How to Manage Your GP Practice E-Book

Farine Clarke

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: HOW - How To
• Sprache: Englisch

Seitenzahl: 185

Veröffentlichungsjahr: 2011

Beschreibung

The business side of running a medical practice may be unappealing but it's crucial

• How to Manage Your GP Practice is written for GPs and other health professionals running their own practices.
• It tells you in simple, engaging style what the pitfalls are and how to avoid them.
• It illustrates the good and bad ways of negotiating through management issues, using case examples and lightening the messages with witty cartoons.

Written by a GP with over 10 years' experience editing a leading GP magazine, and an accountant whose firm advises over 2500 GPs, the information here is sound, relevant and up to date. It provides reliable and reassuring information for doctors starting out in their careers as well as those looking to refresh their management skills.

Leseprobe

Contents

Cover

Series Page

Title Page

Copyright

Preface

Chapter 1: The business as an organism

Dirty Money or Life Blood?

The Keys to Success

Your Vision or Mine?

You go in that Direction and l'll go . . .!

Can We Decide Who's Making the Decisions?

Which Operational Model Works for me?

What Constitutes Practice Staff?

To Rent or Buy . . . that is the Question

Appealing to Your Patients

Key Points

Chapter 2: The challenge that is staff

‘You're Fired!’

Do What's Right for the Practice

Recruitment is Now a Minefield

I Like You . . . You Remind me of me

Selection of Candidates for Interview

Did You Write This Reference?

In My Humble Opinion . . .

You do the Management . . . I'll Get on with the Real Work

Ensure the Staff Handbook is up-to-date

Guess What Motivates Me?

I Told You I was Unhappy

Rewarding Staff Rewards the Practice

Being Rewarded is a Bonus

Practice Meetings Add Value

Property Isn't the Only Thing Worth Stealing

Should I Treat You or Pay You?

‘Me Time’

Discipline: A Thorny Problem

Disciplinary Procedures Can Save a Practice

Key Points

Chapter 3: Basic practice accounting

De-mystifying the Accounts

Which Accounting System is Best for Your Practice?

Does Double Entry Mean I Go in Twice?

Capital and Current Accounts

No Apples Ever Kept the Taxman at Bay

Key Points

Chapter 4: Budgeting

Good Businesses Compile Good Budgets

Key Points

Chapter 5: Choosing the right operational model for the practice

GP Liability for Debts or Obligations

Additional Stakeholders

Making Finances Public

Forming a Partnership, Limited Company or Limited Liability Partnership

Key Points

Chapter 6: Business growth

Methodology of Expansion

Bidding for a New Practice

What is Goodwill?

Key Points

Chapter 7: Planning for the exit

The Partner Voluntarily Leaves the Practice

Involuntary Retirement

Death of a Partner

Funding a Retiring or Deceased Partner

Partner Joining with Stages to Parity

Buying in and Out of Premises

Key Points

Chapter 8: Ten questions answered

Chapter 9: Thou shalt . . . thou shalt not,

Thou shalt . . .

Thou Shalt Not . . .

Appendix 1: Useful contacts

Appendix 2: Full set of practice accounts

Index

Series Page

This edition first published 2012 © 2012 by John Wiley & Sons, Ltd.

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Library of Congress Cataloging-in-Publication Data

Clarke, Farine.

How to manage your GP practice / by Farine Clarke and Laurence Slavin.

p. ; cm.

Includes index.

ISBN 978-0-470-65784-3 (pbk.)

