Practice Managers – How Well Can You Juggle?

The modern day Practice Manager has to be able to have a level of expertise in a vast array of varying, complex and sometimes difficult areas.

It is sometimes forgotten how much more demanding a current Practice Manager’s responsibility has become compared with ten to fifteen years ago.

So, does that mean that the sole responsibility lies with your Practice Manager, or are there areas that could be delegated to another member of staff, or even an outside provider?

I thought I would spend some time looking at the different functions a Practice Manager has under their remit and what I think are the common pitfalls and whether it would make sense to get outside help.

Staff Payroll

There are several issues with payroll that are new and a lot more complicated than before. Pension deductions are tiered for the employee’s rate but, for non-GP members of staff, this tier rate is based on whole time equivalence rather than just salary.

Salaried GPs’ deductions are not dealt with on the normal monthly GP1 return, as deductions are taken via the monthly statement on Open Exeter. These are now not reconciled until a salaried GP completes an annual Type 2 pension certificate and that is processed by PCSE. (I am not sure which would take a Practice Manager longer - to convince a salaried GP to complete the certificate or to ensure that PCSE process it?).

Maternity Leave is another area of complication for pensions as EE’s contributions are based on actual pay, whereas ER’s contributions are based on pay continuing at the pre-maternity leave level.

Real Time Information means payroll has to be processed in a timely fashion and there are deadlines and fines for late submission or errors.

Overtime, Annual Leave, etc. - do you keep a record of this (or is it scribbled down on an envelope to be added each month?). How is it authorised? Who is in control? Payroll expenses probably make up 50% of the practice expenses, so keeping track of who gets what is really important.

Delegate? I would absolutely advise practices to find a payroll agent who can perform this task for you as the complexities and variations are so difficult to keep up with that a small monthly cost is worth the time that will free up your Practice Manager.

Bookkeeping

Some practices are up-to-date and keep on top of recording their financial information, whereas others save everything up for an annual assault on the paperwork. Other than looking at the bank balance, how do you know how the practice is doing apart from when you get your annual accounts?

Are PCSE being chased for outstanding income; have the cleaners been paid twice for a month; has the annual CQC fee been reimbursed?

It would be a lot easier if the practice bookkeeping was kept up-to-date to answer all of these questions. Some Practice Managers have their own systems for recording things, but to be able to tie things back to a physical receipt or payment at a bank account is always the best way to record everything.

Even if you are not concerned about knowing how your practice is doing periodically, there is a new system called Making Tax Digital that means HMRC are looking to receive information from you quarterly, rather than just the annual tax return. This is like Real Time Information in payroll, therefore you will need to keep records up-to-date throughout the year in order to report these to HMRC.

Delegate? If, as a Practice Manager, you are comfortable with financial information and recording it, then it may be that you just need some support and training so you get onto the right accounts package and use it to monitor everything that you probably do in other ways now. If looking at a spreadsheet is your idea of torture, then a cloud-based package and a bookkeeper to whom you can just email invoices and remittance advices may be a good option.

Accounts

Dealing with us at Ramsay Brown seems to be some Practice Managers’ idea of torture. Maybe not dealing with us, but the annual email from us regarding beginning the accounts preparation is sometimes a cause for major concern.

It should not be, as we are aware of how busy Practice Managers are, but it would be easier to break things down rather than have the annual day of hunting down all of the paperwork. The things we really need are items you should have access to relatively easy, so once your year-end comes, you could put them all in a folder and send them to us via our portal.

All we need to get started is your bank statements, monthly payroll summaries and Open Exeter statements. With those, we can at least get started and it will cover your biggest expense (payroll) and your biggest provider (CCG). Obviously, a cashbook or accounts package reconciled to your year-end would be a good start as well, but we understand that sometimes takes longer.

HR

A modern minefield to ensure that everything you should be doing, you are doing, to ensure your contracts are correct and up-to-date as well, as reflecting what you want them to.

Delegate? Although this is not a full-time role, I would definitely suggest that the practice looks at getting a support package from a specialist HR firm. It is normally a monthly expense, but the downside of not doing things as you should could be huge.

“Filling In”

I thought I would finish with a slightly strange one. There are several practices that I liaise with and the Practice Manager is covering reception, or standing in for the filing clerk due to illness or holidays.

This may seem to be the only option as the need is pressing on that day. However, I feel that forward planning should come into place so there is a plan for scenarios or “what ifs”. If your Practice Manager is covering for another member of staff, then that means their daily work is not being dealt with. If they are like me, then no-one comes and completes this for them, so their work just builds up and things are put off as they are not immediately pressing.

Planning for some eventualities that always seem to crop up will mean that those bottlenecks are avoided and (hopefully) things can run more smoothly.

If you feel that any of the areas above are giving your Practice Manager or you sleepless nights, then please get in touch with us as we have partners that we work with who can help free up your time to ensure your practice moves forward more smoothly and you can concentrate on what you need to rather than the things that have to be done.