Webinars
Structured Chronic Disease Management Programme (2023 - Foundations)
Start here if you’re new to CDM.
Our 2023 webinar on the Structured Chronic Disease Management Programme covers the key foundations and is a useful introduction if you're just getting started or still finding your feet.
If you're already familiar with the basics, check out the updated 2025 webinar which builds on this and covers recent developments.
Delivering CDM with Confidence: From Eligibility to Income
Chronic Disease Management (CDM) doesn’t have to be complicated.
Join Rachel & Siobhan for a practical session that breaks it down step by step – helping you and your team feel confident in delivering CDM that works for your patients and your practice.
You’ll come away with a clear understanding of eligibility, review requirements and how to streamline your processes – from setting up recalls to tracking income.
Whether you're just getting started or looking to fine-tune your approach, this session will give you the tools to make CDM easy to implement, impactful and financially sustainable.
After this session, you’ll be able to:
Identify which patients are eligible for each programme
Get eligible patients started on the right programme and keep their reviews on track
Understand what’s needed at each review
Submit & track claims with confidence
Set up a recall system that runs smoothly
See how CDM can support the financial health of your practice
Take practical steps to embed CDM in your practice’s day-to-day workflow
Preventing Spread of Infection in Your GP Practice
Infection prevention is a daily responsibility, but it can feel overwhelming without clear systems.
This practical session with Ann Higgins from Medical Audits will:
Walk through the HIQA Infection Prevention & Control standards in the context of everyday general practice
Provide tips on auditing your practice environment
Explore how to engage your whole team – making infection control a shared responsibility, not just one person’s job
Healthy Practice in Focus - Systems, Finances, Teams (Panel, GPPA Summit 2025)
In the years ahead, demand for GP consultations is projected to rise by 30%, with over a thousand extra GPs and 800 nurses needed. At the same time, more structured care is being shifted into primary care and digital transformation is accelerating.
Against this backdrop, our theme this year is the Healthy GP Practice – and just like patient health, it’s never about one thing alone. For patients, physical, mental and social health are inseparable; for practices, it’s systems, finances and teams.
Each pillar strengthens the others – and if one falls behind, the whole structure is weakened. And that’s what we are going to talk about today!
You Can’t Pour From An Empty Cup: Why Practice Health Starts With You - with Tara Rafter (GPPA Summit 2025)
This session shows why your own wellbeing sets the tone for the entire practice. Tara looks at capacity, neurolinguistics and the habits that help you steady your mind, protect your energy and lead with clarity.
It’s a straight, honest look at what it takes to stay resourced so you can support others without running yourself dry.
Practice Management Progress: The Power of Proactive Leadership
This recording from the GPPA Summit 2024 captures a dynamic panel discussion featuring practice managers in conversation with Rachel Bothwell. It explores the value of community and the importance of investing in learning and development for practice managers. The conversation highlights how proactive leadership fosters collaboration, supports staff growth and strengthens GP practices.
Optimising the 2023 GP Agreement:
Effective Implementation & Winter Planning
Date: Wednesday 14th August, 13.00-14.00
Presenters: Rachel Bothwell & Siobhan O’Neill (GP Practice Ally)
This GPPA Premium webinar aims to summarise the changes introduced since the 2023 GP Agreement between the HSE and the IMO one year ago, and to highlight strategies for maximising these changes and leveraging winter opportunities like vaccine clinics.
After this webinar, participants will:
Understand Key Changes: Gain a comprehensive understanding of the changes implemented since the 2023 GP Agreement between the HSE and the IMO.
Implement Strategies: Learn effective strategies to maximise these changes to enhance practice efficiency and patient care.
Prepare for Winter: Be equipped with knowledge on how to leverage winter opportunities, such as optimising vaccine clinics.
Clarify Doubts: Have their questions addressed through an interactive Q&A session, ensuring clarity on the practical applications of the 2023 GP Agreement changes.
2023 GP Agreement: Navigating the Changes
Check out our webinar on the new 2023 GP Agreement on Wednesday 12th July.
The aim of this webinar is to summarise and explain the impact of the new 2023 GP Agreement between the HSE & the IMO. At the end of this webinar you will be aware of the changes coming with this new deal and know how to analyse the impact on your practice.
Content:
Additional DVC
Under 8s - Extension of free GP care to children aged 6 & 7
Households below the median incomeLimits on HSE panel assignments
Capitation Increases
Contraception – Extension of Universal Scheme & LARC STCs
CDM Expansion
Changes to Practice Subsidies
Increases in amounts reclaimable
Inclusion of Employer’s PRSI
Recognition of prior nursing experience
New calculation method
New recurrent practice staff subsidy grant
New grade/role
Staff maternity subsidy
Check out the resources below.
Optimising Practice Management with PCRS GP Suite
The aim of this webinar is to empower practice managers & practice teams to maximise the potential of the GP Application Suite, improving operational efficiency, financial management and compliance.
At the end of this webinar, you will:
Understand the key functionalities of the GP Application Suite and how they benefit practice operations.
Confidently navigate the system to streamline claims, manage patient eligibility and handle capitation processes.
Apply actionable strategies to optimise financial management, ensuring accurate subsidy capture and compliance.
Enhance overall practice efficiency through effective use of the suite's tools.
PCRS Year-End & GMS Entitlements:
Maximising Grants, Subsidies & Supports
This webinar is designed to empower GP practices with the knowledge and tools to maximise funding, optimise revenue, and enhance long-term sustainability.
Join Siobhan & Rachel for a practical, results-driven session on navigating year-end procedures and leveraging financial supports effectively. You’ll gain actionable insights to strengthen compliance, secure all available revenue, and improve operational efficiency.
What You’ll Learn:
Maximise PCRS claims & subsidies to ensure your practice receives all eligible funding
Boost revenue through smarter panel management and funding strategies
Enhance compliance with structured claiming and accurate record-keeping
Leverage GP Suite tools to streamline entitlements and prevent revenue loss
Identify untapped subsidies and plan for future grant opportunities
Key Focus Areas:
How to Maximise Entitlements & Supports
GMS Entitlements:
Leave & Indemnity Refunds
Practice SubsidiesCDM Nursing Grant
Other Grants
Strategic Approach to PCRS Year-End & Grant Planning
This session will provide practical steps and expert guidance to help your practice maximise financial opportunities and secure its sustainability.
Professional & Regulatory Responsibilities for Clinicians:
What Practice Managers Need to Know
Led by Suzanne Creed from Medisec, this session is designed to equip practice managers with a clear understanding of the professional and regulatory responsibilities that apply to clinicians working in general practice.
With this knowledge, managers can provide effective oversight, ensure compliance and offer meaningful support to their clinical teams.
Learning Objectives
By the end of the session, participants will be able to:
Understand the core professional and regulatory frameworks that clinicians must adhere to in general practice
Recognise common areas of compliance risk and how to proactively manage them
Apply practical strategies to support clinicians in meeting their professional obligations
Develop effective internal systems to monitor adherence to clinical guidelines and regulatory requirements
HR Management
To have effective human resource management, every practice should:
Develop written job descriptions that clearly outline staff roles, responsibilities and conditions of employment.
Have an induction system to orient new staff members to the practice’s specific systems.
Clearly identify who has primary responsibility for quality improvement and risk management.
Clearly identify who has primary responsibility for the investigation and resolution of administrative and/or other complaints.
Hold regular practice meetings where involvement and input from all team members is encouraged.
Have a system to review staff performance against their job description.
Observe and adhere to employment legislation.
Consider appointing a GP partner to be responsible for HR matters.
Job Analysis
Practices should regularly review their staffing situation and consider the workflows and roles of each department and staff member. The need for increased staffing can be an opportunity to review and reorganise existing positions and workflows.
Conducting a Job Analysis
Analyse the role by considering:
What are the needs of the practice?
Who would best meet these needs?
Does the role need to be simplified, enlarged, split or redesigned?
What tasks could be organised more effectively?
Could the role be filled with existing staff changes?
What training would existing staff require to fill the role?Write a detailed job description and competency profile
Job Descriptions
All job descriptions should detail the purpose, tasks, skills, qualifications, experience and responsibilities required for the job. Each job description should include:
Job Title
Person/role this position reports to
e.g. Receptionist to Practice Manager, Nurse to GP PartnerPurpose
Describe the objectives of this position in one sentenceDuties, tasks & responsibilities
Use specific active verbs, e.g. ‘answering phones, making appointments’ instead of ‘dealing with patients’Essential skills, qualifications and experience
e.g. Registration boards that maintain competency standards (An Bord Altranais, Irish Medical Council, ICGP)Desirable skills, qualifications and experience
For sample position descriptions, see Practice Roles.
Competency Profile Framework
We have developed a competency framework for all general practice staff to develop job descriptions, selection criteria, interview questions and performance appraisals:
Communication & interpersonal skills
Teamwork & collaboration
Judgement & problem-solving
Planning & organising
Self-management
Clinical governance
Professional & technical expertise
Professional development
Each competency is explained in more detail below and can be adapted to each position accordingly (see Practice Roles).
Communication & interpersonal skills
The ability to listen, interpret and convey information in a clear, timely and accurate manner, and select the most appropriate method of communication.
The ability to deal effectively with others on a personal level, maintain trust and confidentiality, remain calm and professional under pressure and act fairly in all interactions with genuine empathy.
Teamwork & collaboration
The ability to collaborate and work within a team environment, assist and involve others, value the contribution of others, and coordinate tasks with team members.
Judgement & problem-solving
The ability to anticipate, identify and analyse issues, consider options, develop solutions and decide on the most appropriate solution to achieve the desired outcomes, and implement and monitor the solution to ensure its effectiveness.
Planning & organising
The ability to look ahead, develop strategies, consult with others, establish priorities, schedule work and coordinate with others in a logical order, manage own time, accurately allocate resources.
Self-management
The ability to adapt to change, take responsibility for own tasks and performance, self-motivate and take initiative.
Clinical governance
A commitment to maintaining and improving the quality of patient care and safety, taking a patient-centred approach and following clinical standards and practice policies.
Note: All general practice staff are accountable for patient safety and the quality of patient care on some level. Clinical staff hold more responsibility, however reception staff also need to be aware of critical symptoms and risk, and know what procedures to follow in the case of an emergency.
See more on the principles of good clinical governance in the HSE’s clinical governance framework here.
Professional & technical expertise
The ability to apply appropriate expertise, skills and knowledge to achieve required work outcomes.
Professional development
Clinical staff must have a long-term commitment to learning and maintenance of continuous professional development (CPD).
All staff must be willing to learn and develop new ways of working to adapt to the rapidly changing environment of general practice.
Recruitment & Selection
When recruiting for a new staff member, the following steps should be considered:
Advertise the role
Consider the Employment Equality Acts 1998-2015, being mindful to avoid any wording that could be considered discrimination
Specify essential qualifications/experience (e.g. registration with An Bord Altranais, 5 years nursing experience) and other desirable qualifications/experience (e.g. cervical smears, mid-wife, two years’ nursing experience in general practice)
Advertise on popular general practice sites (such as GP Practice Ally, GP Buddy, ICGP, Irish Medical Times), local papers and online (sites such as Indeed.com are useful for screening applicants)
A standard application form can be useful to compare and contrast applicants (again this is easier on online platforms)
Selection
Filtering of applicants can be done through online system as above
Initial phone interviews can reduce time required on formal interviews
Interviews
Write specific interview questions focusing more on experience and less on hypothetical situations
Develop a scoring system to rate responses fairly (a written scoring grid for each member of the panel is useful)
Chose a panel for interviews (e.g. practice manager, GP partner, nurse manager)
Conduct all interviews in same format, over same amount of time
Panel should discuss each candidate immediately after the interview and finalise ratings
Retain all interview notes/scoring records for 12 months (as applicants have 6-12 months to raise a discrimination claim it is essential to keep records of fair recruitment processes)
Trial
Where possible, test the potential employee’s ability to perform tasks by doing a trial session (e.g. observing someone answering phone calls or dealing with patients at the front desk would be an appropriate test for a receptionist)
Check references
Contacting references by phone is often more informative than reviewing a written reference
See Employer Obligations for information on contracts and more.
Induction
It is important to have an induction system to ensure all new staff are integrated effectively into the practice. Steps can include:
Pre-arrival
Send all relevant documentation (statement of core terms, contract, employee handbook, personal information forms for payroll etc)
You may also wish to send an orientation document in advance in relation to the core systems in the practice
Particularly relevant to GP locums, who will be expected to hit the ground running on their first day. See downloadable example at the bottom of the page.Arrange for appropriate IT access (practice management system login, Healthmail, Healthlink etc), keys, other administrative requirements.
It is really helpful to have a simple checklist to complete when you have a new GP locum or registrar starting in the practice. See an example below (downloadable template at the bottom of the page).
On Arrival
Check all forms are completed and signed
Discuss job description, hours, probation period to ensure understanding
Complete orientation tour, showing toilets, facilities, treatment rooms etc
Discuss staff uniforms/appearance, expected behaviours (such as washing own dishes in staff kitchen)
Demonstrate use of office equipment
Assign a clinical staff member to demonstrate use of clinical equipment
Explain processes and procedures of the practice (giving written procedures where possible) and what to do in an emergency
Reinforce confidentiality requirements of the role
Follow-up
Meet weekly for initial month to assess performance, discuss issues and observations they have had that could improve the processes, role or environment
Meet monthly or quarterly during probation period to review performance
Consider further training requirements – informal & formal
Documents
New GP Orientation (PDF)
New GP Orientation (Editable - Word)
New GP Checklist (PDF)
Practice Staff Roles in General Practice
Check out the recording of our webinar 'Practice Staff Roles in General Practice' from 28th September 2022.
Role of the Medical Receptionist/Administrator
The level of administration required by individual practices can vary. Some will have dedicated receptionist and administrative roles, others may combine the role. In many practices, the practice manager will also delegate tasks to the administration staff.
Practice Receptionist/Administrator - Position Description
Job Title: Practice Receptionist/Administrator
Reports to: Practice Manager
Purpose: To provide accurate and timely administrative support and an empathetic and efficient first point of contact experience for anyone accessing the practice, ensuring that everyone is acknowledged in a professional, friendly and helpful manner.
Duties:
Note: The duties undertaken by the practice receptionist/administrator can vary greatly between practices. List relevant duties as required and include below clause:
In addition to your normal duties, you may be required to undertake other duties appropriate to your position and in line with your level of competency.
Duties may include:
Reception
Ensure all visitors and callers are acknowledged promptly in a courteous and professional manner. Confidentiality must be maintained at all times.
Receive patients and record their attendance
Answer the telephone and screen calls
Record and convey messages, transfer calls appropriately
Schedule patient appointments
Provide information on the practice
Oversee the waiting area
Manage email communication
Process and respond to requests for information, repeat prescriptions and medical certs
Financial
Manage charges and payments and ensure same is entered on the system and balanced daily. Ensure that all billing of patients takes place on a prompt and regular basis and all patient accounts are kept up to date.
Process charges
Collect and record payments
Bill patients according to practice billing procedure
Daily reconciliation of cash
Collect/manage STCs
Office
Perform administrative duties in a timely manner as required, ensuring that the reception and waiting areas are kept tidy and clean.
Maintain and manage patient records, including GMS panel management
Scan, file and shred documents
Handle incoming and outgoing post and communications
Type documents such as medical reports, referral letters
Maintain stock of forms and office supplies
Key Competencies
Communication & interpersonal skills
Demonstrate high level communication and interpersonal skills, remaining calm and professional under pressure.
Communicate effectively with other organisations to coordinate patient care.
Maintain trust and confidentiality with all stakeholders, using discretion when dealing with sensitive information.
Planning & organising
Multi-task and prioritise with meticulous attention to detail.
Maintain accurate documentation using practice management system, IT and information management procedures, including recall/reminder systems.
Implement accurate claiming and billing procedures to ensure practice viability.
Manage supplies and resources within budget.
Teamwork & collaboration
Demonstrate a high level of team work, support, engagement and communication with the practice team.
Work as an inclusive member of the team, providing appropriate mentoring and guidance for registrars, medical students and other staff.
Judgement & problem-solving
Identify critical issues, consider options and develop practical solutions.
Decide on appropriate solution, implement and monitor effectiveness.
Self-management
Adapt to change willingly and effectively.
Take responsibility for own tasks and performance.
Act with confidence without direct supervision.