1. Family medicine–Practice. I. Slavin, Laurence. II. Title.

[DNLM: 1. Practice Management, Medical–organization & administration–Great Britain. 2. General Practice–organization & administration–Great Britain. 3. State Medicine–Great Britain. W 80]

R729.5.G4C63 2011

610.68–dc23

2011020602

This book is published in the following electronic formats: ePDF 9781119959533; Wiley Online Library 9781119959564; ePub 9781119959540

Preface

Doctors practice medicine to treat patients. If they had wanted to be business people or managers, they would have done MBAs and entered commerce; all of this is true. But GPs in partnerships today have to be all things to all people: they have to make sure their patients receive rapid and appropriate treatment, and they also have to ensure their practices remain healthy. To achieve this, partners need to have as advanced an understanding of what it takes to run a small business as they do to manage complex patients. Just as the pressure on patient care has increased beyond recognition in recent decades, so has the pressure on small business to demonstrate ‘best practice’. Doctors need to be prepared for a host of new threats to their practice, from staff litigation which is increasing at a rate reminiscent to that of medico-legal cases in recent years, to the rules and regulations accompanying European legislation, and their impact on practice management. All of this comes on top of the basic need for partners to make sufficient profit to pay themselves and their staff appropriately, and to grow and develop their practices as they wish.

This book sprang from a conversation between the authors about the lack of credible practical information for doctors and the need to arm GPs or private practitioners with the right information to achieve success. It was written in response to a request from doctors for a clear, accessible book detailing the most useful financial and business information for them. They did not want a lecture or to be blinded by management jargon, but wanted straightforward practical information, presented using real-life examples to illustrate the salient points. In short, a book which they could draw on for advice, but with which they could easily relate. The authors believe and hope that this is such a book.

Farine Clarke qualified from St George's Hospital Medical School, London in 1986 and completed the St Helier hospital GP vocational Training Scheme. She decided to pursue a career in publishing where she worked first on Pulse and then on GP as editor and editorial director. She was promoted through the ranks to managing director firstly at Haymarket Medical Ltd, where she was responsible for GP, Medeconomics and MIMS, and then at Archant Specialist Ltd, where she ran 15 consumer magazines, ranging from Photography Monthly to The English Garden. In her roles as managing director and main board director, Farine was responsible for the profit and loss, staff management, product development and expansion of the companies she ran, both in the United Kingdom and overseas. Farine feels strongly that doctors have the skills to manage complex businesses, but have not always received the most appropriate training and do not always have access to the type of information which would help them the most. Farine is married to Nick Clarke, a consultant old age psychiatrist. They have one son and live in East Sussex.

Laurence Slavin is a chartered accountant and has been a partner with the London based firm Ramsay Brown and Partners for more than 20 years. His practice specialises in advising and working with GPs and GP practices. Currently Laurence's practice has more than 500 GP practices on their books and advises more than 2,500 GPs. Laurence was a specialist advisor to the former NHS Management Executive for ten years, and served as an advisor to the Department of Health sitting on the Pensions Sub-committee during the negotiations over the 2004 New Contract. Since 1989 he has been writing a regular column in GP magazine and Medeconomics, advising GPs on financial and practice management. Laurence lectures regularly to GPs, practice managers and GP registrars on matters of personal and practice finance in both the United Kingdom and overseas. He has appeared as an expert witness in a number of legal civil actions involving GPs. Laurence is married to a GP and has four children and a giant schnauzer named Hector.

Chapter 1

The Business as an Organism

The Green practice used to be a successful five-partner practice led for many years by the two senior partners, whose main aim was to provide excellent clinical service. As a result the practice expanded rapidly, although the partners showed little interest in the accounts, referring to them as ‘Monopoly money’. At their annual meeting the accountant expressed concern that profits were falling faster than expected. Instead of trying to get to the root of this downward pressure on profits, the partners remained disinterested and continued with their usual drawings. At the following annual meeting, one of the senior partners revealed that the practice funds were exhausted and the bank had recalled the existing overdraft, with no prospect of extending a new one, due to the current economic climate. As a result the partners had to repay six months' drawings and accept reduced continuing drawings. Two partners subsequently resigned. Not surprisingly, the Green practice is now a shadow of its former self.

Dr Stevens was one of a four-partner GP practice in Northampton. Instead of saving money each month to pay his tax, he borrowed the funds whenever this payment was due. In January 2009 he requested the usual finance from his bank manager, but this year, as a result of the economic downturn, the bank refused. Dr Stevens ignored the demands and letters from HMRC and was ultimately bankrupted by them. As a result, he was expelled from his partnership because, by law, he could not be a principal and a bankrupt. Dr Stevens was employed as a salaried GP before finally being made redundant.

