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Dilemma: Should I make staff cutbacks?

Because of shrinking profits, you ask your practice manager to provide an in-depth report on the practice’s income and expenditure. One of her conclusions is that you need to make some cuts in staff hours and numbers. How can you do this without falling foul of employment law or destroying staff morale?

It’s not too late to look for alternative ways to boost profits

Has your practice manager explored all the possibilities? Challenging her view may appear difficult and potentially disruptive, but it needs to be done. 

Profit is not just about income, and not just about expenditure. It is about the relationship between the two. Asking the manager for this report may not have been the only solution; it may have been more important to ask about the profitability of sections of the practice business. It is not too late to address that question. Some areas of work – elements of the QOF, extended hours or items of non-NHS work – may not be as profitable as they once were. 

There may be alternatives to cuts in staff hours and roles if some members of staff are redeployed. There may be new CCG work or Any Qualified Provider contracts. Finally, don’t forget to seek the views of staff on ways to reduce costs.

When addressing reductions in staffing costs, GPs must act within the law, and behave fairly and sensitively. The practice manager will be a key focus for discussion and liaison, but the partners should not shirk from being the bearers of bad news. 

Removing overtime and additional hours is the first step, but redundancy may be inevitable for some. Selecting which roles to make redundant may be obvious – if, for example, a particular service is no longer contracted for by the CCG. But in other cases the GPs will want to establish strict criteria such as an individual’s attendance or disciplinary record and their aptitude, skill and performance. Go to or the BMA for more support and advice.

Dr John Canning is chair of the GPC’s contracts and regulation committee and a GP in Cleveland

Don’t rush into actions that will risk the cost and stigma of an employment tribunal

Keep staff informed and ensure you are following due process as set out in contracts and the staff handbook. If you need to reduce hours or cut posts, do not use this as a way to get rid of less productive or difficult staff: this is not an alternative to disciplinary procedures. Your actions cannot be seen to fall foul of the Equality Act or be discriminatory. Do not rush into actions that will risk the cost and stigma of an employment tribunal.

If cuts are necessary, ask for volunteers. If there are none, seek a human resources or legal opinion to ensure you can substantiate decisions in which hours or posts are being cut.

Review the percentage spent on contract salary against overtime and temporary staffing costs. What is the division between clinical, nursing and non-clinical staff? Look at the distribution of hours of wastage that could be cut – even a couple of hours a week makes a difference in a year.

Involve staff in discussions about productivity. They may not like the process, but they will appreciate a fair and clear approach to the issues.

Caroline Kerby is co-lead of the NHS Alliance General Practice Network and a practice manager in Brent, north-west London

You cannot rush a situation where you make jobs redundant

A cut in hours can be dealt with as a contractual change. Any proposed change must follow a fair and proper consultation process with the employees, done verbally and followed up in writing.

If an employee does not accept the proposed change there should be a period of negotiation or consideration of alternatives. The practice may offer incentives or amend the proposal to make it acceptable by phasing in the cut. If an employee continues to work under the new terms without protest, then after a reasonable period (likely to be measured in months), they are deemed to have accepted.

There are further alternatives if no agreement can be reached, but these come with risks of claims for constructive or unfair dismissal. You could terminate the employee’s contract and offer to re-employ on new terms. The correct notice must be given, and the proper procedure for dismissal must be followed.

You cannot rush a redundancy situation. Short-term options should be considered as well.

Elspeth Buck is an HR adviser at First Practice Management


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