Additional Competencies
Professional & technical expertise
Operate practice management software effectively.
Operate Microsoft Office applications effectively (Word, Excel, Outlook).
Operate phone system effectively.
Clinical governance
Demonstrate a patient-centred approach.
Have an understanding of workplace health and safety principles.
Participate in quality improvement processes with the practice team to bring efficiencies to patient care and practice processes and procedures.
Personal Development
Willing to undertake professional development as required by the practice.
Selection Criteria
Note: To be set according to individual practice requirements, examples below.
Essential
Working knowledge of Windows-based software systems (e.g. Word and Excel)
Strong computer literacy
Excellent communication skills, written and verbal
Desirable
Previous experience in a busy medical reception or similar administrative position
Previous experience with practice management software (name)
An understanding of the GMS system
An understanding of medical terminology, medical and health professional organisations and relevant stakeholders
Documents
Practice Receptionist/Administrator - Sample Position Description (PDF)
Practice Receptionist/Administrator - Sample Position Description (Editable - Word)
Practice Receptionist/Administrator - Sample Professional Development Plan (PDF)
Practice Receptionist/Administrator - Sample Professional Development Plan (Editable - Excel)
Practice Receptionist/Administrator - Sample Interview Questions (PDF)
Practice Receptionist/Administrator - Sample Interview Questions (Editable - Word)
Role of the Practice Nurse
General practice nursing is a very varied role. In addition to providing clinical patient care, the practice nurse has a vital role in preventative care through patient education, health promotion and infection control.
Your practice demographic profile may influence the focus of your practice nurse role. For example, mostly:
Elderly: chronic disease management, smoking cessation, phlebotomy, wound management, weight management
Young adults: family planning/contraception, ante/post-natal care, travel health & immunisations, cervical screening, sexual health screening
Children: childhood immunisations, asthma management
Practice Nurse - Position Description
Job Title: Practice Nurse
Reports to: GP Partner
Purpose: To provide clinical patient care, screening and immunisation services, patient education and assist in the management of chronic disease in the practice population.
Duties:
Note: The duties undertaken by the practice nurse can vary based on the skills of the nurse and the size, location and demographics of the practice. List relevant duties as required and include below clause:
In addition to your normal duties, you may be required to undertake other duties appropriate to your position and in line with your level of competency.
Duties may include:
Clinical Tasks
Phlebotomy
Administration of injections & immunisations
Wound care & dressings
Cervical smears
Ear irrigation
Spirometry
Audiometry
Electrocardiograph (ECG)
Blood pressure monitoring
Application of 24hr blood pressure monitors
Health assessments
Chronic disease management activities
Triage & advice
Patient education & health promotion activities
Minor surgery assistance
Cardiopulmonary resuscitation/basic life support activities
Emergency care
Cryotherapy
Antenatal & postnatal care
STI screening
Methadone maintenance
Occupational health assessments
Administrative tasks
Liaise with other health professionals in the community and hospitals
Co-write and regularly review practice protocols
Conduct audits of patient care and practice services
Sterilise and maintain surgical instruments
Maintain emergency equipment
Maintain treatment room stock & cold chain compliance
Manage practice recall systems and disease registers
Manage infection control
Maintain HIQA compliance
Process repeat prescription requests
Key Competencies
Professional & technical expertise
Demonstrate proficiency in a wide range of clinical skills, in scope of practice.
Demonstrate proficiency in delivering health promotion and preventative care advice and education.
Operate practice management software and other required applications effectively.
Clinical governance
Ensure care is patient-focused and delivered within clinical standards and practice policies.
Maintain awareness of current legislation to ensure compliance with all statutory and regulatory obligations.
Demonstrate understanding of workplace health and safety principles.
Ensure quality systems and procedures are in place and reviewed regularly.
Participate in quality improvement processes with the practice team to bring efficiencies to patient care and practice processes and procedures.
Professional development
Undertake continuing professional development in line with national registration requirements.
Communication & interpersonal skills
Demonstrate high level communication and interpersonal skills, remaining calm and professional under pressure.
Communicate effectively with hospitals, community agencies and laboratories to coordinate patient care.
Maintain trust and confidentiality with all stakeholders.
Teamwork & collaboration
Demonstrate a high level of team work, support, engagement and communication with the practice team.
Work as an inclusive member of the clinical team, providing appropriate mentoring and guidance for registrars, medical students and non-clinical staff.
Planning & organising
Demonstrate patient-focused, goal-orientated approach.
Maintain accurate documentation using clinical software, IT and information management procedures, including recall/reminder systems.
Implement accurate claiming and billing procedures to ensure practice viability.
Manage supplies and clinical resources within budget.
Judgement & problem-solving
Identify critical issues, consider options and develop practical solutions.
Decide on appropriate solution, implement and monitor effectiveness.
Self-management
Adapt to change willingly and effectively.
Take responsibility for own tasks and performance.
Act with confidence without direct supervision (where appropriate).
Selection Criteria
Note: To be set according to individual practice requirements, examples below.
Essential
Registered General Nurse with An Bord Altranais
2 years post-graduate experience (example only, some practices may require 5 years)
Desirable
Certificate, Diploma or Higher Diploma in Practice Nursing/BSc Nursing/MSc Nursing
Certificate/Diploma in Asthma/COPD/Diabetes/Heart Disease Care
Certificate in Cervical Screening
2 years general practice experience
Previous experience with practice management software (name)
Role of the General Practice Assistant (GPA)
The role of the General Practice Assistant (GPA) was introduced in 2023 and is claimable under the Practice Support Grant only. Read more here.
According to the IMO, the purpose of the role is to carry out certain basic tasks which would improve patient experience, patient flow through the practice, practice efficiency and free up nurse and doctor time for more clinical tasks.
A non-exhaustive list of the duties and responsibilities that such a role could undertake is set out below. Each practice will have its own requirements but at all times General Practice Assistants will have the necessary training and indemnity for the tasks they are required to do.
Duties and Responsibilities (as set out by the IMO):
observing, monitoring and recording patients' conditions by taking temperatures, pulse, respirations and weight
communication with patients, relatives and carers
assisting with clinical duties
personal care including infection prevention and control, patient communication and overallreassurance, comfort and safety
promoting positive mental/physical/nutritional health with patients
checking and ordering supplies/restocking consultation rooms
covering administrative duties
taking urine samples
sterilising equipment
Documents
Introduction to HR Compliance
Check out the recording of our webinar 'Introduction to HR Compliance' from March 2022.
Please note that there has been some updates to the Day 5 Statement and the Written Statement of Terms (Contract) as set out in the European Union (Transparent and Predictable Working Conditions) Regulations 2022.
These are laid out in the information below and in the Key Workplace & Employment Law Updates webinar.
An employer is responsible for ensuring all their employees receive certain basic employment rights. Although some industries require employers to meet different requirements, the main obligations include:
Written statement of core terms (Day 5 Statement), provided to employee within 5 days of commencing employment
Written statement (Contract) of terms and conditions of employment, provided to employee within 1 month of commencement of employment
Payslip for each pay period
A minimum wage
A maximum working week
Unpaid breaks during work hours
Annual leave from work
Minimum notice period for termination of employment
Maintenance of records relating to each employee and their entitlements
See more on employer obligations:
Workplace Relations Commission: Employment Law Explained and Guide to Employment, Labour & Equality Law
Citizens Information: Employer Obligations
Core Terms of Employment (Day 5 Statement)
You must provide employees with a written statement of core terms within 5 days of the commencement of their employment, as set out in the European Union (Transparent and Predictable Working Conditions) Regulations 2022. Employers face serious penalties if they do not comply.
The core terms that must be provided are:
the full names of the employer and the employee;
the address of the employer or of the principal place of business in the State;
the place of work, or where there is no fixed or main place of work, a statement specifying that the employee is employed at various places or is free to determine his or her place of work or to work at various places;
the title, grade, nature or category of work for which the employee is employed or a brief description of the work;
the date of commencement of the contract of employment;
the duration and conditions relating to a probationary period, if applicable;
the expected duration of the contract, in the case of a temporary contract, or the end date if the contract is a fixed-term contract;
the remuneration, including the initial basic amount, any other component elements, if applicable, indicated separately, the frequency and method of payment of the remuneration to which the employee is entitled and the pay reference period for the purposes of the National Minimum Wage Act, 2000;
the number of hours the employer reasonably expects the employee to work per normal working day and per normal working week;
any terms and conditions relating to hours of work (including overtime);
if applicable, the employer’s policy on the manner in which tips or gratuities and mandatory charges are treated.
Written Statement of Terms (Contract)
The written statement must be provided within 1 month of commencement of employment and include the following:
The full names of the employer and the employee
The address of the employer
The employee may request a written statement of the average hourly rate of pay
Whether pay is weekly, fortnightly, monthly or otherwise*
Terms or conditions relating to paid leave (other than paid sick leave)*
Any terms or conditions relating to incapacity for work due to sickness or injury*
Any terms or conditions relating to pensions and pension schemes*
Periods of Notice or method for determining periods of notice*
A reference to any collective agreements which affect the terms of employment
A reference to any appliable Registered Employment Agreement (REA) or Employment Regulation Order (ERO) and where the employee may obtain a copy of same
The training entitlement, if any, provided by the employer
If the employee is a temporary agency worker, the identity of the user undertakings
If the work pattern is entirely or mostly unpredictable, the statement must state:
that that work schedule is variable, the number of guaranteed paid hours and the remuneration for work performed in addition to those guaranteed hours
the reference hours and days within which the employee may be required to work
the minimum notice period to which the employee is entitled to before the start of a work assignment and, where applicable, the deadline for notification in accordance with Section 17 of the Organisation of Working Time Act 1997, and
where it is the responsibility of the employer, the identity of the social security institutions receiving the social insurance contributions attached to the contract of employment and any protection relating to social security provided by the employer.
In relation to items marked with an asterisk (*) above, the employer may, as an alternative to providing all the details in the statement, use the statement to refer the employee to certain other documents containing the particulars (see WRC). For example, such reference could be to an Employment Regulation Order, Registered Employment Agreement, or collective agreement relating to the particular employment involved: however, the separate documentation referred to should be readily accessible to the employee for reference purposes.
Additional Terms the Practice may want to consider including in the contract:
Deductions
Confidentiality
Indemnity (required for GP Assistants & all locums)
Required Registrations (An Bord Altranais, Medical Council
The Workplace Relations Commission (WRC)
The WRC seeks to achieve a culture of compliance with employment law, by informing employers and employees of their respective responsibilities and entitlements, and by working in close cooperation with them and their representatives.
Working with individual employers through the WRC inspection process is a key element of checking and ensuring compliance. For more information see An Employer’s Guide to WRC Inspections. The guide is designed to assist an employer to understand the inspection process and prepare for an inspection. A WRC inspection need not be a difficult or onerous event for an employer. Compliant employers, and those willing to become so who cooperate with the inspection process, have nothing to fear. Maintaining the correct records and making them available to the Inspector will help them to establish quickly if an employer’s workplace is compliant, or to provide an employer with the information necessary to become compliant. Areas of non-compliance identified during the inspection process can usually be resolved satisfactorily by communicating and cooperating with the Inspector.
The best way to be prepared for a WRC inspection (expected or not) is to ensure you have the appropriate records in place. You can download a simple checklist below to ensure your records are compliant.
Key Workplace & Employment Law Updates
Check out the recording of our webinar 'Key Workplace & Employment Law Updates' from May 2023.
This webinar outlines key changes to sick leave, remote working & work life balance, transparent and predictable working conditions, probation, and pensions.
You can download the slides here, they have additional information including auto-enrolment pension scheme and new 3 waiting days for illness benefit (no longer 6 days).
An employer is responsible for ensuring all their employees receive certain basic employment rights. Although some industries require employers to meet different requirements, the main obligations include:
Written statement of core terms (Day 5 Statement), provided to employee within 5 days of commencing employment
Written statement (Contract) of terms and conditions of employment, provided to employee within 1 month of commencement of employment
Payslip for each pay period
A minimum wage
A maximum working week
Unpaid breaks during work hours
Annual leave from work
Minimum notice period for termination of employment
Maintenance of records relating to each employee and their entitlements
See more on employer obligations:
Workplace Relations Commission: Employment Law Explained and Guide to Employment, Labour & Equality Law
Citizens Information: Employer Obligations
Core Terms of Employment (Day 5 Statement)
You must provide employees with a written statement of core terms within 5 days of the commencement of their employment, as set out in the European Union (Transparent and Predictable Working Conditions) Regulations 2022. Employers face serious penalties if they do not comply.
The core terms that must be provided are:
the full names of the employer and the employee;
the address of the employer or of the principal place of business in the State;
the place of work, or where there is no fixed or main place of work, a statement specifying that the employee is employed at various places or is free to determine his or her place of work or to work at various places;
the title, grade, nature or category of work for which the employee is employed or a brief description of the work;
the date of commencement of the contract of employment;
the duration and conditions relating to a probationary period, if applicable;
the expected duration of the contract, in the case of a temporary contract, or the end date if the contract is a fixed-term contract;
the remuneration, including the initial basic amount, any other component elements, if applicable, indicated separately, the frequency and method of payment of the remuneration to which the employee is entitled and the pay reference period for the purposes of the National Minimum Wage Act, 2000;
the number of hours the employer reasonably expects the employee to work per normal working day and per normal working week;
any terms and conditions relating to hours of work (including overtime);
if applicable, the employer’s policy on the manner in which tips or gratuities and mandatory charges are treated.
Written Statement of Terms (Contract)
The written statement must be provided within 1 month of commencement of employment and include the following:
The full names of the employer and the employee
The address of the employer
The employee may request a written statement of the average hourly rate of pay
Whether pay is weekly, fortnightly, monthly or otherwise*
Terms or conditions relating to paid leave (other than paid sick leave)*
Any terms or conditions relating to incapacity for work due to sickness or injury*
Any terms or conditions relating to pensions and pension schemes*
Periods of Notice or method for determining periods of notice*
A reference to any collective agreements which affect the terms of employment
A reference to any appliable Registered Employment Agreement (REA) or Employment Regulation Order (ERO) and where the employee may obtain a copy of same
The training entitlement, if any, provided by the employer
If the employee is a temporary agency worker, the identity of the user undertakings
If the work pattern is entirely or mostly unpredictable, the statement must state:
that that work schedule is variable, the number of guaranteed paid hours and the remuneration for work performed in addition to those guaranteed hours
the reference hours and days within which the employee may be required to work
the minimum notice period to which the employee is entitled to before the start of a work assignment and, where applicable, the deadline for notification in accordance with Section 17 of the Organisation of Working Time Act 1997, and
where it is the responsibility of the employer, the identity of the social security institutions receiving the social insurance contributions attached to the contract of employment and any protection relating to social security provided by the employer.
In relation to items marked with an asterisk (*) above, the employer may, as an alternative to providing all the details in the statement, use the statement to refer the employee to certain other documents containing the particulars (see WRC). For example, such reference could be to an Employment Regulation Order, Registered Employment Agreement, or collective agreement relating to the particular employment involved: however, the separate documentation referred to should be readily accessible to the employee for reference purposes.
Additional Terms the Practice may want to consider including in the contract:
Deductions
Confidentiality
Indemnity (required for GP Assistants & all locums)
Required Registrations (An Bord Altranais, Medical Council
The Workplace Relations Commission (WRC)
The WRC seeks to achieve a culture of compliance with employment law, by informing employers and employees of their respective responsibilities and entitlements, and by working in close cooperation with them and their representatives.
Working with individual employers through the WRC inspection process is a key element of checking and ensuring compliance. For more information see An Employer’s Guide to WRC Inspections. The guide is designed to assist an employer to understand the inspection process and prepare for an inspection. A WRC inspection need not be a difficult or onerous event for an employer. Compliant employers, and those willing to become so who cooperate with the inspection process, have nothing to fear. Maintaining the correct records and making them available to the Inspector will help them to establish quickly if an employer’s workplace is compliant, or to provide an employer with the information necessary to become compliant. Areas of non-compliance identified during the inspection process can usually be resolved satisfactorily by communicating and cooperating with the Inspector.
The best way to be prepared for a WRC inspection (expected or not) is to ensure you have the appropriate records in place. You can download a simple checklist below to ensure your records are compliant.
Employee Handbook
The below information highlights some important information on policies to be included in your employee handbook. However, for more information, check out the recording of our webinar 'Introduction to HR Policies & Procedures' with Donna Reilly People & Wellness on 28th February 2024, which highlights key policies included in the handbook.