The two examples above may seem extreme, but they are both real-life cases, and demonstrate issues which can, to a greater or lesser degree, affect many GPs. In this book the authors will use a range of anecdotes like these to illustrate what it takes to run a successful practice as well as highlighting the pitfalls along the way. The examples given may push the boundaries of credibility, but they are all genuine cases. The names and locations have been changed to preserve anonymity. By drawing on examples in other business disciplines, we aim to arm GPs with additional tools to make the most of their practices. This book explains best practice with regard to accounts, partnerships, staff and competition, whichever government is in power and whatever changes are taking place in the NHS, from the dissolution of primary care trusts (PCTs) to the creation of consortia. The business skills detailed here are eminently transferable across disciplines and economic conditions. GPs can operate as sole traders, partners in a partnership or directors of a limited company, and although the text refers to partners the issues will apply to all roles. Most importantly this book is definitely not a ‘GPs should do this’ or ‘GPs must do that’ title: we feel there is quite enough lecturing in other publications. Instead we hope that, as a specialist GP accountant who has advised thousands of GP practices for many years, and a former GP with decades of experience running commercial businesses at main board level, we have valuable expertise to share with colleagues. Most of all, we hope GPs will enjoy reading this book, benefit from those chapters which are most relevant to them and feel far better informed and equipped at the end of it than they did at the beginning.

Dirty Money or Life Blood?

To many GPs, ‘money’ is a dirty word in the context of professional practice. This is perfectly understandable: after all, the vast majority have grown up in the NHS where best clinical practice, not revenue and profit, governs their professionalism. Even those who eventually work in private practice always put their patients before the profit, and the authors would not have it any other way. However, a healthy practice is not simply one which treats its patients successfully. Indeed a healthy practice, like any commercial business, will be more successful if it manages all aspects of its being, including its staff, buildings, contracts, relationships and, yes, finances at optimum levels. Only by doing this effectively can a practice truly develop, grow and serve its patients to its full potential.

Your practice is a living, breathing organism: it has objectives and purpose, but it also needs a life force to support it. Money represents the blood circulating through the practice: cut off the supply and the practice will die. Ensure nothing is blocking or reducing the circulation and the practice will thrive.

What do we mean by money? When someone says they are making lots of money we assume they are making profits. Conversely, when they say they are not making money we assume they are unable to pay their debts, which means, they are insolvent. In this context, money has two meanings, profitability and solvency, and it is vital to understand the difference to maintain a healthy practice. A healthy practice will be profitable and solvent. An unhealthy practice will be profitable and insolvent, or unprofitable and solvent, or, worst of all, unprofitable and insolvent.

No business dies because it is unprofitable; it dies because it is insolvent. If, for example, it is unprofitable but is still solvent, that is, it can still raise funds, it is sick, but it is not dead. However, if that business has a number of creditors and the bank calls in its overdraft facility, then it will switch from being unprofitable and solvent to unprofitable and insolvent, at which point it will die. This is what happened to the Green practice. If a company cannot pay its bills, a creditor can petition for it to be put into liquidation. For professional partnerships, unless they operate as a limited company, the equivalent of liquidation is the bankruptcy of a partner. Both liquidation and bankruptcy have catastrophic results. In the case of the Green practice, the problem only became critical when the bank withdrew the overdraft, effectively cutting off the practice's blood supply and rendering it insolvent. In Dr Stevens' case, it ended a successful medical career and added considerable tensions to his private life.

The Keys to Success

In a successful practice, the following key components work together in harmony:

VisionDirectionDecision makingPartnershipStaffPremisesServicePatients

Your Vision or Mine?

