As we recover from the last-minute QOF work to maximise income, we now move on to the new QOF year, and the challenges are just as intense, says FPM's secret diarist and practice manager. 

Staffing

Coping with a 2% increase in the GMS income, but a 9.8% increase in the minimum wage, is a difficult problem.

There is a promise of more money later in the year, but is this any way to run primary care? As a surgery, we try and pay over the minimum wage, and have once again given increases over and above the minimum wage.

We are losing two full-time receptionists who are leaving for several reasons. We have tried to keep them, but it’s clear that the role is stressful and tougher than it has ever been.

Part-time staff do not seem to be as affected, and you can understand the logic of this; who wants to work 8.5 hours a day and put up with the type of unrelenting pressure that now seems common from patients?

When staff say they dread coming to work, and they are leaving not solely for the money, but for their sanity, then there really is a major issue.

I cannot see an answer to this other than to go for more part-time staff, but that then makes staffing reception far more difficult.

As I write this, we have offered employment to two people and hope they are as good as they interviewed.

Physician Associates (PA)

With the current view that PAs should be more regulated, and their duties curtailed significantly, it’s clear that they are going to become a luxury we just cannot afford.

If they are just going to be a glorified HCA for the same salary they are looking for, it is not an effective use of money, and I can see many unfortunately being made redundant in the future.

I understand that there have been issues with some PA, but there are also issues with doctors and nurses and regrettably, that will always be the case.

Of course, as a matter of routine they should be checked in-house and be supervised. But reducing what they can do will stop new people from even wanting to be trained up.

Until the NHS supports its workforce and explains to the patients what different staff can do, we are always going to be in the situation that “I only want to see a GP.”

Finance

So, is this year going to be any easier? Not in my view. Primary care always seems to be the poor relation. There has been money found to fund a substantial increase to hospital consultants, and yet next to nothing for Primary Care. In real terms, income is going down and I foresee many practices either having to shrink or go out of business.

Practice Learning Time

During our monthly afternoon closures for Practice learning time, we have been experimenting with making the first item on the agenda a cross-team topic aimed at team building. If you have not tried this, I really recommend it as it can be fun. This month I asked a simple question to the thirty people present. “If you were to take part in an Olympic event, what would it be and why?”

I kicked off the answers with my choice, it being a running event as it reminded me of many years ago at school. I didn’t like sports, so I opted for cross-country running, and as I was so bad I did the shorter run.

However, in those days the public buses had a rear entrance and if we timed it right, we could jump on for a short distance and then jump off further down the road, and nobody found out.

This of course broke the ice in the meeting, and everyone contributed, some serious and others with funny reasons. The exercise was no more than 10/15 minutes, but it relaxed everyone and broke down barriers.