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An Employee Handbook allows the employer to outline the policies and procedures operating within the organisation in detail and provides a guideline for all parties in dealing with these issues as they may arise.
The following policies and procedures are essential and should be provided to employees:
Grievance Procedure
Disciplinary Procedure
Bullying & Harassment Policy
Equality Policy
Data Protection Policy
Health & Safety Policy (see Health & Safety resources here)
Policies and procedures should be reviewed and up-dated periodically so that they are consistent with changed circumstances in the workplace, developments in employment legislation and case law, and good practice generally. They should be written in a format that is easily understood. Written copies should be given to all employees when they commence employment and changes to any policy or procedures should be communicated to all employees.
Grievance & Disciplinary Procedures
Procedures are necessary to ensure that grievances and disciplinary measures are handled in a fair and consistent manner. Maintaining a positive working atmosphere in the workplace requires that fair procedures are in place and observed.
At all stages of the grievance and disciplinary procedures, the general principles of natural justice and fair procedures must apply, which include:
That employee grievances are fairly examined and processed
That details of any allegations or complaints are put to the employee concerned
That the employee concerned is given the opportunity to respond fully to any such allegations or complaints
That the employee concerned is given the opportunity to avail of the right to be represented during the procedure
That the employee concerned has the right to a fair and impartial determination of the issues concerned, taking into account any representations made by, or on behalf of, the employee and any other relevant or appropriate evidence, factors, circumstances.
Good practice entails a number of stages in discipline and grievance handling. These can include an informal discussion with the practice manager and if unresolved, the matter can progress through a number of clearly defined steps.
One of the most important things about grievance and disciplinary procedures for the employer is to ensure they are followed in all cases. In the case of further proceedings, the employer must prove that they followed fair procedure so it is important to keep comprehensive records at all stages.
Grievance Procedure - Employee issue with Employer
A grievance is any event, condition, rule or practice, which an employee believes violates their civil rights, treats them unfairly, or causes them any degree of unpleasantness or unhappiness on the job. A grievance may also relate to the behaviour of a co-worker. The grievance procedure is a process that enables employees to raise a complaint to their employer regarding treatment believed to be wrong or unfair.
Disciplinary Procedure - Employer issue with Employee
From time to time, an employer may need to address the standards of an employee's performance or conduct in the workplace. The disciplinary procedure aims to help employees whose performance or conduct falls below the employer's requirements to achieve the necessary improvement.
Disciplinary action may include:
An oral warning
A written warning
A final written warning
Suspension without pay
Transfer to another task, or section of the enterprise
Demotion
Some other appropriate disciplinary action short of dismissal
Dismissal
Some points from the WRC Code of Practice:
Generally, the steps in the procedure will be progressive, for example, an oral warning, a written warning, a final written warning, and dismissal. However, there may be instances where more serious action, including dismissal, is warranted at an earlier stage.
An employee may be suspended on full pay pending the outcome of an investigation into an alleged breach of discipline.
Warnings should be removed from an employee's record after a specified period and the employee advised accordingly.
You can read the WRC Grievance & Disciplinary Procedures Code of Practice here.
Equality Policy
The Employment Equality Act, 1998-2015 prevents discrimination on nine grounds and promotes equality. It provides the foundation for a workplace culture of equality.
Discrimination is treating one person less favourably in the workplace than another person on any of the nine grounds:
Age
Disability
Family status
Gender
Marital status
Membership of the Traveller community
Race including nationality
Religion
Sexual orientation
The policy should include:
A commitment to equal opportunity, a clear definition of discrimination and the 9 grounds
Standards for aspects of employment covered by the Employment Equality Acts including:
Job advertisement & recruitment
Working conditions
Workplace culture
Training
Career progression
Pay
Dismissal
Reasonable accommodation of diversity, including disabilities
Steps takes to ensure equal opportunity & upholding of standards
Link to grievance procedure
Read more:
Irish Human Rights & Equality Commission (IHREC), Guidelines for Employment Equality Policies in Enterprises
Citizens Information, Equality in the Workplace
Bullying & Harassment Policy
The employers duties in relation to bullying in the workplace are set out in the Safety, Health and Welfare at Work Act 2005. The WRC Code of Practice sets out these responsibilities in more detail, providing very practical guidance for employers on developing a bullying policy.
The interchangeable use of the words harassment and bullying can lead to a misunderstanding of what each one relates to. They are legally distinct concepts and so a behaviour can be deemed either bullying or harassment, not both. While the Code refers to workplace bullying only and doesn’t include harassment cases, this does not prevent employers from having one policy/document encompassing procedures for processing both bullying and harassment cases.
'Workplace bullying is repeated inappropriate behaviour, direct or indirect, whether verbal, physical or otherwise, conducted by one or more persons against another or others, at the place of work and/or in the course of employment, which could be reasonably regarded as undermining the individual’s right to dignity at work.' - WRC'
Harassment is any form of unwanted conduct related to any of the discriminatory grounds. Sexual harassment is any form of unwanted conduct of a sexual nature. In both cases it is conduct which has the purpose or effect of violating a person’s dignity and creating an intimidating, hostile, degrading, humiliating or offensive environment for the person.' - IHREC
Employers have a duty to prevent behaviour that risks employee welfare, meaning they must take reasonable steps to prevent bullying and respond appropriately to incidents of bullying. In further proceedings, the employer will likely be deemed liable if no steps were taken to prevent such behaviour in the workplace. Therefore, employers should adopt, implement and monitor a comprehensive, effective and accessible policy on bullying at work.
Read more:
HSA & WRC, Code of Practice for Employers and Employees on the Prevention and Resolution of Bullying at Work (2021)
Hours of Work
Statutory Rest Breaks
Employees are entitled to;
A 15-minute break where more than 4.5 hours have been worked
A 30-minute break where more than 6 hours have been worked, which may include the first break
A daily rest period of 11 consecutive hours per 24 hour period
A weekly rest period of 24 consecutive hours per seven days, following a daily rest period
Payment for breaks is not a statutory entitlement.
Maximum Working Week
The maximum number of hours that an adult employees can work in an average working week is 48 hours. The average is worked out over 4 months for most employees. This does not mean that a working week can never exceed 48 hours, it is the average that is important. The 48 hours of work do not include time spent on any other form of leave.
Statutory Sick Pay
The Sick Leave Act came into effect on 1 January 2023. It provides for a statutory sick pay scheme for all employees.
How many days paid sick leave are provided for?From 1st January 2024, the entitlement is 5 days paid sick leave.
In 2023, the entitlement was 3 days paid sick leave.
It is proposed to increase the entitlement to:
5 days in 2024
7 days in 2025
10 days in 2026
These increases will be provided for by Ministerial Regulations in due course.
What is the rate of payment payable to an employee?
Employees are entitled to a rate of 70% of their usual daily earnings up to a maximum of €110 a day for certified leave only.Further details regarding the prescribed daily rate of payment can be found in The Sick Leave Act 2022 (Prescribed Daily Rate of Payment) Regulations 2022.
Who qualifies for Statutory Sick Leave and what conditions apply?
Employees must have completed 13 weeks’ continuous service with the employer before availing of statutory sick leave. The employee must provide their employer with a medical certificate from a registered medical practitioner and the certificate must state that the employee named is unfit to work due to their illness or injury.
The entitlement is triggered by the employee’s first statutory sick leave day. The leave must be in relation to a day or days when an employee would ordinarily work but is incapable of doing so due to illness or injury. The leave can be taken on consecutive or non-consecutive days.
Are there any circumstances where Statutory Sick Leave does not apply?Yes, but such instances are limited; as follows:
An employment contract may provide for more favourable sick leave provisions.
Where an employer provides employees with a sick leave scheme the benefits of which are more favourable.
An employer whose business is experiencing severe financial difficulties may apply to the Labour Court for an exemption to pay sick leave. If an exemption is granted, it will be for a minimum of three months and up to one year.
Do it apply to employees on probation?
The statutory sick pay scheme applies to employees on probation, employees undergoing training and employees employed under a contract of apprenticeship. However, probation, training or the apprenticeship may be suspended for the duration of the statutory sick leave where the employer considers that the employee’s absence from employment while on statutory sick leave would not be consistent with the continuance of the probation, training or apprenticeship.
What employee protections are included?
Employers are obliged to ensure their employees receive no negative treatment for requesting this leave. Employees on statutory sick leave must be treated as if they have not been absent from work and this leave shall not affect any rights related to the employee’s employment. Therefore, employees may not be penalised or threatened with penalisation for exercising or proposing to exercise their entitlement to statutory sick leave.
How many days before employees can claim Illness Benefit through Social Welfare?
The employee may claim Illness Benefit after the first 3 days of illness. These are known as ‘waiting days’ (Sunday is not counted as a waiting day.) There are no waiting days if the employee was getting certain other social welfare payments within 3 days of the start of their illness. Read more on Illness Benefit here.
Records to be retained by an employer:
An employer must maintain a record of all statutory sick leave taken to include:
(a) the period of employment of each employee who availed of statutory sick leave,
(b) the dates and times of statutory sick leave in respect of each employee who availed of such leave, and
(c) the rate of statutory sick leave payment in relation to each employee who availed of statutory sick leave.
Records must be retained for four years. Employers failing to keep accurate records may be convicted and subject to fines up to €2,500.
See here for information from Citizens Information on the new scheme and illness benefit.
Statutory Leave
Annual Leave
The Organisation of Working Time Act, 1997 provides that all employees, whether they are full-time, part-time, temporary or casual, earn annual leave entitlements from the time they start work. Most employees are entitled to four weeks’ paid annual leave per leave year.
Depending on time worked, employees' holiday entitlements should be calculated by one of the following methods:-
4 working weeks in a leave year in which the employee works at least 1,365 hours (unless it is a leave year in which he or she changes employment)
1/3 of a working week per calendar month that the employee works at least 117 hours
8% of the hours an employee works in a leave year (but subject to a maximum of 4 working weeks).
If more than one of the preceding methods at (1), (2) or (3) above is applicable, the employee shall be entitled to whichever method provides the greater entitlement. However the maximum statutory annual leave entitlement of an employee in a leave year is four of his/her normal working weeks.
Maternity/paternity/adoptive leave, parental leave, sick leave and force majeure leave do not affect annual leave entitlements.
Accrual of Annual Leave while on Certified Sick Leave:
From 1st August 2015, workers can accrue annual leave when they are on long term sick leave. This means:
Statutory annual leave entitlement accrues during a period of certified sick leave.
An annual leave carryover period of 15 months after a leave year will apply to those employees who could not, due to illness, take annual leave during the relevant leave year or during the normal carryover period of 6 months.
On termination of employment, payment in lieu of untaken accrued annual leave will apply to leave which was untaken as a result of illness in circumstances where the employee leaves the employment within a period of 15 months following the end of the leave year during which the statutory leave entitlement accrued.
Public Holidays
The Act also provides the following nine public holidays:
1st January (New Year’s Day)
St. Patrick’s Day
Easter Monday
First Monday in May
First Monday in June
First Monday in August
Last Monday in October
Christmas Day
St. Stephen’s Day
In respect of a public holiday the employee is entitled to one of the following (determined by employer):
a) a paid day off on that day
b) a paid day off within a month of that day
c) an additional day of annual leave
d) an additional days pay
Full-time workers have immediate entitlement to benefit for public holidays, and part-time workers have entitlement to benefit when they have worked a total of 40 hours in the previous 5 weeks. If a part-time employee is not normally rostered to work, then they will be entitled to one-fifth of their normal weekly wage extra.
Where the public holiday falls on a weekend (and the employee does not normally work over the weekend) employees are still entitled to receive a benefit. Options (b), (c) or (d) apply (as determined by the employer).
If the business is open and an employee works, he/she is entitled to either paid time off or an additional day's pay.
If an employee ceases to be employed during the week ending before a public holiday, having worked during the 4 weeks preceding that week, they are entitled to receive pay for the public holiday (includes part-time employees if they have worked 40 hours in the previous 5 weeks as above).
Other Statutory Leave Entitlements
Maternity Leave - Gives mothers the right to take 26 weeks' maternity leave.
Adoptive Leave - Gives one parent of the adoptive couple, or a parent adopting alone the right to 24 weeks' leave.
Paternity Leave - Gives new parents (usually the father or the partner of the mother, or in the case of adoption, the parent who is not taking adoptive leave) the right to take 2 weeks’ leave in the first 6 months after the baby is born or adopted.
Parental Leave - Gives parents the right to take 26 weeks’ unpaid leave from work to look after their children aged under 12.
Parent's Leave - Gives parents the right to take 7 weeks’ leave during the first 2 years of a child’s life, or in the case of adoption, within 2 years of the placement of the child with the family.
Carer's Leave - For people who need to take time off work to provide full-time care for someone who needs it.
Force Majeure - For people who need to take time off work urgently because of an injury or illness of a close family member.
Types of Leave for Parents:
Notice of Termination
The Minimum Notice and Terms of Employment Acts 1973 to 2005 provide that every employee who has been in the employment of their employer for at least 13 weeks is entitled to a minimum period of notice before that employer may dismiss them. An employer and employee may agree payment in lieu of notice.
An employee who has 13 weeks service with his/her employer is obliged to give one week’s notice to his/ her employer when resigning, unless there is a written contract of employment that provides for a longer period, in which case this notice period must be given.
Minimum notice periods are set out below:
Employment contracts can be terminated in a variety of ways, such as dismissal, redundancy, or insolvency. Employers should be familiar with the rules relating to termination of employment in any of these contexts. To justify a dismissal, an employer must show that it either resulted from one or more of the following causes:
the capability, competence or qualifications of the employee for the work they were employed to do;
the employee’s conduct;
redundancy;
the fact that continuation of the employment would contravene another statutory requirement;
that there were other substantial grounds for the dismissal.
Employee Records
The records required to be kept by the employer are mainly prescribed by S.I. No. 473 of 2001, Organisation of Working Time (Records) (Prescribed Form and Exemptions) Regulations, 2001.
These records must be retained for 3 years and must be available for inspection by Inspectors of the Workplace Relations Commission.
In compliance with employment legislation, and in order to demonstrate that employees are receiving their proper entitlements, an employer is obliged to maintain certain statutory records. The list below sets out the main records required:
Employer registration number with the Revenue Commissioners
Full Name, Address and PPS Number for each employee (full-time and part-time)
Terms of Employment for each employee
Payroll details – i.e. Gross to Net, Rate per hour, Overtime, Deductions, Shift and other Premiums and Allowances, Commissions and Bonuses, Service Charges, etc.
Copies of Payslips
Employees’ Job Classifications
Dates of commencement and, where relevant, termination of employment
Hours of Work for each employee (including starting and finishing times, meal breaks and rest periods). These may be in the form of Form OWT1 or in a form substantially to like effect.
Register of employees under 18 years of age
Whether board and/or lodgings are provided and relevant details
Holiday and Public Holiday entitlements received by each employee
Any documentation necessary to demonstrate compliance with employment rights legislation
The Regulations also require that an employer keep a copy of the statement provided to each employee under the provisions of the Terms of Employment (Information) Act, 1994.
For more information, see here.
Additional records are required by the Statutory Sick Pay scheme, see here for more information.
See here for the WRC employment records checklist.
HR Templates - Employee Handbook & Contracts
July 2025: Updated Employee Handbook Below!
The GP Practice Ally Employee Handbook & Contract templates have been developed specifically for General Practice in collaboration with the team at Donna Reilly People & Wellness (DRPW).
The aim of these resources is to take at least some of the stress off your desk and assist you in being compliant and protected as an employer. With regular updates from the DRPW team, we will provide you with new policies and procedures as changes are made legislation - meaning you can focus on running the practice instead of constantly worrying if you have everything in place.
Check out the recording of our webinar 'Introduction to HR Policies & Procedures' with Donna Reilly People & Wellness on 28th February 2024, which highlights key policies included in the handbook.
The aim of this informative webinar is to highlight the key policies which practice managers and GPs should be aware of as employers.
The objectives are to:
1. Help practice managers and GPs understand their role and responsibilities for all HR policies and procedures as employers
2. Understand 5 key HR policies and procedures in their Employee Handbook
3. Know when to escalate and seek external support
You can download the slides for this webinar here.
