This article first appeared on 12.5.09 on digitalhealth.net.
General practice is a business and I get annoyed when the press talks about GP salaries. We don’t get a salary. Partners are exactly that; a profit share partner in a business in which the magic equation is Income – Expenses = Profit.
General practices receive income from the NHS for providing services and from some non-NHS sources for things like insurance medicals and travel vaccines. A practice that has lots of income and few expenses makes a lot of profit and this is spread among its partners.
However, some practices do better than others and this is partly down to their enthusiasm for the business side. Meanwhile, expenses eat into any profit. Leaving the lights or computers on at night costs me money; real money. I actually take home less to live on each month if this happens.
Now, I could do a column on software that turns itself off at night and on low energy light bulbs. But having illustrated my point, I really want to talk about how general practice IT is concentrating too much on delivering government targets and not enough on improving our business effectiveness. I would also like to point out to IT companies there may be a gap in the market.
To be clear, I am not saying that good clinical care is unimportant. And most of the existing computer suppliers could rightly say that they reacted to the government’s Quality and Outcomes Framework and that this helped GP income. However, within the National Programme for IT in the NHS there has been little emphasis on software to help the business.
For example, I know of no good stock control software. My surgery is large; we have at least 25 consultation rooms that house doctors and nurses. They all have drugs, towels, gloves, couch rolls, soap and forms in them – and don’t forget the vaccines.
Most of the treatment rooms are over-stocked, as we tend to buy in bulk when we can, in the hope we can use stuff before it goes out of date. This represents a large capital expense that may not be needed.
I can’t believe a hospital does this on paper. My local corner shop has a bar code reader and a database that tells it when it is running low on something. Supply chain logistics is one of the great-unsung heroes of retail. I can’t believe that there isn’t a profit to be made here for a company that provides a stock control solution – perhaps linked with a bulk purchasing deal for practices signed up to the scheme.
Another example is staff. Most of the appointment systems I have seen are good at booking appointments. Some of the clever ones have all sorts of clever filters to find the next free appointment by doctor, nurse, type of clinic and so on. They offer online booking and text reminders.
What they aren’t as good at is producing reports on business or staff performance in a pre-determined, useful way. We use a stand-alone system that I consider to be one of the best on the market, but even this requires a lot of user effort.
At a recent cross-provider event, the managing director of my local community provider unit bemoaned the lack of information he had about what his staff were actually doing – or even know how many district nurses he had working at any one time.
He complimented general practice on our data; but I don’t feel I know that much, either. Why isn’t the appointment system linked to the payroll? The two often don’t seem to match up – but they should.
I would like to know – without spending hundreds of hours analysing data – things like which clinic is always under-booked and can be cut, which clinic always under-runs so we can reduce it and fit something else in, and which is always over-booked and needs expanding.
I am sure there are all sorts of other things I haven’t even thought of. Basically, I want an appointment system that acts as a business consultant and advises me where things are going wrong or where opportunities to make savings lie.
I would also like to explore linking appointments to disease. Then I could easily see things like how many post-op wound dressings are done in our treatment room and bill my local hospital for doing its work.
I would like to see pathways linked to patient journeys – with outliers highlighted. For example, why has one patient attended 30 times about hypertension, when on average such patients attend twice a year? Is this a difficult case that needs a referral – or does a junior member of staff have a learning need?
I am interested to hear of providers’ solutions. This may all seem a bit control freaky to some, but my profits have gone down the last two years because of government funding cuts; and it’s time to deal with expenses seriously.