There are many ways practices can make the most of their current staff and premises to maximise revenue coming in
In general practice we are feeling the squeeze financially as we see a variety of our income streams ebbing away, and we have to work harder to earn the income we do get. If the commentators are to be believed (and they probably need to be), that isn’t going to get any better any time soon. If we wish our ‘businesses’ to remain sustainable we have three variables we can play with – our costs, our income and our levels of profit. Many of our costs are hard to control, the main variable we can control is our staff costs - but this brings other challenges, which is a whole other article.
We can accept lower profits (however unpalatable) but there is also a limit to this and we need to maintain these at a level that is competitive and will enable us to attract new partners in the future. So that leaves doing all we can try and reverse the trend and find ways in which we can boost our practice income. In this article we will look at some of the options for doing this and the challenges that we face in making them a reality.
In general there are strategies that we can borrow from the private sector when times are getting harder. Firstly, by maximising each opportunity – where you have existing income streams make sure that you are making the most of these. Look at each area of NHS income that you get and make sure that you are making the maximum that you possibly can. Probably the easiest way to get more income is to grow your patient numbers, though the key is to do this without increasing your overall costs. Achieving this means keeping a focus on access, as this area is what is most likely to drive the numbers joining or leaving your practice. However it is important to be aware of what it is costing you to earn this income. By all means chase every penny of revenue from each incentive scheme, but make sure that you know how profitable each income stream is and make sure you focus on the most profitable ones first.
Secondly, diversify. It is better to have a range of different income streams, as this helps to spread the risk when many opportunities are not guaranteed to be ongoing or long-term. This helps to reduce the exposure that the practice has in the event that some sources of income dry up, and it is unlikely that these will all come at once. At the moment, finding new alternative NHS income opportunities is still fairly hard as clinical commissioning groups (CCGs) work through the complications of commissioning services from primary care, understand the regulations and make sure that if they do this it is done in an ethical and proper manner. There are a number of services which are well suited to being delivered from within primary care and the CCG is able to commission these. If the service is one that really can only realistically be offered as a list-based service then the CCG can commission this from all the practices in its area (and if an individual practice can’t or doesn’t wish to provide it they can subcontract it to a neighbour). Other services are best suited to contracting via an ‘any qualified provider’ (AQP) route, and in this case primary care can provide the service, though it is of course open to other capable providers who wish to deliver it. Many CCGs are adopting these approaches with some services and will soon be commissioning these from primary care. If your CCG is taking this approach, then make sure you can gear up to provide these services if they become available. If not, suggest to your board that perhaps there may be some things that could be commissioned from primary care.
Looking outside the things that the CCG or NHS England could commission us to provide, there are a number of other options that you can consider. These include the following:
Many of you will already be training practices. If not, consider becoming one. If you are already a training practice then there are more training opportunities that you could take advantage of. As well as GP registrars, there are opportunities to train medical students, FY2s and fourth year BSc students on the medical side. Also look into opportunities to train nurse students who now go on two placements a year in each of the three years, and universities are often looking for more places for them. This also has the advantage of exposing trainee nurses to practice nursing, many of who are oblivious to this as a career option, and has led in several cases locally to the nurse wanting to go into practice nursing when they qualify. There are other opportunities for trainees as well – disciplines including occupational therapists, dentists and physiotherapists also do taster sessions in primary care. This varies around the country, but enquire locally to see what you may be able to offer. As with all these options for income, there is some cost (often in staff time away from the front line), so make sure that you evaluate its viability carefully.
Do you have specific skills in your clinical team? Can you develop any courses around these that you can then provide to others? Perhaps even getting together with some other local practices to develop a small training company that can do courses like immunisation updates, chaperone training and other such areas, which you can then market to other practices in your region.
Most practices will do a few of these for patients that ask, but few really maximise the possibility that these can offer. While I recognise that it is not an area of work that many GPs find particularly stimulating or part of their desire to provide care to their local community, it is nonetheless a potentially good source of income, and in these times is perhaps an area that you should consider as a means of maintaining profit levels. As well as offering a convenient service for your registered patients who may wish to have a medical, there are opportunities to offer this service to local companies who may wish existing or new staff to have medicals, or to the lager insurance companies who may wish policyholders to have medicals for a number of reasons.
To take the ideas above a bit further, a possible service you can offer to local companies is an occupational health service. For one (or more) of your GPs to gain an occupational health diploma or similar qualification is relatively simple, and this could provide you with another source of income. A spin-off benefit from this is the ability to work more closely with local companies and the local community, and it provides the chance to work on health promotion ideas locally, which can help improve your community’s health generally, which in turn could help reduce access demand.
Links with schools
Taking some of the ideas above a stage further, you can develop some presentations to deliver in local schools. Our practice has managed to get some non-recurrent funding from the CCG to develop this work, and we have managed to get some schools to pay for us to come and promote better health with both students and parents. This gives us an opportunity to share some key health messages with them – including hand washing lessons and how to access the right NHS services (choose well) messages. Again we are working to try and remove inappropriate access from our surgery as well as getting a small income stream in return.
Make sure that you are getting the most out of your premises and opportunities to rent out rooms to others. With the ‘care closer to home’ mantra, a lot of organisations are looking for alternative locations to deliver services from, so consider making rooms available to let. While we need to be careful about being seen to endorse particular treatments or particular individuals, there are a number of ‘alternative’ practitioners out there that many of our patients do find some relief from, and these are often willing to pay for a good quality room in a health centre. We currently are renting a room one morning a week to the local Slimming World representative, which is mutually beneficial. We get income from letting the space and a handy place to suggest to patients who want to lose weight, and they get a good room and trickle of new referrals from us to join her group.
Many practices offer some travel vaccines, but consider training up some of your nurses to be able to offer a more comprehensive service locally – including becoming a yellow fever centre. Given the right training, you can market a service that includes giving detailed advice on patients’ health while travelling and is not just merely an ‘injection’ service.
There are opportunities out there for practices to boost their income. In the current climate there are few suggestions I can make that will be the magic token to sudden riches, but by developing a number of relatively simple services that, with the minimum of training, your existing staff can offer you can bring in a number of new or increased revenue streams. As well as helping to boost flagging income they also help to spread the risk and help to provide a more secure future as all your eggs are not concentrated on a relatively few income streams.
However, as mentioned earlier, the introduction of these needs to be carefully managed to make sure that as well as bringing income they deliver some profit (and certainly don’t cost you more money). Ideally with good planning and good management you will be able to deliver these from existing resources by making more efficient use of your staff and resources without doing it at the expense of front line access time.