July 2025 Handbook Updates & Information
B2. Sick Leave
The Sick Leave Act 2022 - Statutory sick leave payments for Employees
The Sick Leave Act provides that an Employee, subject to their having 13 weeks continuous service with the Company shall be entitled to, up to and including 5 days per year from 1st January 2024. Statutory sick pay entitlement remains at 5 days per year in 2025.
There was a scheduled increase to 7 days statutory sick pay for 2025, however the government has currently paused any such and future increase.
B3. Maternity Leave
Postponement of Maternity Leave Due to Serious Health Conditions
Under the Maternity Protection, Employment Equality and Preservation of Certain Records Act 2024, in cases of serious health conditions (including physical and mental health conditions), employees may postpone the start or continuation of their maternity leave. To do so, the employee must:
Provide written notification to their manager at least 2 weeks prior to the proposed postponement date.
Include the start and end dates of the postponement, ensuring the period does not exceed 52 weeks from the start of the postponement.
Attach a medical certificate from a qualified practitioner specifying the relevant dates.
The end date of the postponement must be at least 5 weeks after the start date specified and must not exceed 52 weeks duration.
This is a new clause in current Maternity Legislation and the Statutory entitlement for 2025.
B12. Parent's Leave
Parent’s leave increased from 7 weeks to 9 weeks for children born or adopted after 1 August 2024.
A relevant parent can claim the additional 2 weeks' parent’s leave if their child was under the age of 2 on 1st August 2024 or if their adopted child had been placed with their family less than 2 years on 1st August 2024. The extra leave must be completed on or before their child’s second birthday or within 2 years of the adoption placement.
This increase in Parent's Leave entitlement came in to effect in August 2024.
B14. Flexible Working Policy
This policy applies to all employees who meet the eligibility criteria for flexible working as set out in the Parental Leave Acts 1998 - 2023 and the Work Life Balance and Miscellaneous Provisions Act 2023. Requests for flexible working will be agreed on a case-by-case basis based on objective criteria and according to the policy.
This policy covers the Right to Request Flexible Working i.e. a contractual change to working arrangements.
There was previously a Formal Flexible Working Policy in Section D of our Employee Handbook template that allowed Practices to outline their policy on flexible working for all employees. This has now been moved to Section B of the Statutory Policies, as the Parental Leave Act has revised legislation allowing employees who meet the criteria under this Act the right to request flexible working.
D.4 Hybrid and Remote Working Policy
Confidentiality and Data
The confidential nature of the business must be observed at all times. Whilst working from home or remotely (within Ireland) it is your responsibility to ensure the security of our data and to understand and comply with the Practice’s policies in this regard.
This is an additional statement added to revised Employee Handbooks, incorporating Data Protection laws in 2025.
D.10 Pay, Benefits, Employee Data and Employee Files
Payroll
Employees will be paid in accordance with the Practice specific payment arrangements as per their contract of employment. All Employees are paid ( insert as appropriate) weekly/bi-weekly/monthly in arrears by electronic fund transfer. Generally, this is done on the [insert date or / i.e. last day of every month], unless otherwise advised.
Payslips will be sent by email on (insert as appropriate) weekly/fortnightly/monthly basis and will be password protected with an agreed password.
This is an amendment to phrasing encompassing all employees and their separate contractual agreements with a recommendation that payslips should all be password protected to comply with Data Protection legislation.
Importance of Supporting Menopause in the Workplace
Wednesday 2nd October 2024
Check out the recording of the insightful webinar on Supporting Menopause in the Workplace with Catherine O'Keeffe, known as the Wellness Warrior, who took part in our insightful GPPA Summit panel 'From Maternity to Menopause: Fostering Support in the Workplace'.
As menopause increasingly becomes a focus in workplace wellbeing, this session explores its importance and impact on both work and life. Catherine offers a high-level introduction to menopause, including the types and timeline, and discuss the strategic approaches needed to address it within organisations.
Key topics include:
- Why supporting menopause in the workplace is vital for employee wellbeing and performance.
- Practical advice on how to implement supportive measures aligned with internal policies.
- Tools and strategies for managers to foster open, effective communication with employees.
- Insights on change management and cultivating a workplace culture of openness.
- The future role of workplaces in supporting staff through menopause.
Equip yourself with the knowledge and tools to create a menopause-inclusive workplace, ensuring both staff wellbeing and organisational success.
Positive Mental Health in Your Practice
We are all familiar with the increasing pressures faced by everyone working in healthcare. Whether you’re providing direct care to patients or managing the complexities of a busy practice, the demands can take a toll on your mental health. Stress, anxiety and burnout are common challenges across the board, affecting not only personal wellbeing but also team dynamics and the overall workplace environment.
We understand that practice teams as a whole carry the responsibility of ensuring excellent care and operational efficiency, and it’s easy to overlook your own mental health along the way. That’s why together with Donna Reilly People & Wellness, we’re offering a special online Mental Health & Wellbeing Workshop, to help everyone look after their own wellbeing and support each other.
This 60-minute workshop offers practical, actionable strategies to help every member of the practice team assess their mental health, maintain balance and engage in open conversations about wellbeing. Together, we can create a healthier, more supportive workplace for everyone.
We’ll cover:
Understanding Mental Health
Understanding Positive Mental Health
What Impacts Our Mental Health
Becoming Aware of the Signs of Change
Having a Wellbeing Conversation
Self-Care for Positive Mental Health
Enhancing Employee Performance through the Performance Management Process
This webinar with Donna Reilly from Donna Reilly People & Wellness will guide you through the essentials of the performance management process, focusing on aligning individual and team goals with practice objectives. Learn how to implement practical strategies to support employee development, provide meaningful feedback and conduct effective performance reviews, driving both personal and practice success.
Learning Objectives:
Understand the purpose and benefits of the performance management process.
Learn how to set and achieve SMART objectives.
Develop practical skills for delivering constructive feedback.
Explore effective approaches to managing underperformance.
Gain confidence in conducting performance reviews and calibration meetings.
You Can’t Pour From An Empty Cup: Why Practice Health Starts With You - with Tara Rafter (GPPA Summit 2025)
This session shows why your own wellbeing sets the tone for the entire practice. Tara looks at capacity, neurolinguistics and the habits that help
you steady your mind, protect your energy and lead with clarity.
It’s a straight, honest look at what it takes to stay resourced so you can support others without running yourself dry.
Developing a Safety Statement for Your Practice
Check out the recording of our webinar 'Developing a Safety Statement for Your Practice' from 13th April 2022.
Legislation
The Safety, Health and Welfare at Work Act 2005 outlines the responsibilities of employer‘s, the self-employed, employees and various other parties in relation to safety and health at work.
You can find detailed information and frequently asked questions on the HSA website here.
The ICGP guide Managing Occupational Health & Safety in General Practice is very comprehensive, with many examples and further advice. You can access it when logged in to the ICGP website.
You can sign up to receive the HSA newsletters and view any recent ones here. It’s a useful way to stay in touch with any updates to legislation and get notice of relevant H&S webinars.
Duties:
Employers (including self-employed persons) are primarily responsible for creating and maintaining a safe and healthy workplace. An employer must ensure, so far as is reasonably practicable:
Work activities are managed so as to ensure the safety, health and welfare of employees
The Safety Statement is maintained and updated, risk assessments are carried out and reviewed as required and brought to the attention of all employees at least annually
Identified protective and preventive measures are implemented and maintained
Improper conduct likely to put an employee’s safety and health at risk is prevented
A safe place of work is provided, which is adequately designed and maintained
A safe means of access and egress is provided
Safe plant and equipment are provided
Safe systems of work are provided
Risks to health from any article or substance are prevented
Appropriate information, instruction, training and supervision are provided
Where hazards cannot be eliminated, adequate arrangements, including the provision of suitable protective clothing and equipment, will be put in place to reduce the risk of injury
Emergency plans are prepared and revised
Welfare facilities are provided and adequately maintained
Accidents are reported to the Health & Safety Authority when necessary
Competent personnel to advise and assist in securing the safety, health and welfare of employees are employed when required.
Why does your practice need a Risk Assessment & Safety Statement?
Legal Requirement - Under the Safety, Health and Welfare at Work Act, 2005, employers are required by law to carry out risk assessments, prepare a Safety Statement and implement what it contains. The Health & Safety Authority (HSA) inspectors will review these during a visit and will scrutinise them if they are investigating an incident. They can impose financial penalties and non-compliance is an offence.
Working Conditions - Reducing and minimising risks can prevent accidents or ill-health in the workplace and promotes safe working conditions. This can improve employee and patient morale.
Business Sense – Safety awareness contributes to practice success. Accidents can cause a huge drain on resources and patients also appreciate a well-run practice.
Health & Safety Management Checklist
Once complete (or if you already have a Safety Statement in your practice), you can use this Health & Safety Management Checklist for Small Healthcare Facilities from the HSA to double check that you have everything in place in the areas of:
Risk Assessment
Safety Statement
Competence
Emergency Plans
Contractors & Others
Consultation
Instruction, Information, Training & Supervision
Accidents & Incidents
Occupational Health
Monitoring Health & Safety Performance
HSA Inspections: Is Your GP Practice Ready?
With an increase in Health & Safety Authority (HSA) inspections, GP practices need to be fully prepared to ensure compliance and safety.
This practical webinar, led by Ann Higgins, Clinical Director of Medical Audits and RCSI Honorary Lecturer, will guide you through what to expect from an inspection and how to meet HSA requirements with confidence.
What the HSA Focuses On:
Management Awareness – How well GPs and practice staff understand and implement health and safety responsibilities
Safety Documentation – Reviewing the Safety Statement, risk assessments and other compliance requirements
Workplace Inspection – Identifying key risks such as infection control, fire safety, manual handling and hazardous substances
Implementation & Compliance – Ensuring policies are in place, followed and regularly monitored
This session will provide clear, actionable steps to strengthen your practice’s safety measures and help you prepare for an inspection.
Preventing Spread of Infection in Your GP Practice
Infection prevention is a daily responsibility, but it can feel overwhelming without clear systems.
This practical session with Ann Higgins from Medical Audits will:
Walk through the HIQA Infection Prevention & Control standards in the context of everyday general practice
Provide tips on auditing your practice environment
Explore how to engage your whole team – making infection control a shared responsibility, not just one person’s job
Introduction to Practice Finances
Check out the recording of our webinar 'Introduction to Practice Finances'.
Like patients and information, money flows through a practice. You need to understand the flow of practice income and to be able to make wise judgements about the allocation of practice income to cover expenses and ensure the practice thrives.
Financial literacy is important for GPs and practice managers. You need to be able to read the documents that provide information about the flow of income and expenditure and to be able to have appropriate discussions with financial advisers.
Ways to ensure good financial management in general practice:
Keep good financial records
Prepare financial reports
monthly statement of financial performance (profit & loss report)
annual statement of financial position (balance sheet)Perform simple financial analysis
Reconcile bank statements monthly
Prepare a budget annually and compare to actual monthly reports
Perform simple cash flow analysis
Have a clear credit control procedure
Key terms:
Accounting refers to the record keeping and reporting of activities conducted by a practice measured in monetary values.
Financial accounting involves the preparation of financial reports (profit & loss, balance sheet) required by external parties such as the Revenue Commissioners, shareholders and lenders.
Management accounting provides information needed for management decisions, using varied internal reports (e.g. budgets, cash flow plans, internal performance reports).
Revenue (often referred to as income) is payment for services rendered and is generated from a number of sources including state schemes and private practice.
Expenses are the costs of the practice. Expenses do not include drawings or GP income tax.
Break-even point is when the total practice revenue matches the total practice expenses. Any further revenue is considered as profit
If you budget your expenses for the year you should know how much revenue you need to generate to cover those expenses and how much more to generate to create enough profit for the partners.Profit is the amount of income retained after expenses are paid. Profits are shared between GP partners.
Revenue – Expenses = ProfitDrawings refer to the money withdrawn from the practice by the GP partners. Drawings are recorded in the partner capital accounts. Any personal expenses paid out of the practice account should be classed as drawings (they should not be paid from the practice account if possible).
GP Income Tax is calculated based on the GP’s share of the profits, not their drawings. The GPs must be aware of how much money they can withdraw and how much to set aside for income tax.
Professional Services Withholding Tax (PSWT) of 20% is deducted from gross fees by state and semi-state bodies at source, with the practice receiving the net amount. When GPs submit their yearly income tax return, they deduct the withholding tax from the tax they owe Revenue and only pay the balance (plus preliminary tax for the following year). See more here.
For example:
Both GPs are entitled to a profit share (personal income) of €200,000.
Both pay €100,000 in income tax (for ease of the example).
They both take home €100,000.
Both have a capital account balance of €0 at the start of the year.
Dr A withdraws €90,000 from the practice in 2021.
She has €110,000 left in her capital account for the year.
She can pay the €100,000 income tax out of the practice account.
She can withdraw the remaining €10,000 or retain it in her capital account and withdraw it at a later date.
Dr B withdraws €120,000 from the practice in 2021.
He only has €80,000 left in his capital account for the year.
He can pay €80,000 income tax out of the practice account, but he may have to pay €20,000 out of his own personal accounts.
If the practice has a lot of surplus cash, he could pay the full €100,000 out of the practice account and have a negative capital account balance (i.e. he would owe the practice €20,000 if he left).
Profit & Loss
The term profit and loss (P&L) statement refers to a financial report that summarises the income and expenses incurred during a specified period (e.g. month, quarter, year). This report provides information about a practice’s ability or inability to generate profit by increasing revenue, reducing costs, or both. It is presented on a cash or accrual basis.
Cash basis – income and expenditure is recorded as they are received and paid in cash (as per the bank statement).
Accrual basis – records income when it is earned and expenses when they are incurred.
For example, if you invoice your occupational health clients at the end of every month, the cash method would record the income from October when it is received, in November or December (perhaps 30-60 days later). However the accrual method would record it as the last day of October as that is the month that it relates to.
Another example is, if you pay your phone bill on direct debit your October bill may not come out of the practice account until the middle of November. The cash method would record this as an expense in November, and the accrual method would record it in October.Accrual based accounting is considered to be more accurate, however it makes planning cash flow more difficult.
Practices generally continue to use whatever system they have used in previous years, as switching from one to the other would make it difficult to compare to previous periods.
Below are examples of common income and expenses in General Practice.
Income
Private Practice
Patient fees - private patient fees & fees charged to GMS/DVC patients for services not covered by GMS contract
Private 3rd Parties:
Insurance companies - reports, PMAs, procedures
Medicolegal reports – generally charged to patient’s solicitor
Occupational health – pre-placement medicals, annual medicals
Receipts from Government Agencies
GMS – capitation, STCs, vaccines, CDM, allowances etc
Other State Contracts – Maternity, Childhood Immunisations, Social Welfare etc
State Bodies – Garda, Irish Prison Service, CIE etc
Training fees
The practice may also have rental income if it rents out any rooms (e.g. to a psychotherapist or physiotherapist).
Expenses
Staff
Wages & Salaries (including employers PRSI)
Subcontractors: Locums – paid directly, agency fees, out of hours fee
Staff welfare
Staff training
Staff pensions (may not be relevant)Medical Supplies
Medical Equipment (some will be classified as assets not expenses)
IT
Practice management system
Hardware (some will be classified as assets not expenses)
SoftwareLight & Heat
Electricity
Gas/oilTelephone
Telephone
Internet
SMSFacilities
Rent
Rates
Repairs & MaintenanceInsurance & indemnity
Sundry expenses
Canteen
Course and conference fees
Subscriptions
Cleaning supplies
Advertising
WastePrinting, postage & stationery
Motor running costs
Travel & subsistence
Bank interest and charges
Consultancy, professional fees
Accounting
Legal
ConsultingCharitable donations
Depreciation (generally calculated by accountant)
Balance Sheet
The term balance sheet refers to a financial statement that reports a company's assets, liabilities, and shareholder equity at a specific point in time. In short, the balance sheet is a financial statement that provides a snapshot of what a practice owns and owes, as well as the amount invested by the partners. An accountant will prepare this at year end.
The balance sheet will classify assets and liabilities into different categories to provide additional information.
One of the important ways to categorise assets is how readily they are converted to cash. A current asset is either cash or an asset that could be converted into cash within 12 months from the date of the balance sheet, e.g. cash in the bank and patient accounts receivable. Assets not defined as current assets are called fixed assets, such as buildings and equipment.
Accounts receivable arise when you have outstanding invoices against debtors (patients or 3rd parties) on the date of the balance sheet.