Every component of a successful practice stems from its vision. By vision we mean the aims and targets for that practice and its partners. These may be long term, for example doubling the practice size over the next five years through a combination of acquisition and organic growth. Or they may be short term, for example introducing a specialist facility or extending an existing building within six months. Of course many practices will have a combination of long and short term visions, and, as with any business, these will require review and revision from time to time, depending on progress and changing circumstances. There are no hard and fast rules governing visions, except perhaps that they should be shared and documented. The worst thing would be for three partners in a practice to be dreaming of three quite different aims in isolation in their individual consulting rooms. This makes the likelihood of success rather slim.

The practice vision may come from all the partners or just one person. But, if there is nobody with vision, the business will be devoid of direction, and without a direction the partners and staff will work in a vacuum, unable to prioritise and coordinate with each other to achieve the same goals. Therefore every practice will benefit from identifying those individuals who are visionary, without automatically assuming that this person is the senior partner:

Dr Collins, aged 43, and Dr Graham, aged 29, were part of a well respected, successful surgery that was run by Dr Smythe, an autocratic but extremely talented senior partner. When Dr Smythe died suddenly aged 55, Dr Collins automatically took over the ‘senior’ role including the financial and directional responsibilities. He was preoccupied with detail, spending extraordinary amounts of time preparing schedules of the practice expenses, and analysing invoices from each and every supplier. He was troubled by making claims to the PCT unless he was satisfied the content was complete and correct, and referenced back to the original work done in the practice. But Dr Collins never stepped back to take a strategic, long term view of his practice. At the same time Dr Graham generated 80% of the practice work. Within a year of Dr Smythe's death, the practice was in debt and unable to service its bank overdraft. Dr Graham, who was unaware of the severity of the situation, was horrified when the bank asked both partners to take out second mortgages on their homes. He held an emergency meeting with the bank manager in which he explained how the practice had been working. As a result, he dissolved the partnership and set up on his own without a second mortgage. Dr Graham now runs a successful practice with two new partners, while Dr Collins barely manages to stay afloat.

Vision alone is not enough for success. Indeed, those without vision will still have very important qualities which are vital for a practice. Success requires a balance of partners, each playing to their individual strengths. A business full of visionaries will fail if it is unable to manage those visions when they become reality:

The Black practice had four visionary partners and an equally visionary manager. As a team, they had no difficulty agreeing and executing their aims, meaning the practice expanded rapidly by taking over a number of local surgeries. Their size doubled, but their profits fell. When this was investigated, it turned out that none of the partners, or the practice manager, took an active interest in running the new surgeries post acquisition. They had not even visited any of the new sites, which were left to manage themselves. No effort was made to boost morale or control costs. In the end, the acquired practices were disbanded and the patients dispersed to neighbouring surgeries.

When commercial companies make acquisitions, they go through a vigorous process involving business plans, due diligence and, as importantly, a post-acquisition consolidation plan. In these plans the methods by which the new business will be incorporated into the existing one are set out in detail. Cost savings are identified together with the timescale for executing them, as well as opportunities for further growth. Above all, the individuals who will carry out the consolidation process are clearly identified and charged with this responsibility. This is because what can be achieved on paper is often different when it comes to the reality of encouraging new and old staff with differing working practices to work together to deliver the plans. GPs may be a unique group, but the principles governing the consolidation of two companies are the same for any business.

You go in that Direction and l'll go . . .!

All practices both have and need a direction. A practice may go round in circles, but it still has a direction, albeit one which drains its energy without taking it forward.

Everyone involved in the practice needs to know where it is going and why it is going there, together with some idea of the method and timescale. Mission statements are somewhat clichéd, but nevertheless without direction a practice will never achieve its goals:

Partners at the Blue practice had two issues: they owed their ex-partner Dr Hill £100,000 to buy her out of the premises, and they also wanted to expand their activities. As a result they swung from negotiating with Dr Hill to searching for new premises, but never in a co-ordinated fashion. The partners remained stuck in this hopeless position for more than five years without resolution: Dr Hill continued to demand her money, while the premises were increasingly unsuitable and limiting. If the partners had written a plan, together with a realistic timetable to achieve both aims, they would have avoided this impasse.

Can We Decide Who's Making the Decisions?