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‘We’re planning for a £50,000 increase in costs this winter’

‘We’re planning for a £50,000 increase in costs this winter’

GP practices may have to make cuts due to rising inflationary costs, says Dr Gary Armstrong

No doubt every practice has started to look closely at their finances. In my practice we’ve done a bit of work to look at the impact of inflationary costs. We’ve got a list size of nearly 15,000 and we cover five sites across a large area in rural North Lincolnshire. Our buildings are old and we use air conditioning units as our main source of heating. Our GMS income is fixed and there are limited sources of additional income.

We’re trying to think of ways to manage. Maybe there will be a national or ICS solution as we approach the winter, but as this is likely to involve significant sums of money, we need to start making plans now. In addition to energy costs, we’ve got consumables and other practice expenses. That’s before considering the pressure on wages. Staff are thin on the ground, and recruitment and retention are a challenge. We’re looking at all options, but these are limited. I can’t charge the NHS any more for my services either.

As an independent business, we’re not subject to energy caps. We’re budgeting for an increase of at least £30,000, but it will probably be nearer £50,000, just for energy costs. If you’ve got a fixed income and you’ve got to meet those inflationary costs, how will practices deal with that? As a partner, you either have to take less income, drop sessions, put recruitment plans on hold or, worst case scenario, look at redundancies.

But there’s no clear plan. Even if the NHS finds a way to support these additional practice costs, when do we find that out? This will probably be well into the winter months, but by then we’ll have had to decide where we’re saving money. Our largest expense is staffing costs. Where else can we make savings? We have already exhausted most of our options. We can look at where we buy our consumables, but we can’t make massive inroads into huge energy bill increases.

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I’ve asked the local place partnership team to make sure other health and social care partners in the area are aware that practices may have to make cuts this winter. They can’t go overdrawn, they’re not like hospitals. And sadly, people need to be aware that some of the services they’re used to accessing may not be available. It’s going to be terrible PR for practices, too. We’re already being criticised by some media outlets. 

Unless there are some additional funds to pay for heating and energy costs, I don’t know how we’ll get around it. Clearly, it’s affecting other small businesses, such as cafes and shops, but at least they can increase their prices, however difficult that may be. General practice has no option but to cut costs. At the same time as we are facing a significant workload increase, a fall in GP numbers, more bureaucracy and an autumn vaccination drive, we will be forced to further reduce the capacity of our practices.

Part of the fear for me as well is that the future of general practice is already hanging in the balance, newly qualified GPs have little interest in becoming a partner. The financial risk is too high. Is this a step too far for general practice as we know it?

We’re going to face tough choices this winter.

Dr Gary Armstrong is a GP partner in North Lincolnshire 



Please note, only GPs are permitted to add comments to articles

Decorum Est 26 August, 2022 3:12 pm

‘Locked-in’ to an intolerable scenario? Anyway you could go ‘on sick’ and return as a part-time locum (it’s all you can manage – it’s not reprehensible)?

David jenkins 29 August, 2022 11:49 am

the first thing you need to do is increase any charges you can make for “ganfyd” letters and such like. and enforce it without any exception. it’s only a minute amount – but you can do that immediately, without any messing about. you will have to explain to the patients (who buy the beans), that the price of beans has gone up, and there is nothing you can do about it. to those who want it for nothing, i explain they are in fact asking me to pay MY secretary to type out THEIR letters.

“all medical reports etc. are non nhs work, and must be done in non nhs time – which must be paid for” i explain.

unpaid, but contracted, dwp work, etc, should be put further down the queue – send them a letter to explain it’s “pressure of work, covid, staff shortages” etc etc etc – everyone else does this, and so should you.

you won’t be able to attend some of those important meetings, arranged by the beancounters and managers, “due to pressure of work, staff shortages, covid etc etc etc”. if you HAVE to attend them, turn up late, contribute nothing, and make sure your phone rings all the time with those “sick patients” – or give the surgery the landline number, so they can phone you direct (due, no doubt, to poor signal, flat battery etc on your mobile).

if it isn’t in your contract, and it’s silly admin stuff “to help with our planning” etc, DO NOT DO IT, or explain that, due to “covid, staff sickness, pressure of work etc etc etc” you will do it when you have time.


or, get out as soon as you can; take your pension if you can; come to locumland where you can work as much, or as little as you want, take holidays when you like, set your own fees, choose where you work, don’t have anything to do with nhs managers, and get paid accurately, and on time.

i’m 72, and still working with reduced lung capacity, and i enjoy it. when i no longer enjoy it, i’ll stop.