Liabilities are also categorised as to when payment is required. Similarly, a current liability is an amount that is expected to be repaid within 12 months, e.g. accounts payable to suppliers or a bank overdraft. An amount that is due to be paid at a later date is a long-term liability, such as bank loans.
Accounts payable arise when you owe creditors (suppliers) for delivered goods or completed services (e.g. phone or electricity bills) on the date of the balance sheet.
One of the most relevant things about the balance sheet to consider is if equipment purchased during the year is considered as an expense or an asset. Generally speaking, if an item has a value of over €500, it would be considered as an asset and should not be included in the profit and loss account as an expense. However you should flag these purchases to your accountant and get their advice before taking any action.
Budgeting
Budgeting is a key management tool to assist with planning and resource allocation decisions and to provide adequate control of spending. Budgets project the practice income and expenditure for the year and are usually prepared annually but should be broken down by month. Budgeting also helps to create cash flow plans. Failure to properly plan cash flow is one of the leading causes for small business failures.
Income Forecasting
Until COVID, forecasting practice income was relatively straightforward as it was generally quite stable (if the practice situation remained stable).
Generally:
GMS capitation is stable and increases such as FEMPI reversals could be included in budgets in advance.
Fee per item is quite predictable, and you can forecast an increase in ECGs due to the introduction of the CDM programme for example.
Private practice is also relatively stable, provided that you have adequate availability of GP and nurse consulting hours.
So as a rough income forecast you can use the previous year’s income and account for any extraordinary income by taking it out (e.g. remove fees for COVID boosters as that is not ‘guaranteed’ income).
To prepare an income budget, you need to forecast the practice activity levels to forecast income. The availability of doctors is one of the main drivers for practice activity and has a significant effect on income. A GP trainee (or extended period without one) could have an impact on income. The timing of doctors leave will also impact expenses and cashflow if a GP locum is required, and if they are not replaced the number of available appointments will be reduced and private income may fall (along with some fee per item GMS services).
Know roughly when your GPs may take leave and consider if this will result in a reduction of income (e.g. less appointments available if not replaced or a locum may not do the special procedures of the GP on leave).
An easy way to do this is to record how many GP sessions you had last year and forecast out this year’s.
Other constraining factors on the practice activity may be identified in the budgeting/planning process. These may relate to staffing (availability of practice nurses) or facilities (practice re-location or renovation).
Expense Budgeting
If you have a consistent pattern of expenses, you can develop a simple expenses budget by using the same monthly figures for next year (and possibly adding on a small amount for inflation). Accounting software can automate this process. This will reduce the time involved and is often a reasonably accurate way of creating the budget. After this has been done, it is possible to make variations in known changes to cash outflows for the year ahead. This may be the commencement of a new computer lease, purchase of equipment, or provision for staff leave.
Using an expense budget is the primary management tool for controlling overhead expenses. Checking actual expenses against budgeted amounts will provide an opportunity to make corrective actions early.
Cash Flow Budgeting
The income forecast and the expense budget enables the construction of a cash flow budget. This allows an practice to know the timing of cash inflows and outflows and the availability of cash in the bank. The inflows and outflows for each month are recorded with a predicted cash balance.
Record Keeping
Anyone who owns a business (the GP or GP partners) must keep certain records for tax purposes. Records can be used to confirm information contained in the individual GPs’ tax returns. Practices must keep the original of these documents for six years. It is possible to store a digital copy of your receipts using accounting software.
The process of keeping financial records is called bookkeeping. The historical development has resulted in many, sometimes confusing, accounting terms such as credits, debits, journals and ledgers. Current computer accounting packages have simplified many of the processes involved in data entry and recording transactions.
What types of records are kept?
You must keep anything that is used to calculate the GP’s Income Tax. You should keep records for all transactions. These can include:
bank statements
invoices sent – patient fees charged, invoices sent to 3rd parties, remittances
receipts for expenses
receipts for purchases
cheque stubs
lodgement records
nominal ledgers (these are created automatically in accounting softwares)
accounting books
Keeping good financial records makes it easier to:
Determine the financial condition or profitability of the practice
Compare performance with budgets and previous performance
Make sound business decisions
Prepare end of year accounts
Plan cash flow
Bank Statement Reconciliation
Performing a bank statement reconciliation is a key task in ensuring business accounts are a true representation of the current financial position. The bank statement will record all transactions as the bank processes them. Some entries on the bank statement may not have been recorded in the practice’s accounting system. These are commonly bank fees and interest charges and payments. There are also errors the bank may make that need to be identified. There will also be cheques that have been written but not presented. Additionally, the practice will have some cash and cheques on hand that have not been banked.
Most accounting software is able to simplify this process. It is normally done monthly on receipt of the bank statement.
Computer or Manual Systems
The difference between keeping manual records and using accounting software is information management. Data should be entered into the accounts package only once; it should then emerge in the form of Profit and Loss Accounts, Balance Sheets etc. Many accounting softwares allow you to reconcile your bank statement with invoices and bills loaded into the accounts package, which improves record keeping.
The main advantages of computerised accounting include:
high speed and flexibility of reporting
real-time information
reliability
increased accuracy
increased productivity
active control system
easy back-up and restoration of records
The disadvantages include:
relatively high costs of introducing and using the system
special training for staff/user
Before you choose an accounting software it might be worth speaking to your accountant to see what programme they would recommend. It’s generally easier to use one that your accountant is familiar with.
Income Control
Good financial control requires consistent processes, clear procedures and accurate record keeping. Your record keeping system, whether on paper or on a computer, should be simple to use, easy to understand, reliable, accurate, consistent and designed to provide information on a timely basis.
The practice management role here is to maximise income to the practice. You can do that by having good claiming and invoicing processes. The goal is to ensure that the practice is paid for all work completed and opportunities for increasing revenue are identified.
Record Keeping
You must record income from all sources – i.e. you can’t have an unexplained deposit in your bank account. You must keep all relevant records of income for six years.
You must have a way of keeping track of all invoices and claims sent and payment monitored. Outstanding fees or claims must be followed up promptly. Suggestions for each income source are detailed below.
Private Practice
Patient Fees:
Use your GP software to record patient charges and payments. Records are stored in the system and can be used to generate reports at any time.
Ensure all patients are charged on the day of services.
Where possible, ensure payment is taken on the day.
If payment is not received, ensure that patient is billed promptly.
Billing methods: send online payment link by SMS/email, call or send letter.
Many practices now take payment at time of booking or check-in. This can help to reduce no-shows and outstanding charges.
Ensure that reception staff are aware to look at outstanding balances when on the phone, booking appointments and dealing with patients face-to-face.Reconcile daily payments (cash, card, online, cheques) with daily records generated from your practice software.
You must also ensure that the amount received from card or online services is correct when it hits the bank account.
If you use accounting software, it should be easy to record these payments in your accounts.You may have multiple ways for patients to pay – online portal, online payment links, card payments, cheques and cash.
It is important to ensure all payments are recorded and checked off against charges within your practice software. If you do not allocate payments to outstanding charges you may over-inflate your outstanding charges at year-end.
See our 'Cash & Cheque Lodgement Template' here.You can easily generate reports using your practice management system at the end of each week/month to check for outstanding amounts due to the practice.
Effective credit control is essential to ensuring the viability of the practice.
You should have a credit control procedure in place – what will you do if you have outstanding charges? Example: You may attempt to contact someone by a number of contact methods (SMS, phone, letter) as a starting point (state these in order, and how many times you will attempt each method before moving on to the next) . After exhausting all avenues and the doctor/patient relationship has broken down, you may consider asking the patient to find another practice (seek appropriate advice from your medical indemnity provider).Keep records of cash and cheque lodgements.
Reconcile with bank statement.
Private 3rd Parties:
You can also use your GP software to record 3rd party charges and payments.
Ensure all charges for private 3rd parties are recorded daily.
Invoice on a regular basis.
E.g. monthly for occupational health clients, weekly for sending insurance claims, daily/as they arise for medicolegal charges. Just ensure you are consistent so you do not miss any invoices.
Many practices do not release medicolegal reports until payment is made by solicitor.
It is advisable to at least confirm your fee with an insurance company before you submit the report, as you may charge more than their standard fee.
Add invoice to accounting software (or log in manual records - see our '3rd Party Invoices Sent' Excel template here).Reconcile payments:
When payment is made you need to mark off the practice management system and reconcile on your accounting software (or your manual records).
You may do this as part of your bank reconciliation instead of marking off as they come in.You must have a system in place to check for payments and chase them once they are overdue.
Accounting software can be useful for this, you can easily see overdue invoices, which can be checked weekly.
Other manual methods:
Keep an excel template of invoices sent and check for payments due weekly.
Keep a copy of all invoices sent and keep in a file in order of due date, check weekly.Decide on a system for storing your invoices – whether it is paper, copies saved in a computer folder or in your accounting software. Paper or computer folder examples:
Label by month and store all invoices sent that month
Label by 3rd party and store all invoices sent to that organisation in date order
Receipts from Government Agencies
PCRS:
All PCRS income should be recorded in an accessible manner so that it can be reviewed for fluctuations or errors easily.
GMS Capitation – download and keep your itemised listing from PCRS every month (previously referred to as ‘pink sheets’)
Ensure to download your GMS panel from PCRS each month to update your practice management software. This will ensure you only have valid cards on your system.
GMS panel management is essential to ensure cards due to expire are renewed by patients and patients are accepted online via the PCRS suite.STCs/vaccines – keep all paper STCs and paper vaccine claim forms for 6 years.
Valid claims entered online by the last day of the month, will be paid by the 15th day of the following month.
A robust system is required to ensure all STCs are claimed.
In some practices, receptionists are responsible for all STCs.
In others, the HCP who delivers the service is responsible for the STC.
It is important at the end of every day to ensure that you have an STC for every relevant service delivered that day.
Review of the pink sheets is required to ensure all STCs are paid and ones that are rejected are followed up.
There are external software providers that can identify missed STCs.
Have a recall system for patients who require repeat ECGs, 24hr ABPMs, LARCs etc.
Ensure all bonus payments are paid for vaccines – be careful to submit in correct batches to get bonus payment.CDM
Ensure all reviews are submitted and paid.
A good recall system is essential to keep on top of this growing programme.Allowances
Annual/study/sick leave applications and indemnity to be submitted promptly for payment.
All leave entitlements should be claimed.
Practice subsidies should be kept up to date and monitored.Maternity
Claims can now be submitted online via the PCRS suite.
You need to have a system in place to ensure no ANC visits are missed – some practices submit the claims on the day of the visit, some wait until all visits are completed.
You must ensure that all visits are paid. You can view all claims in the PCRS suite and it will show if it is ‘Paid’ or ‘To Pay’.Cervical Check
Keep a log of all cervical check samples sent and reconcile payments on the pink sheets each month.
Other State Contracts:
Childhood Immunisations
In some areas, childhood immunisations are paid through the PCRS.
Keep a record of all immunisations and ensure they are paid.
You must notify the CHO of defaulters (those who will not attend for childhood immunisations) or those who have moved to another area to ensure that the practice receives its bonuses (paid when the child’s full vaccine schedule is complete).Social Welfare
Paid quarterly.
Keep a record of all issued social welfare certs and ensure they are paid.
State Bodies:
Garda Scheme
GPs can contract to provide free GP visits to Gardaí, all other fees must be covered directly by the patient.
Similar to 3rd party invoicing, you need to ensure that all visits are claimed.
You must get the Garda to sign a claim form.
You can generate an invoice from your PMS which will have an invoice number and the correct details.
You can send these as they arise or send one batch every month (monthly may be easier to keep track of payments, as long as you ensure all visits are applied to the account correctly on the day).CIE
This scheme is like capitation – you are paid a set amount every quarter per patient on your list.
CIE employees and their spouse and dependents (children up to the age of 16) are entitled to free GP visits.
It is worth checking that the list is accurate as per the patients on your system (you should have their patient type categorised on your practice management system to be able to generate lists).
Keep the printed lists provided on file for 6 years.
There are some other schemes available to employees of some other public institutions, such as An Post.
Training Fees:
GPs can become GP trainers and can also take on medical students for short rotations.
GP training scheme – ensure that your grant is paid (paid in arrears every 6 months) and that expenses are claimed. Contact the scheme directly to discuss how to claim expenses.
Medical students – invoice the college directly & ensure timely payment.
Professional Services Withholding Tax (PSWT)
State and semi-state bodies deduct 20% professional services withholding tax at source, with the practice receiving the net amount. When GPs submit their yearly income tax return, they deduct the withholding tax from the tax they owe Revenue and only pay the balance (plus preliminary tax for the following year).
Before July 2021, practices had to retain their F45s (paper withholding tax records) as proof of the deduction. With the rollout of Revenue’s new electronic format for allocating PSWT it is now possible to view the records via Revenue Online Services (ROS). However unlike the postal system where the practice would have received all F45s directly, the PSWT record for services provided under the individual GP’s PPSN (PCRS, social welfare certs etc) will be attached to each individual GP’s ROS account. In most cases, the Practice Manager may only be able to view the PSWT records that come through to the practice partnership number.
A CSV file can be downloaded from Revenue which contains all the relevant payment information (payor, security number, date, gross and net payment details). It is important to liaise with the practice accountant to make sure the Revenue record is correct. While it is no longer necessary to keep a file with the F45 number etc, it is still worth reconciling each month (perhaps with the help of your accountant downloading the GP files from ROS) to ensure that all relevant payments have a corresponding ‘Payment Notification’ within ROS.
The gross payment represents the income to the practice. However, it is important to record the net amount of state payments every month and record the withholding tax in a separate account or column. This makes it easier to identify the total amount of withholding tax deducted from the practice and available as tax credits for the GPs at year end. Discuss this with your accountant and decide how best to split this out.
GP Employee PSWT
As of December 2021, under the new system a GP employee with a GMS panel would be required to submit their tax return and claim a refund of the withholding tax from Revenue to reimburse the practice. This is different to the system prior to 2021, where the practice can claim the withholding tax before the employee tax return is filed.
It is our understanding that the Tax Institute is engaging with Revenue on this matter and hope that a better system can be agreed. The best thing to do for now is just discuss this with your accountant if you have a GP employee with a GMS panel and they can liaise with the Tax Institute for guidance. We will of course let you know if there are any further updates.
PSWT Management Online
For anyone who has not yet accessed the PSWT section on ROS - if you have access to the practice account, the steps are laid out below. You can also access the relevant circular here.
When you log in, you are automatically brought to the My Services page.
Scroll down to the bottom of that page and select 'Manage Professional Services Withholding Tax'.
You will be brought through to this page. Select 'View Payment Notifications' to view and download your PSWT records.
Income Control
Good financial control requires consistent processes, clear procedures and accurate record keeping. Your record keeping system, whether on paper or on a computer, should be simple to use, easy to understand, reliable, accurate, consistent and designed to provide information on a timely basis.
The practice management role here is to maximise income to the practice. You can do that by having good claiming and invoicing processes. The goal is to ensure that the practice is paid for all work completed and opportunities for increasing revenue are identified.
Record Keeping
You must record income from all sources – i.e. you can’t have an unexplained deposit in your bank account. You must keep all relevant records of income for six years.
You must have a way of keeping track of all invoices and claims sent and payment monitored. Outstanding fees or claims must be followed up promptly. Suggestions for each income source are detailed below.
Private Practice
Patient Fees:
Use your GP software to record patient charges and payments. Records are stored in the system and can be used to generate reports at any time.
Ensure all patients are charged on the day of services.
Where possible, ensure payment is taken on the day.
If payment is not received, ensure that patient is billed promptly.
Billing methods: send online payment link by SMS/email, call or send letter.
Many practices now take payment at time of booking or check-in. This can help to reduce no-shows and outstanding charges.
Ensure that reception staff are aware to look at outstanding balances when on the phone, booking appointments and dealing with patients face-to-face.Reconcile daily payments (cash, card, online, cheques) with daily records generated from your practice software.
You must also ensure that the amount received from card or online services is correct when it hits the bank account.
If you use accounting software, it should be easy to record these payments in your accounts.You may have multiple ways for patients to pay – online portal, online payment links, card payments, cheques and cash.
It is important to ensure all payments are recorded and checked off against charges within your practice software. If you do not allocate payments to outstanding charges you may over-inflate your outstanding charges at year-end.
