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At the heart of general practice since 1960

The new contract ­ balancing staff costs and quality

The key to maximising net profit is to discover your optimum level of staff expenditure, says Dr John Couch

For all practices the new contract is prompting vital decisions on staffing levels and skills. The results of these will have more impact over practices' success and profitability than at any time in the last 40 years.

GPC joint-deputy chair

Dr Simon Fradd makes the comment: 'Practices will have to balance the cost of staff against the level they want to reach on the quality and outcomes framework. The profit level is in the hands of individual practices. They will have to make decisions on staff but I'm convinced I won't need to hire anyone extra.'

At stake for an average practice achieving 700 quality points is £17,500 gross per GP in 2004/5 and £28,000 per GP in 2005/6. To whet appetites further, any practice achieving a maximum 1,050 points will earn an average £42,000 per GP in 2005/6.

The key to maximising net profit is to discover your optimum level of staff expenditure. As with other business expenses there is usually a happy medium. You will fail to maximise net profit by spending too little or too much.

The ideal would be to achieve high points with existing staff. Practices that are already highly computerised are in the best position. I check all computer summaries arriving with new patients records. The majority are inadequate. Many practices will receive a nasty surprise when they do their initial quality framework computer searches.

All practices should be considering their own balance of staff and projected profit, especially as quality preparation payments of around £3,000 per GP are imminent. As a teaching practice we have reasonable computer records, but after random searches we have found we have still a long way to go to get near the elusive 1,050 maximum points.

We are going through the framework point by point and it is clear that high-quality, uniform IT is the key to success. This will require a considerable amount of time. We estimate that, excluding clinical input, our large practice will require at least 20 extra hours of dedicated staff IT time per week. Our hard-pressed practice manager and his deputy currently manage IT so we initially decided to bring in a part-time IT manager.

However, this level of expertise would be costly, £15,000-£17,500 a year for a 20-hour week. So following an audit of tasks and skill mix we decided instead to employ an extra administrative assistant. The aim is to take some tasks away from the manager and his deputy to allow them more space for IT. This has several advantages. It ensures the IT team already have working knowledge of our current software. Their multi-tasking skills will continue, allowing holiday and sickness cover. Finally, the extra staff time will cost less.

Any extra IT training needed by the manager and his deputy will be performed by our software company, which will send personnel to our surgery. There is some cost involved, as the company is based in the Midlands, but we feel we get value for money.

IT training is also available from the local PCO.

Not only are we ensuring our manager and his deputy have the best IT training we have also decided to increase staff and GP training too ­ having first-class IT in place is useless without accurate and consistent data entry.

Training, both theoretical and practical, will be held weekly in-house, with locum cover where needed. Again, outside experts will be used when necessary. Progress and quality control will be monitored monthly using software searches. These will reveal whether the practice is on course to achieve the required number of quality points ­ a sort of computerised progress report.

We are aware that achieving the last few, most difficult, points may not be cost-effective.

Many practices will need to catch up with summarising and data transferring written records as well. Extra, temporary, staff or GP time will be required, around eight working weeks per average list. Without this, practices will always be disadvantaged. PCOs have extra money to allocate for this task.

Practices that attempt to use existing staff time should monitor progress carefully, adding extra staff gradually as needed and always keeping the cut-off date for the first year's points target, 31/3/05, firmly in view.

To optimise staff expenditure

 · Decide what quality level you want to reach

 · Establish whether you have the staff skill mix

 · Decide what new skills are needed and whether you can afford them

 · If possible, retrain existing staff to meet new skills;

lif not possible but affordable, hire new staff

 · Maintain a cost-effective training programme

 · Monitor staff costs and practice profits

NB Practice that use computers well are in the strongest position

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