Simon Appleyard, senior area manager at Wesleyan, discusses financial liabilities for practices and networks and how to manage these risks.
Good people doing good work is essential to any enterprise or organisation and Primary Care Networks (PCNs) are no exception.
Recently, networks have increasingly been moving from a contractor model to a value-based model, focussed on attracting – and, crucially, retaining – the right staff. Offering the right level of pay and benefits is a key differentiator.
And while pay and ‘perks’ have always been central to getting the right people and keeping them, increasing salaries and offering extra benefits, like enhanced sick pay, also creates new financial liabilities for practices and networks – liabilities that they will need to plan for and manage.
The challenge ahead
PCNs have funds available to help increase their collective workforce through streams such as the Additional Roles Reimbursement Scheme (AARS).
As networks have grown and developed, they are using these to hire the very best staff they can – supporting delivery of the highest quality patient care, but often simultaneously increasing their overall staffing costs against what is ultimately a capped NHS budget.
The challenge comes when a members of PCN staff – whether a role funded by the AARS, or otherwise – are off ill, and practices or the network needs to cover their responsibilities.
In these cases, management teams across the network will have two options – they can either hire in temporary cover, or ask other members of practices’ staff to step in.
For some networks, staffing costs will be such that they have very limited headroom within their budgets to cover the cost of hiring replacements. This risk is heightened during periods when multiple members of staff go on leave at once.
The money will, however, need to come from somewhere, and could ultimately end-up being paid for from a practice or partnership’s own pocket – reducing profitability, and potentially reducing budget available for other business costs.
On the other hand, if a practice tries to fill an absence by having another team member cover, they immediately create a capacity pressure, and a similar requirement to hire extra resource to help shoulder the covering individual’s workload.
Where a GP, for example, needs to step in to cover a another serving in a PCN clinical director role, this could mean hiring a locum to help meet the doctor’s contracted number of sessions – another cost that the practice, and network, needs to manage.
The first step to addressing this financial risk is to have a thorough and up-to-date view – across a practice, and a wider PCN community – as to the full financial liability that hiring new staff will pose.
This will allow practices to adequately anticipate and plan for instances were staff are ill or on leave – ultimately, helping them make the most of the staff funding available, while minimising the risk that by doing so they’ll be financially caught out.
In a PCN setting, these discussions should include conversations about which practice – whether the lead or otherwise – is responsible for which shared network employees in cases of absences.
Considerations like this can be set out in a PCNs network agreement. Doing so will give clarity to all involved and help the network better plan for any financial or operational hits.
Practices could also consider insuring the risk. For example, at Wesleyan, our Primary Care Network Protector solution has been designed especially to mitigate against the financial risk of staff illness.
It makes regular benefit payments to the network if a member of the plan is unable to work because of illness or incapacitation – protecting against network members needing to fund any cost of hiring replacement, or paying for extra staff hours, themselves.
However you choose to manage the risk, seeking support from a financial adviser who understands the challenges your practice and network faces will be invaluable.
They can help build factors such as staffing risk into network agreements, and identify what financial products – like insurance – are right for your specific circumstances.
For more information you can speak to a Specialist Financial Adviser from Wesleyan Financial Services as part of a no obligation financial review.