See our 'Cash & Cheque Lodgement Template' here.You can easily generate reports using your practice management system at the end of each week/month to check for outstanding amounts due to the practice.
Effective credit control is essential to ensuring the viability of the practice.
You should have a credit control procedure in place – what will you do if you have outstanding charges? Example: You may attempt to contact someone by a number of contact methods (SMS, phone, letter) as a starting point (state these in order, and how many times you will attempt each method before moving on to the next) . After exhausting all avenues and the doctor/patient relationship has broken down, you may consider asking the patient to find another practice (seek appropriate advice from your medical indemnity provider).Keep records of cash and cheque lodgements.
Reconcile with bank statement.
Private 3rd Parties:
You can also use your GP software to record 3rd party charges and payments.
Ensure all charges for private 3rd parties are recorded daily.
Invoice on a regular basis.
E.g. monthly for occupational health clients, weekly for sending insurance claims, daily/as they arise for medicolegal charges. Just ensure you are consistent so you do not miss any invoices.
Many practices do not release medicolegal reports until payment is made by solicitor.
It is advisable to at least confirm your fee with an insurance company before you submit the report, as you may charge more than their standard fee.
Add invoice to accounting software (or log in manual records - see our '3rd Party Invoices Sent' Excel template here).Reconcile payments:
When payment is made you need to mark off the practice management system and reconcile on your accounting software (or your manual records).
You may do this as part of your bank reconciliation instead of marking off as they come in.You must have a system in place to check for payments and chase them once they are overdue.
Accounting software can be useful for this, you can easily see overdue invoices, which can be checked weekly.
Other manual methods:
Keep an excel template of invoices sent and check for payments due weekly.
Keep a copy of all invoices sent and keep in a file in order of due date, check weekly.Decide on a system for storing your invoices – whether it is paper, copies saved in a computer folder or in your accounting software. Paper or computer folder examples:
Label by month and store all invoices sent that month
Label by 3rd party and store all invoices sent to that organisation in date order
Receipts from Government Agencies
PCRS:
All PCRS income should be recorded in an accessible manner so that it can be reviewed for fluctuations or errors easily.
GMS Capitation – download and keep your itemised listing from PCRS every month (previously referred to as ‘pink sheets’)
Ensure to download your GMS panel from PCRS each month to update your practice management software. This will ensure you only have valid cards on your system.
GMS panel management is essential to ensure cards due to expire are renewed by patients and patients are accepted online via the PCRS suite.STCs/vaccines – keep all paper STCs and paper vaccine claim forms for 6 years.
Valid claims entered online by the last day of the month, will be paid by the 15th day of the following month.
A robust system is required to ensure all STCs are claimed.
In some practices, receptionists are responsible for all STCs.
In others, the HCP who delivers the service is responsible for the STC.
It is important at the end of every day to ensure that you have an STC for every relevant service delivered that day.
Review of the pink sheets is required to ensure all STCs are paid and ones that are rejected are followed up.
There are external software providers that can identify missed STCs.
Have a recall system for patients who require repeat ECGs, 24hr ABPMs, LARCs etc.
Ensure all bonus payments are paid for vaccines – be careful to submit in correct batches to get bonus payment.CDM
Ensure all reviews are submitted and paid.
A good recall system is essential to keep on top of this growing programme.Allowances
Annual/study/sick leave applications and indemnity to be submitted promptly for payment.
All leave entitlements should be claimed.
Practice subsidies should be kept up to date and monitored.Maternity
Claims can now be submitted online via the PCRS suite.
You need to have a system in place to ensure no ANC visits are missed – some practices submit the claims on the day of the visit, some wait until all visits are completed.
You must ensure that all visits are paid. You can view all claims in the PCRS suite and it will show if it is ‘Paid’ or ‘To Pay’.Cervical Check
Keep a log of all cervical check samples sent and reconcile payments on the pink sheets each month.
Other State Contracts:
Childhood Immunisations
In some areas, childhood immunisations are paid through the PCRS.
Keep a record of all immunisations and ensure they are paid.
You must notify the CHO of defaulters (those who will not attend for childhood immunisations) or those who have moved to another area to ensure that the practice receives its bonuses (paid when the child’s full vaccine schedule is complete).Social Welfare
Paid quarterly.
Keep a record of all issued social welfare certs and ensure they are paid.
State Bodies:
Garda Scheme
GPs can contract to provide free GP visits to Gardaí, all other fees must be covered directly by the patient.
Similar to 3rd party invoicing, you need to ensure that all visits are claimed.
You must get the Garda to sign a claim form.
You can generate an invoice from your PMS which will have an invoice number and the correct details.
You can send these as they arise or send one batch every month (monthly may be easier to keep track of payments, as long as you ensure all visits are applied to the account correctly on the day).CIE
This scheme is like capitation – you are paid a set amount every quarter per patient on your list.
CIE employees and their spouse and dependents (children up to the age of 16) are entitled to free GP visits.
It is worth checking that the list is accurate as per the patients on your system (you should have their patient type categorised on your practice management system to be able to generate lists).
Keep the printed lists provided on file for 6 years.
There are some other schemes available to employees of some other public institutions, such as An Post.
Training Fees:
GPs can become GP trainers and can also take on medical students for short rotations.
GP training scheme – ensure that your grant is paid (paid in arrears every 6 months) and that expenses are claimed. Contact the scheme directly to discuss how to claim expenses.
Medical students – invoice the college directly & ensure timely payment.
Professional Services Withholding Tax (PSWT)
State and semi-state bodies deduct 20% professional services withholding tax at source, with the practice receiving the net amount. When GPs submit their yearly income tax return, they deduct the withholding tax from the tax they owe Revenue and only pay the balance (plus preliminary tax for the following year).
Before July 2021, practices had to retain their F45s (paper withholding tax records) as proof of the deduction. With the rollout of Revenue’s new electronic format for allocating PSWT it is now possible to view the records via Revenue Online Services (ROS). However unlike the postal system where the practice would have received all F45s directly, the PSWT record for services provided under the individual GP’s PPSN (PCRS, social welfare certs etc) will be attached to each individual GP’s ROS account. In most cases, the Practice Manager may only be able to view the PSWT records that come through to the practice partnership number.
A CSV file can be downloaded from Revenue which contains all the relevant payment information (payor, security number, date, gross and net payment details). It is important to liaise with the practice accountant to make sure the Revenue record is correct. While it is no longer necessary to keep a file with the F45 number etc, it is still worth reconciling each month (perhaps with the help of your accountant downloading the GP files from ROS) to ensure that all relevant payments have a corresponding ‘Payment Notification’ within ROS.
The gross payment represents the income to the practice. However, it is important to record the net amount of state payments every month and record the withholding tax in a separate account or column. This makes it easier to identify the total amount of withholding tax deducted from the practice and available as tax credits for the GPs at year end. Discuss this with your accountant and decide how best to split this out.
GP Employee PSWT
As of December 2021, under the new system a GP employee with a GMS panel would be required to submit their tax return and claim a refund of the withholding tax from Revenue to reimburse the practice. This is different to the system prior to 2021, where the practice can claim the withholding tax before the employee tax return is filed.
It is our understanding that the Tax Institute is engaging with Revenue on this matter and hope that a better system can be agreed. The best thing to do for now is just discuss this with your accountant if you have a GP employee with a GMS panel and they can liaise with the Tax Institute for guidance. We will of course let you know if there are any further updates.
PSWT Management Online
For anyone who has not yet accessed the PSWT section on ROS - if you have access to the practice account, the steps are laid out below. You can also access the relevant circular here.
When you log in, you are automatically brought to the My Services page.
Scroll down to the bottom of that page and select 'Manage Professional Services Withholding Tax'.
You will be brought through to this page. Select 'View Payment Notifications' to view and download your PSWT records.
Income Control
Good financial control requires consistent processes, clear procedures and accurate record keeping. Your record keeping system, whether on paper or on a computer, should be simple to use, easy to understand, reliable, accurate, consistent and designed to provide information on a timely basis.
The practice management role here is to maximise income to the practice. You can do that by having good claiming and invoicing processes. The goal is to ensure that the practice is paid for all work completed and opportunities for increasing revenue are identified.
Record Keeping
You must record income from all sources – i.e. you can’t have an unexplained deposit in your bank account. You must keep all relevant records of income for six years.
You must have a way of keeping track of all invoices and claims sent and payment monitored. Outstanding fees or claims must be followed up promptly. Suggestions for each income source are detailed below.
Private Practice
Patient Fees:
Use your GP software to record patient charges and payments. Records are stored in the system and can be used to generate reports at any time.
Ensure all patients are charged on the day of services.
Where possible, ensure payment is taken on the day.
If payment is not received, ensure that patient is billed promptly.
Billing methods: send online payment link by SMS/email, call or send letter.
Many practices now take payment at time of booking or check-in. This can help to reduce no-shows and outstanding charges.
Ensure that reception staff are aware to look at outstanding balances when on the phone, booking appointments and dealing with patients face-to-face.Reconcile daily payments (cash, card, online, cheques) with daily records generated from your practice software.
You must also ensure that the amount received from card or online services is correct when it hits the bank account.
If you use accounting software, it should be easy to record these payments in your accounts.You may have multiple ways for patients to pay – online portal, online payment links, card payments, cheques and cash.
It is important to ensure all payments are recorded and checked off against charges within your practice software. If you do not allocate payments to outstanding charges you may over-inflate your outstanding charges at year-end.
See our 'Cash & Cheque Lodgement Template' here.You can easily generate reports using your practice management system at the end of each week/month to check for outstanding amounts due to the practice.
Effective credit control is essential to ensuring the viability of the practice.
You should have a credit control procedure in place – what will you do if you have outstanding charges? Example: You may attempt to contact someone by a number of contact methods (SMS, phone, letter) as a starting point (state these in order, and how many times you will attempt each method before moving on to the next) . After exhausting all avenues and the doctor/patient relationship has broken down, you may consider asking the patient to find another practice (seek appropriate advice from your medical indemnity provider).Keep records of cash and cheque lodgements.
Reconcile with bank statement.
Private 3rd Parties:
You can also use your GP software to record 3rd party charges and payments.
Ensure all charges for private 3rd parties are recorded daily.
Invoice on a regular basis.
E.g. monthly for occupational health clients, weekly for sending insurance claims, daily/as they arise for medicolegal charges. Just ensure you are consistent so you do not miss any invoices.
Many practices do not release medicolegal reports until payment is made by solicitor.
It is advisable to at least confirm your fee with an insurance company before you submit the report, as you may charge more than their standard fee.
Add invoice to accounting software (or log in manual records - see our '3rd Party Invoices Sent' Excel template here).Reconcile payments:
When payment is made you need to mark off the practice management system and reconcile on your accounting software (or your manual records).
You may do this as part of your bank reconciliation instead of marking off as they come in.You must have a system in place to check for payments and chase them once they are overdue.
Accounting software can be useful for this, you can easily see overdue invoices, which can be checked weekly.
Other manual methods:
Keep an excel template of invoices sent and check for payments due weekly.
Keep a copy of all invoices sent and keep in a file in order of due date, check weekly.Decide on a system for storing your invoices – whether it is paper, copies saved in a computer folder or in your accounting software. Paper or computer folder examples:
Label by month and store all invoices sent that month
Label by 3rd party and store all invoices sent to that organisation in date order
Receipts from Government Agencies
PCRS:
All PCRS income should be recorded in an accessible manner so that it can be reviewed for fluctuations or errors easily.
GMS Capitation – download and keep your itemised listing from PCRS every month (previously referred to as ‘pink sheets’)
Ensure to download your GMS panel from PCRS each month to update your practice management software. This will ensure you only have valid cards on your system.
GMS panel management is essential to ensure cards due to expire are renewed by patients and patients are accepted online via the PCRS suite.STCs/vaccines – keep all paper STCs and paper vaccine claim forms for 6 years.
Valid claims entered online by the last day of the month, will be paid by the 15th day of the following month.
A robust system is required to ensure all STCs are claimed.
In some practices, receptionists are responsible for all STCs.
In others, the HCP who delivers the service is responsible for the STC.
It is important at the end of every day to ensure that you have an STC for every relevant service delivered that day.
Review of the pink sheets is required to ensure all STCs are paid and ones that are rejected are followed up.
There are external software providers that can identify missed STCs.
Have a recall system for patients who require repeat ECGs, 24hr ABPMs, LARCs etc.
Ensure all bonus payments are paid for vaccines – be careful to submit in correct batches to get bonus payment.CDM
Ensure all reviews are submitted and paid.
A good recall system is essential to keep on top of this growing programme.Allowances
Annual/study/sick leave applications and indemnity to be submitted promptly for payment.
All leave entitlements should be claimed.
Practice subsidies should be kept up to date and monitored.Maternity
Claims can now be submitted online via the PCRS suite.
You need to have a system in place to ensure no ANC visits are missed – some practices submit the claims on the day of the visit, some wait until all visits are completed.
You must ensure that all visits are paid. You can view all claims in the PCRS suite and it will show if it is ‘Paid’ or ‘To Pay’.Cervical Check
Keep a log of all cervical check samples sent and reconcile payments on the pink sheets each month.
Other State Contracts:
Childhood Immunisations
In some areas, childhood immunisations are paid through the PCRS.
Keep a record of all immunisations and ensure they are paid.
You must notify the CHO of defaulters (those who will not attend for childhood immunisations) or those who have moved to another area to ensure that the practice receives its bonuses (paid when the child’s full vaccine schedule is complete).Social Welfare
Paid quarterly.
Keep a record of all issued social welfare certs and ensure they are paid.
State Bodies:
Garda Scheme
GPs can contract to provide free GP visits to Gardaí, all other fees must be covered directly by the patient.
Similar to 3rd party invoicing, you need to ensure that all visits are claimed.
You must get the Garda to sign a claim form.
You can generate an invoice from your PMS which will have an invoice number and the correct details.
You can send these as they arise or send one batch every month (monthly may be easier to keep track of payments, as long as you ensure all visits are applied to the account correctly on the day).CIE
This scheme is like capitation – you are paid a set amount every quarter per patient on your list.
CIE employees and their spouse and dependents (children up to the age of 16) are entitled to free GP visits.
It is worth checking that the list is accurate as per the patients on your system (you should have their patient type categorised on your practice management system to be able to generate lists).
Keep the printed lists provided on file for 6 years.
There are some other schemes available to employees of some other public institutions, such as An Post.
Training Fees:
GPs can become GP trainers and can also take on medical students for short rotations.
GP training scheme – ensure that your grant is paid (paid in arrears every 6 months) and that expenses are claimed. Contact the scheme directly to discuss how to claim expenses.
Medical students – invoice the college directly & ensure timely payment.
Professional Services Withholding Tax (PSWT)
State and semi-state bodies deduct 20% professional services withholding tax at source, with the practice receiving the net amount. When GPs submit their yearly income tax return, they deduct the withholding tax from the tax they owe Revenue and only pay the balance (plus preliminary tax for the following year).
Before July 2021, practices had to retain their F45s (paper withholding tax records) as proof of the deduction. With the rollout of Revenue’s new electronic format for allocating PSWT it is now possible to view the records via Revenue Online Services (ROS). However unlike the postal system where the practice would have received all F45s directly, the PSWT record for services provided under the individual GP’s PPSN (PCRS, social welfare certs etc) will be attached to each individual GP’s ROS account. In most cases, the Practice Manager may only be able to view the PSWT records that come through to the practice partnership number.
A CSV file can be downloaded from Revenue which contains all the relevant payment information (payor, security number, date, gross and net payment details). It is important to liaise with the practice accountant to make sure the Revenue record is correct. While it is no longer necessary to keep a file with the F45 number etc, it is still worth reconciling each month (perhaps with the help of your accountant downloading the GP files from ROS) to ensure that all relevant payments have a corresponding ‘Payment Notification’ within ROS.
The gross payment represents the income to the practice. However, it is important to record the net amount of state payments every month and record the withholding tax in a separate account or column. This makes it easier to identify the total amount of withholding tax deducted from the practice and available as tax credits for the GPs at year end. Discuss this with your accountant and decide how best to split this out.
GP Employee PSWT
As of December 2021, under the new system a GP employee with a GMS panel would be required to submit their tax return and claim a refund of the withholding tax from Revenue to reimburse the practice. This is different to the system prior to 2021, where the practice can claim the withholding tax before the employee tax return is filed.
