Dr Adrian Midgley, GP in Exeter
One day we might add voice recognition – until then our typists appreciate the clarity of sound and we never run short of tapes.
When dictating for transcription, we use Olympus voice recorders. We bought transcription pedals for our typists, and use the free but proprietary Express Dictate transcription software from an Australian firm. The pedals cost £100, the handsets for doctors are currently £49, and the headsets for typists come in a range of prices. The handsets plug into a USB socket, the files have to be moved to the storage folder on the server, and one must avoid deleting anyone’s files. But this is no more complicated than remembering where to put a tape, and not picking up and re-using one that has not been transcribed. One day we might add voice recognition – until then our typists appreciate the clarity of sound and we never run short of tapes.
Olympus voice recorders: £49 each
Transcription pedals for typists: £100 each
Headsets for typists: £11–£44 each
Dictation software: Free
LES backfill and shredding
Dr Peter Young, GP in Gateshead and Sheinaz Stansfield, practice manager
Our list has grown by 7.7% since we started.
We have recently taken up a LES from the local CCG to care for patients at eight local nursing homes. To resource this work, we invested in eight sessions a week of backfill, and dedicated four sessions a week from our experienced partners and salaried doctors to do visits and work with nursing home staff.
We modelled the project carefully and in terms of the LES itself we only just break even. They offer a cost per patient for every new registration at our practice, plus £1,500 for undertaking the LES, patient reviews at £25 per quarter, and £500 if we have evidence we’ve reduced admissions by improving care.
The return on investment comes from the list growth from registering nursing home patients with us. Our list has grown by 7.7% since we started.
On the admin front, we’ve switched from shredding our own documents to using a contractor. Our receptionist used to spend three hours a day doing it, which, at an hourly rate of £7, cost around £20 a day. Now we have locked boxes around the practice that are picked up every six weeks – this costs £48 every time they are collected. We’ve also improved data protection compliance by doing this as we shred everything with two pieces of identification, rather than whatever we can get through in three hours.
Sessional GP backfill: Eight sessions’ worth a week
Shredding service: £48 every six weeks
A height, weight and BP machine
Dr Tayza Aung, GP in Brentwood, Essex
I think in the long term it will be cost effective, both from a staffing cost perspective, but also for capturing data for annual QOF targets.
We bought a combined height, weight and BP machine for the surgery within the last year. It was expensive, but it was bought out of prescribing incentive money. It has been very useful in terms of the QOF, as we have been able to capture BMI readings and blood pressure from patients very easily, without the need for an appointment with a nurse or healthcare assistant. If we identify someone with outstanding readings we ask them to use the machine before giving them their next repeat prescription.
Occasionally the machine will give an abnormal reading but generally it is very accurate. I think in the long term it will be cost effective, both from a staffing cost perspective, but also for capturing data for annual QOF targets.
Combined height, weight and BP machine: Around £3,000–£4,000
An in-house pharmacist
Dr Peter Patel, development director and partner in Birmingham
We estimate that the pharmacist’s time costs about half that of a GP, and that employing a sessional GP to take on this workload would cost £36,000–£40,000 a year.
Seven years ago, while involved in practice-based commissioning, we evaluated the cost and began to fund an in-house pharmacist through freed-up resources from the PCT. Eighteen months ago, the funding stopped so we decided to continue to fund the pharmacist ourselves from practice income. The pharmacist works two sessions a week seeing patients.
We have continued this service for several reasons. Having a pharmacist in-house frees up GP time – we don’t have to run round doing medicine-use reviews and chasing minor issues, so the pressure on GP time is less. We estimate that the pharmacist’s time costs about half that of a GP, and that employing a sessional GP to take on this workload would cost £36,000–£40,000 a year. We also believe that we are offering better clinical care. The pharmacist helps us to implement NICE guidelines and meet our QOF targets by monitoring patients with complex or long-term conditions, and reviewing those on multiple medications. This has had the effect of improving compliance and patient education, and has led to a reduction in non-elective admissions.
We are finding that patients are very satisfied with the service too. We know of other practices with in-house pharmacists that are finding that the benefits to patients and the practice are similar.
In-house pharmacist: £12,000 a year
Privacy and label printers
Paul Conroy, practice manager in Mersea Island, Essex
Even though they only save the GPs a minute or two in each consultation, by my back-of-an-envelope calculations they paid for themselves within a fortnight.
In the past 18 months our practice had a complete refurbishment. Our practice is quite small, and previously our reception area was also quite small. So we decided to install a ‘pod’-type room in the reception area that you can access from the reception and the back office. It’s made of glass and aluminium, so it’s light without being transparent. It’s about 2m2 and contains an island desk and two chairs.
The idea is that, if a patient needs to discuss something privately, such as arranging a termination or organising a Choose and Book appointment for something confidential, but we don’t need to dedicate a whole room to appointment booking. It’s also useful for hearing out complaints without the attention of everyone in the waiting room.
We also made a much smaller investment, which was buying some label printers from Dymo for each of the clinical rooms, and the reception. They’re used for appointment cards and forms. Even though they only save the GPs a minute or two in each consultation, by my back-of-an-envelope calculations they paid for themselves within a fortnight.
Privacy booth in reception: Around £10,000
Label printers: £90 each
Solar panels and remortgaging
Jenny Whitehead, practice manager in Ilkeston, Derbyshire
We originally estimated that the panels would pay for themselves in five to 10 years, and we will be well within this.
We have installed 20 solar panels, 14 on our main roof and another six on another section of roof. The initial outlay was £28,500, but we are generating our own electricity and selling what we don’t use back to the National Grid. The amount of income that you get for this depends on the tariff in force at the time, but at the moment we are making approximately £2,000 a year for the practice.
We originally estimated that the panels would pay for themselves in five to 10 years, and we will be well within this. You would need to check carefully before getting them installed – for example, you need to know whether your roof faces the right way.
We have also remortgaged our building so that we are benefiting from a different rate for our repayments. This may be worth doing even if you have to pay a fee in order to be released from your current mortgage.
Solar panels: £28,500
Remortgaging: cost varies
What was your best investment this year? Share your tips by commenting below.
For another article in this series of GPs’ own tips, read Insider advice: Managing small practices. If you have an idea for another article in this series, please email firstname.lastname@example.org to pass it on.