run a happy ship. We have a very low turnover of staff.

Everybody knows their work patterns will be challenged and reviewed on occasions to maximise efficiency and this is accepted, as is peer review by the doctors and nurses.

Over the last few years to reach this large size of practice several smaller practices have joined us and successfully integrated. The previous partners have in fact remained as part-time salaried partners for many years.

David Pelta is a GP in Southend on Sea, Essex

Secrets of success

· Develop a high list size

· Take over smaller practices where practicable

· Use doctors and nurses effectively

· Manage as many conditions as possible in-house ­ they can be good earners

· Claim all fees

· Ensure all work undertaken is cost-effective

· Eliminate income-losing activities, such as teaching

· Keep expenses down (ie, staff costs should be no more than 35 per cent of income)

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