It is our understanding that the Tax Institute is engaging with Revenue on this matter and hope that a better system can be agreed. The best thing to do for now is just discuss this with your accountant if you have a GP employee with a GMS panel and they can liaise with the Tax Institute for guidance. We will of course let you know if there are any further updates.
PSWT Management Online
For anyone who has not yet accessed the PSWT section on ROS - if you have access to the practice account, the steps are laid out below. You can also access the relevant circular here.
When you log in, you are automatically brought to the My Services page.
Scroll down to the bottom of that page and select 'Manage Professional Services Withholding Tax'.
You will be brought through to this page. Select 'View Payment Notifications' to view and download your PSWT records.
Income Control
Good financial control requires consistent processes, clear procedures and accurate record keeping. Your record keeping system, whether on paper or on a computer, should be simple to use, easy to understand, reliable, accurate, consistent and designed to provide information on a timely basis.
The practice management role here is to maximise income to the practice. You can do that by having good claiming and invoicing processes. The goal is to ensure that the practice is paid for all work completed and opportunities for increasing revenue are identified.
Record Keeping
You must record income from all sources – i.e. you can’t have an unexplained deposit in your bank account. You must keep all relevant records of income for six years.
You must have a way of keeping track of all invoices and claims sent and payment monitored. Outstanding fees or claims must be followed up promptly. Suggestions for each income source are detailed below.
Private Practice
Patient Fees:
Use your GP software to record patient charges and payments. Records are stored in the system and can be used to generate reports at any time.
Ensure all patients are charged on the day of services.
Where possible, ensure payment is taken on the day.
If payment is not received, ensure that patient is billed promptly.
Billing methods: send online payment link by SMS/email, call or send letter.
Many practices now take payment at time of booking or check-in. This can help to reduce no-shows and outstanding charges.
Ensure that reception staff are aware to look at outstanding balances when on the phone, booking appointments and dealing with patients face-to-face.Reconcile daily payments (cash, card, online, cheques) with daily records generated from your practice software.
You must also ensure that the amount received from card or online services is correct when it hits the bank account.
If you use accounting software, it should be easy to record these payments in your accounts.You may have multiple ways for patients to pay – online portal, online payment links, card payments, cheques and cash.
It is important to ensure all payments are recorded and checked off against charges within your practice software. If you do not allocate payments to outstanding charges you may over-inflate your outstanding charges at year-end.
See our 'Cash & Cheque Lodgement Template' here.You can easily generate reports using your practice management system at the end of each week/month to check for outstanding amounts due to the practice.
Effective credit control is essential to ensuring the viability of the practice.
You should have a credit control procedure in place – what will you do if you have outstanding charges? Example: You may attempt to contact someone by a number of contact methods (SMS, phone, letter) as a starting point (state these in order, and how many times you will attempt each method before moving on to the next) . After exhausting all avenues and the doctor/patient relationship has broken down, you may consider asking the patient to find another practice (seek appropriate advice from your medical indemnity provider).Keep records of cash and cheque lodgements.
Reconcile with bank statement.
Private 3rd Parties:
You can also use your GP software to record 3rd party charges and payments.
Ensure all charges for private 3rd parties are recorded daily.
Invoice on a regular basis.
E.g. monthly for occupational health clients, weekly for sending insurance claims, daily/as they arise for medicolegal charges. Just ensure you are consistent so you do not miss any invoices.
Many practices do not release medicolegal reports until payment is made by solicitor.
It is advisable to at least confirm your fee with an insurance company before you submit the report, as you may charge more than their standard fee.
Add invoice to accounting software (or log in manual records - see our '3rd Party Invoices Sent' Excel template here).Reconcile payments:
When payment is made you need to mark off the practice management system and reconcile on your accounting software (or your manual records).
You may do this as part of your bank reconciliation instead of marking off as they come in.You must have a system in place to check for payments and chase them once they are overdue.
Accounting software can be useful for this, you can easily see overdue invoices, which can be checked weekly.
Other manual methods:
Keep an excel template of invoices sent and check for payments due weekly.
Keep a copy of all invoices sent and keep in a file in order of due date, check weekly.Decide on a system for storing your invoices – whether it is paper, copies saved in a computer folder or in your accounting software. Paper or computer folder examples:
Label by month and store all invoices sent that month
Label by 3rd party and store all invoices sent to that organisation in date order
Receipts from Government Agencies
PCRS:
All PCRS income should be recorded in an accessible manner so that it can be reviewed for fluctuations or errors easily.
GMS Capitation – download and keep your itemised listing from PCRS every month (previously referred to as ‘pink sheets’)
Ensure to download your GMS panel from PCRS each month to update your practice management software. This will ensure you only have valid cards on your system.
GMS panel management is essential to ensure cards due to expire are renewed by patients and patients are accepted online via the PCRS suite.STCs/vaccines – keep all paper STCs and paper vaccine claim forms for 6 years.
Valid claims entered online by the last day of the month, will be paid by the 15th day of the following month.
A robust system is required to ensure all STCs are claimed.
In some practices, receptionists are responsible for all STCs.
In others, the HCP who delivers the service is responsible for the STC.
It is important at the end of every day to ensure that you have an STC for every relevant service delivered that day.
Review of the pink sheets is required to ensure all STCs are paid and ones that are rejected are followed up.
There are external software providers that can identify missed STCs.
Have a recall system for patients who require repeat ECGs, 24hr ABPMs, LARCs etc.
Ensure all bonus payments are paid for vaccines – be careful to submit in correct batches to get bonus payment.CDM
Ensure all reviews are submitted and paid.
A good recall system is essential to keep on top of this growing programme.Allowances
Annual/study/sick leave applications and indemnity to be submitted promptly for payment.
All leave entitlements should be claimed.
Practice subsidies should be kept up to date and monitored.Maternity
Claims can now be submitted online via the PCRS suite.
You need to have a system in place to ensure no ANC visits are missed – some practices submit the claims on the day of the visit, some wait until all visits are completed.
You must ensure that all visits are paid. You can view all claims in the PCRS suite and it will show if it is ‘Paid’ or ‘To Pay’.Cervical Check
Keep a log of all cervical check samples sent and reconcile payments on the pink sheets each month.
Other State Contracts:
Childhood Immunisations
In some areas, childhood immunisations are paid through the PCRS.
Keep a record of all immunisations and ensure they are paid.
You must notify the CHO of defaulters (those who will not attend for childhood immunisations) or those who have moved to another area to ensure that the practice receives its bonuses (paid when the child’s full vaccine schedule is complete).Social Welfare
Paid quarterly.
Keep a record of all issued social welfare certs and ensure they are paid.
State Bodies:
Garda Scheme
GPs can contract to provide free GP visits to Gardaí, all other fees must be covered directly by the patient.
Similar to 3rd party invoicing, you need to ensure that all visits are claimed.
You must get the Garda to sign a claim form.
You can generate an invoice from your PMS which will have an invoice number and the correct details.
You can send these as they arise or send one batch every month (monthly may be easier to keep track of payments, as long as you ensure all visits are applied to the account correctly on the day).CIE
This scheme is like capitation – you are paid a set amount every quarter per patient on your list.
CIE employees and their spouse and dependents (children up to the age of 16) are entitled to free GP visits.
It is worth checking that the list is accurate as per the patients on your system (you should have their patient type categorised on your practice management system to be able to generate lists).
Keep the printed lists provided on file for 6 years.
There are some other schemes available to employees of some other public institutions, such as An Post.
Training Fees:
GPs can become GP trainers and can also take on medical students for short rotations.
GP training scheme – ensure that your grant is paid (paid in arrears every 6 months) and that expenses are claimed. Contact the scheme directly to discuss how to claim expenses.
Medical students – invoice the college directly & ensure timely payment.
Professional Services Withholding Tax (PSWT)
State and semi-state bodies deduct 20% professional services withholding tax at source, with the practice receiving the net amount. When GPs submit their yearly income tax return, they deduct the withholding tax from the tax they owe Revenue and only pay the balance (plus preliminary tax for the following year).
Before July 2021, practices had to retain their F45s (paper withholding tax records) as proof of the deduction. With the rollout of Revenue’s new electronic format for allocating PSWT it is now possible to view the records via Revenue Online Services (ROS). However unlike the postal system where the practice would have received all F45s directly, the PSWT record for services provided under the individual GP’s PPSN (PCRS, social welfare certs etc) will be attached to each individual GP’s ROS account. In most cases, the Practice Manager may only be able to view the PSWT records that come through to the practice partnership number.
A CSV file can be downloaded from Revenue which contains all the relevant payment information (payor, security number, date, gross and net payment details). It is important to liaise with the practice accountant to make sure the Revenue record is correct. While it is no longer necessary to keep a file with the F45 number etc, it is still worth reconciling each month (perhaps with the help of your accountant downloading the GP files from ROS) to ensure that all relevant payments have a corresponding ‘Payment Notification’ within ROS.
The gross payment represents the income to the practice. However, it is important to record the net amount of state payments every month and record the withholding tax in a separate account or column. This makes it easier to identify the total amount of withholding tax deducted from the practice and available as tax credits for the GPs at year end. Discuss this with your accountant and decide how best to split this out.
GP Employee PSWT
As of December 2021, under the new system a GP employee with a GMS panel would be required to submit their tax return and claim a refund of the withholding tax from Revenue to reimburse the practice. This is different to the system prior to 2021, where the practice can claim the withholding tax before the employee tax return is filed.
It is our understanding that the Tax Institute is engaging with Revenue on this matter and hope that a better system can be agreed. The best thing to do for now is just discuss this with your accountant if you have a GP employee with a GMS panel and they can liaise with the Tax Institute for guidance. We will of course let you know if there are any further updates.
PSWT Management Online
For anyone who has not yet accessed the PSWT section on ROS - if you have access to the practice account, the steps are laid out below. You can also access the relevant circular here.
When you log in, you are automatically brought to the My Services page.
Scroll down to the bottom of that page and select 'Manage Professional Services Withholding Tax'.
You will be brought through to this page. Select 'View Payment Notifications' to view and download your PSWT records.
Introduction to Strategic Business Planning
Check out the recording of our webinar 'Introduction to Strategic Business Planning' from 31st January, 2023.
Planning for the future is such an important part of running any business, but is so frequently overlooked in General Practice. It is so easy to become overwhelmed with day-to-day tasks instead of looking ahead, which can result in missed opportunities. It also makes it harder to adapt when change does come along.
Strategy determines the direction of an organisation and defines how resources are allocated to achieve the business needs.
Tools like SWOT Analysis help you to understand the opportunities and threats in the external environment, as well as highlighting the internal strengths to draw on and weaknesses to work on.
To take advantage of the opportunities available to you, you need to anticipate and prepare for the future. Think about what you would like to achieve as a practice in the short/medium/long term.
Consider:
What is our intended GMS list size, our intended growth/decline?
Do we want to grow our private patient list?
How do we plan to manage patient demand – existing and future?
What impact will proposed changes have on us – CDM, under 12s, free GP care etc?
Do we need to recruit more nursing or administrative staff?
How can we increase GMS and/or private income?
How can we reduce costs?
Can we introduce new service offerings to better serve our existing patients or reach new patients?
What changes could we make to opening hours to better serve patients, staff and the practice?
Do we want to stay in our existing premises?
Would it be beneficial to consider a merger with another practice in the area?
What if other GP practices enter our area?
What is our GP succession plan?
Do we need an additional GP now?
Where can we make changes and improvements to our IT systems?
How can we improve the patient experience?
How do you plan to get there?
All plans must address the following:
Objectives - What are we going to do?
Clear objectives ensure that everyone is on the same page moving forward. Objectives should be SMART (specific, measurable, achievable, relevant and time-bound).
More detailed information on performance objectives can be found here.Reasoning - Why are we doing it?
Don’t make changes for the sake of it. Decision making tools such as Force Field Analysis can help you make the case for change, or to prevent you from making changes that will not be successful.Actions - How are we going to do it?
Break it down into sequential steps required to achieve the objective.Timing - When are we going to do it?
Unless you set a deadline for an objective, it can easily be put on the back burner.Accountability - Who is responsible for doing it?
Without assigning responsibility for certain tasks, the objectives are unlikely to be achieved.
SWOT Analysis
SWOT Analysis is a tool for analysing the Strengths, Weaknesses, Opportunities & Threats of a business. You can use it to assess what the practice is doing well right now and identify areas for improvement. It is also useful for mapping out a strategy for future development and resilience.
By examining both internal and external factors, you can identify factors that are within your control and those that are not. Strengths and weaknesses are generally made up of internal factors, while opportunities and threats generally consist of external factors.It is worth noting that factors can be both positive and negative. For example, when considering your human resources, you could note that you have an excellent clinical team (strength) but high turnover of reception staff (weakness). Considering your premises, the location could be good (strength) but you may have no parking (weakness).
Internal
Consider your human resources (skills, productivity, turnover, motivation, morale), physical resources (building, facilities, equipment, technology), service offering, finances, operational management (systems and processes), and intangible factors like reputation.
For example:
Human resources
Location
Building
Facilities e.g. parking
Equipment
Health & safety
Reputation
Services – consider all GMS/private services that could be offered and how effectively existing services are being delivered
Opening hours
Accessibility – patient access points such as phone, website, email, SMS
Availability – patient wait times for clinical care and administrative services
Use of technology
Communication
Resistance to change
Fees
Overheads
Systems, processes and procedures
Financial control – accuracy of claiming, bad debt level
Ability to attract new patients
Organisational structure
Accountability
External
A useful tool for analysing the external environment is PEST (Political, Economic, Social, Technological).
Political – current and potential impact from political pressures.
Government/HSE changes or initiatives (e.g. FEMPI reversal, under 12s free GP care, chronic disease management, pharmacies doing vaccines), employment law, political stability
Economic – impact of local and broader economy.
Brexit, availability of finance, inflation, grants, COVID supports, labour market
Social – the ways in which changes in local and broader society affect the practice.
Demographics, housing, population, immigration/emigration, public perception of GPs/healthcare, patient expectations, media coverage
Technological – effect of new and emerging technologies.
Technological advances (websites, SMS, social media, online bookings), Telehealth (phone/video consults), reliance on IT, remote working
Forming Strategies from SWOT Analysis
Once completed you can identify ways to leverage your strengths and improve areas of weakness. You can also put plans in place to take advantage of opportunities and protect the practice from threats.
Example
Threat – lack of GPs willing to work in the area.
Strength – highly skilled and experienced nursing staff.
Opportunity – development of advanced nurse practitioner training in Ireland.
Strategy to overcome the lack of GPs – train a practice nurse up to have a greater role in the practice, taking pressure off the GPs in the future.
Tips
Be specific
Involve everyone
Keep it simple
Be realistic
Consider your competition
You can use the templates provided below.
Templates
Force Field Analysis
Force Field Analysis is an effective, structured decision-making tool for when you're making difficult or challenging decisions that makes it easier to make the case for or against change. It can improve the quality of your decisions and increase your chances of success. It is also a useful tool for communicating the reasoning behind your decision making.
The process helps to define or map out the forces at play. Driving forces are facilitators that promote change, while restraining forces are barriers that hinder change. The idea behind Force Field Analysis is that situations are maintained by an equilibrium between driving and restraining forces. For change to occur, the overall driving forces must be stronger than the overall restraining forces. This may require some effort to strengthen the forces for change or weaken the forces against change.
Forces can be internal or external. See SWOT Analysis section for further information on internal and external factors.
Internal
Often significant internal drivers or barriers to change come from people’s attitudes and emotions, i.e. their willingness to accept change or their resistance to it.
Resistance to change
Fear
Available resources
Available skills
Budget
Existing organisational structures
Legacy systems and processes
External
External drivers or barriers are generally out of your control, such as the cost of the new product/service, regulations etc.
Cost
Technology
Patient preferences
Regulations/Legislation
New circumstances or challenges (e.g. COVID-19)
The following questions may help you to identify forces:
What business benefit will the change deliver?
Who supports the change? Who is against it? Why?
Do you have the resources to make the change work?
What costs and risks are involved?
What business processes will be affected?
Steps:
Define the change you wish to make.
List all the driving forces for the change.
List all the restraining forces for the change.
Evaluate the influence of the driving and restraining forces on change – score each force from one (very weak) to five (very strong).
Total the scores for both sides.
Once you have completed the exercise, you can use it to:
Decide whether or not to move forward with the change.
Think about which drivers you can strengthen (or additional forces could be added) and which barriers you can weaken, and how to make the change more successful.
You may also return to the decision when circumstances change. In the examples provided below, the score changes due to the pandemic help to sway the decisions towards making the change.
Template
In the above example 'Change Idea: Upgrade Phone System', initially the case against change was stronger.
On further review, the practice decided to increase the amount of training to reduce staff resistance to technology – this increases the training time score, but reduces the staff resistance. Another driving force was also added – the ability to transfer calls to a mobile makes it easier for staff to work remotely. This became increasingly important due to the pandemic.
See the effect below, it is now easier to make the case for change.
In the above example 'Change Idea: Introduce SMS Billing/Online Payments', the initial case against change was also stronger.
Based on changing circumstances due to COVID, several driving factors had to be re-evaluated and two added (see below):
Number of remote consultations increased.
Phone traffic increased, so more admin staff were required to meet the demand.
More remote consultations led to difficulties collecting payment.
More patients are now willing to pay online - need to meet their expectations.
Management and staff growing increasingly frustrated by need to chase payment.
Need to reduce the amount of face-to-face contact at reception.
They also took the below steps to reduce the barriers:
Increase amount of training to reduce staff resistance to technology – this increases training time score, but reduces the staff resistance score.
With the new circumstances and reduced barriers, the below case for change is clear.
Force Field Analysis
Force Field Analysis is an effective, structured decision-making tool for when you're making difficult or challenging decisions that makes it easier to make the case for or against change. It can improve the quality of your decisions and increase your chances of success. It is also a useful tool for communicating the reasoning behind your decision making.
The process helps to define or map out the forces at play. Driving forces are facilitators that promote change, while restraining forces are barriers that hinder change. The idea behind Force Field Analysis is that situations are maintained by an equilibrium between driving and restraining forces. For change to occur, the overall driving forces must be stronger than the overall restraining forces. This may require some effort to strengthen the forces for change or weaken the forces against change.
Forces can be internal or external. See SWOT Analysis section for further information on internal and external factors.
Internal
Often significant internal drivers or barriers to change come from people’s attitudes and emotions, i.e. their willingness to accept change or their resistance to it.
Resistance to change
Fear
Available resources
Available skills
Budget
Existing organisational structures
Legacy systems and processes
External
External drivers or barriers are generally out of your control, such as the cost of the new product/service, regulations etc.
Cost
Technology
Patient preferences
Regulations/Legislation
New circumstances or challenges (e.g. COVID-19)
The following questions may help you to identify forces:
What business benefit will the change deliver?
Who supports the change? Who is against it? Why?
Do you have the resources to make the change work?
What costs and risks are involved?
What business processes will be affected?
Steps:
Define the change you wish to make.
List all the driving forces for the change.
List all the restraining forces for the change.
Evaluate the influence of the driving and restraining forces on change – score each force from one (very weak) to five (very strong).
Total the scores for both sides.
Once you have completed the exercise, you can use it to:
Decide whether or not to move forward with the change.
Think about which drivers you can strengthen (or additional forces could be added) and which barriers you can weaken, and how to make the change more successful.
You may also return to the decision when circumstances change. In the examples provided below, the score changes due to the pandemic help to sway the decisions towards making the change.
Template
In the above example 'Change Idea: Upgrade Phone System', initially the case against change was stronger.
On further review, the practice decided to increase the amount of training to reduce staff resistance to technology – this increases the training time score, but reduces the staff resistance. Another driving force was also added – the ability to transfer calls to a mobile makes it easier for staff to work remotely. This became increasingly important due to the pandemic.
See the effect below, it is now easier to make the case for change.
In the above example 'Change Idea: Introduce SMS Billing/Online Payments', the initial case against change was also stronger.
Based on changing circumstances due to COVID, several driving factors had to be re-evaluated and two added (see below):
Number of remote consultations increased.
Phone traffic increased, so more admin staff were required to meet the demand.
More remote consultations led to difficulties collecting payment.
More patients are now willing to pay online - need to meet their expectations.
Management and staff growing increasingly frustrated by need to chase payment.
Need to reduce the amount of face-to-face contact at reception.
They also took the below steps to reduce the barriers:
Increase amount of training to reduce staff resistance to technology – this increases training time score, but reduces the staff resistance score.
With the new circumstances and reduced barriers, the below case for change is clear.
Force Field Analysis
Force Field Analysis is an effective, structured decision-making tool for when you're making difficult or challenging decisions that makes it easier to make the case for or against change. It can improve the quality of your decisions and increase your chances of success. It is also a useful tool for communicating the reasoning behind your decision making.
The process helps to define or map out the forces at play. Driving forces are facilitators that promote change, while restraining forces are barriers that hinder change. The idea behind Force Field Analysis is that situations are maintained by an equilibrium between driving and restraining forces. For change to occur, the overall driving forces must be stronger than the overall restraining forces. This may require some effort to strengthen the forces for change or weaken the forces against change.
Forces can be internal or external. See SWOT Analysis section for further information on internal and external factors.
Internal
Often significant internal drivers or barriers to change come from people’s attitudes and emotions, i.e. their willingness to accept change or their resistance to it.
Resistance to change
Fear
Available resources
Available skills
Budget
Existing organisational structures
Legacy systems and processes
External
External drivers or barriers are generally out of your control, such as the cost of the new product/service, regulations etc.
Cost
Technology
Patient preferences
Regulations/Legislation
New circumstances or challenges (e.g. COVID-19)
The following questions may help you to identify forces:
What business benefit will the change deliver?
Who supports the change? Who is against it? Why?
Do you have the resources to make the change work?
What costs and risks are involved?
What business processes will be affected?
Steps:
Define the change you wish to make.
List all the driving forces for the change.
List all the restraining forces for the change.
Evaluate the influence of the driving and restraining forces on change – score each force from one (very weak) to five (very strong).
Total the scores for both sides.
Once you have completed the exercise, you can use it to:
Decide whether or not to move forward with the change.
Think about which drivers you can strengthen (or additional forces could be added) and which barriers you can weaken, and how to make the change more successful.
You may also return to the decision when circumstances change. In the examples provided below, the score changes due to the pandemic help to sway the decisions towards making the change.
Template
In the above example 'Change Idea: Upgrade Phone System', initially the case against change was stronger.
On further review, the practice decided to increase the amount of training to reduce staff resistance to technology – this increases the training time score, but reduces the staff resistance. Another driving force was also added – the ability to transfer calls to a mobile makes it easier for staff to work remotely. This became increasingly important due to the pandemic.
See the effect below, it is now easier to make the case for change.
In the above example 'Change Idea: Introduce SMS Billing/Online Payments', the initial case against change was also stronger.
Based on changing circumstances due to COVID, several driving factors had to be re-evaluated and two added (see below):
Number of remote consultations increased.
Phone traffic increased, so more admin staff were required to meet the demand.
More remote consultations led to difficulties collecting payment.
More patients are now willing to pay online - need to meet their expectations.
Management and staff growing increasingly frustrated by need to chase payment.
Need to reduce the amount of face-to-face contact at reception.
They also took the below steps to reduce the barriers:
Increase amount of training to reduce staff resistance to technology – this increases training time score, but reduces the staff resistance score.
With the new circumstances and reduced barriers, the below case for change is clear.
Force Field Analysis
Force Field Analysis is an effective, structured decision-making tool for when you're making difficult or challenging decisions that makes it easier to make the case for or against change. It can improve the quality of your decisions and increase your chances of success. It is also a useful tool for communicating the reasoning behind your decision making.
The process helps to define or map out the forces at play. Driving forces are facilitators that promote change, while restraining forces are barriers that hinder change. The idea behind Force Field Analysis is that situations are maintained by an equilibrium between driving and restraining forces. For change to occur, the overall driving forces must be stronger than the overall restraining forces. This may require some effort to strengthen the forces for change or weaken the forces against change.
Forces can be internal or external. See SWOT Analysis section for further information on internal and external factors.
Internal
Often significant internal drivers or barriers to change come from people’s attitudes and emotions, i.e. their willingness to accept change or their resistance to it.
Resistance to change
Fear
Available resources
Available skills
Budget
Existing organisational structures
Legacy systems and processes
External
External drivers or barriers are generally out of your control, such as the cost of the new product/service, regulations etc.
Cost
Technology
Patient preferences
Regulations/Legislation
New circumstances or challenges (e.g. COVID-19)
The following questions may help you to identify forces:
What business benefit will the change deliver?
Who supports the change? Who is against it? Why?
Do you have the resources to make the change work?
What costs and risks are involved?
What business processes will be affected?
Steps:
Define the change you wish to make.
List all the driving forces for the change.
List all the restraining forces for the change.
Evaluate the influence of the driving and restraining forces on change – score each force from one (very weak) to five (very strong).
Total the scores for both sides.
Once you have completed the exercise, you can use it to:
Decide whether or not to move forward with the change.
Think about which drivers you can strengthen (or additional forces could be added) and which barriers you can weaken, and how to make the change more successful.
You may also return to the decision when circumstances change. In the examples provided below, the score changes due to the pandemic help to sway the decisions towards making the change.
Template
In the above example 'Change Idea: Upgrade Phone System', initially the case against change was stronger.
On further review, the practice decided to increase the amount of training to reduce staff resistance to technology – this increases the training time score, but reduces the staff resistance. Another driving force was also added – the ability to transfer calls to a mobile makes it easier for staff to work remotely. This became increasingly important due to the pandemic.
See the effect below, it is now easier to make the case for change.
In the above example 'Change Idea: Introduce SMS Billing/Online Payments', the initial case against change was also stronger.
Based on changing circumstances due to COVID, several driving factors had to be re-evaluated and two added (see below):
Number of remote consultations increased.
Phone traffic increased, so more admin staff were required to meet the demand.
More remote consultations led to difficulties collecting payment.
More patients are now willing to pay online - need to meet their expectations.
Management and staff growing increasingly frustrated by need to chase payment.
Need to reduce the amount of face-to-face contact at reception.
They also took the below steps to reduce the barriers:
Increase amount of training to reduce staff resistance to technology – this increases training time score, but reduces the staff resistance score.
With the new circumstances and reduced barriers, the below case for change is clear.
Introduction to Operations Management
Check out the recording of our webinar 'Introduction to Operations Management' from 22nd June 2022.
Operations refers to all the activities required to deliver services to patients. Management is concerned with the design, management and improvement of processes required to deliver patient care. It involves understanding the needs of the patients, managing the processes and practice resources, ensuring the practice’s objectives are met, while also paying attention to the continual improvement of the services.
Good service operations management should lead to better (or more appropriate) services and experiences that are better for the patient, better for the staff and also better for the practice:
Patients: Patients are satisfied if they get the right service, a good experience and desired outcomes.
Staff: Satisfied patients are easier to deal with, so staff experience less stress. Staff are also more likely to take pride in their work when they believe a good experience is provided for the patient.
Practice: Satisfied patients improve the reputation of the practice and future viability, improved processes reduce costs and risk, continuous improvement improves the adaptability of the practice.
Effective operations management has the potential to keep costs down, improve revenue, appropriately allocate resources and develop future capabilities to adapt and respond effectively to change. Simply put, the more efficient your processes are, the more adaptable your practice is to change. In the context of a caring profession like General Practice, efficiency is not always easy or advisable in all areas of the business. However, by increasing efficiency in the right areas you can take the rapid changes in your stride, ensuring that patient care comes first without having a detrimental effect on long term profits. This is how you create value – for your patients, your staff and the business itself.
In summary, effective operations management contributes to the success of the practice by utilising resources effectively, resulting in:
Enhanced patient care, satisfaction and retention – through service improvements
Lower costs – through process efficiencies and increased productivity
Lower risk – through reduced errors and better resilience
Improved future capabilities – through learning from continuous improvement
Key challenges for practice managers include:
Over focus on day-to-day tasks and firefighting
Lack of confidence in making changes
Lack of knowledge on how to improve processes
Lack of strategic influence
Difficulty making business case for change
Managing Patient Expectations
Managing patient expectations is critical in any service business. It is a continuous process of communication where the practice tells patients ‘what to expect’ from the first moment of contact.
Patient satisfaction is derived from the patient’s overall assessment of their perceptions of the service compared to their prior expectations. As well as their impression of the overall service, the patient can have expectations and perceptions about each individual interaction in the process.
Causes of gaps between expectations, service and perceptions:
Inappropriate patient expectations or perceptions of outcomes
Lack of understanding of patient expectations
Inappropriate service provision
Poor process design
Inefficient resources
It is important to manage patient expectations to improve perceptions of service quality. There are many opportunities to influence and shape expectations early in the service process. Communication and messaging is very important in the practice environment (including all access points such as phone and website) and must be kept consistent in all areas. This messaging can reduce the load on phones and reception staff as they deal with other queries.
For example:
Updating the reception phone queue message regularly with wait times for routine appointments or vaccine programme information
Advising patients in the waiting room that the doctor is running late due to an emergency
Sending an SMS to all private patients to advise a new payment policy
Signs in reception and waiting areas advising the processing time for repeat prescriptions
Posting a message about a power outage on practice social media pages and advising alternative ways to make contact
Queuing
The amount of queuing involved in a process can influence the patient’s perception of service quality. Patients tend to spend a lot of time queuing in the healthcare system and can be the cause of much dissatisfaction. Queuing time will increase as demand or processing time increases.
Queuing at different points in the process is generally unavoidable in General Practice, given the pressures that the system is under but ignoring the issue entirely can have implications on the perception of the service. It is important to consider all the points of queuing when trying to improve service processes.
Queuing is a subjective experience, so taking simple steps to manage expectations can improve patient queuing experiences. Keeping patients informed of the likely length of wait can improve service quality perceptions.
Patients are generally happier to queue if:
They know what to expect
They believe staff are aware of them
They believe the service is in process
They believe another person has more medically urgent needs
For example:
If the GP is already running late when a patient arrives, the receptionist can inform that patient immediately that they will need to wait a little longer than normal. This allows the patient to decide if they can stay or not, if they need to get someone else to collect their child from school, if they need to call work to tell them they will be longer than expected and so on. This will avoid the patient sitting in the waiting room, wondering if they have been forgotten and getting more and more frustrated as time goes on.
Systems, Processes & Procedures
People often refer to systems and processes interchangeably. For clarity, they are defined below.
A system is ‘a way of working, organising, or doing something which follows a fixed plan or set of rules’.
A process is ‘a series of actions which are carried out in order to achieve a particular result’.
Practices have service related processes (e.g. answering phones, clinical procedures) and back office processes (e.g. claiming and ordering stock). Process improvement should be patient focused (where relevant) and involve everyone in the practice.
All practices can strive for a culture of continuous improvement – seeking to improve all processes in the practice to improve quality, enhance flow and reduce wasteful activities. Continuous improvement makes a practice’s workflow more effective, more efficient, and more capable of
adapting to an ever-changing environment.
Benefits from continuous improvement:
Improved quality and safety – fewer mistakes
Improved delivery – better work gets done sooner
Improved throughput – same people and equipment capable of achieving more
More stable working environment with clear standardised procedures
Improved staff morale
1. Diagnose
There are many tools for evaluating an existing process including:
Process Mapping
Fishbone Diagrams
Significant Event Analysis
Process Mapping: Mapping processes from beginning to end can be a useful way to review and improve them (e.g. the patient journey from making contact to seeing the GP, the repeat prescription process – from the patient requesting it to it arriving in the pharmacy). The mapping process can identify which activities in the process work well and which activities need to be removed or redesigned. It can also be used to map the flow of patients or information through a process and identify if there is a more logical sequence of activities.
Process maps can be created on a computer or hand drawn, however one of the best ways to map a process is using post-its, as it can be difficult to get it right on paper the first time around.
See a detailed guide to process mapping using post-its from the RCGP here.
Fishbone Diagrams: Also known as cause and effect analysis or Ishikawa diagrams.
The problem (effect) you are trying to identify the causes of go on the right hand side – creating the head of the fish.
The major potential cause categories create the spine – you can use ones that are relevant to the situation or use generic ones such as: environment, people, equipment, methods, materials.
Discuss each category and list all cause ideas as sub-branches off the spine.
Ask ‘why does this happen?’ and consider from all perspectives (patient, GP, nurse, receptionist).
This will create the layers of causes that will help to identify the root cause of the problem.
Once you have the diagram, you can decide which cause to tackle first.
Significant Event Analysis (SEA): SEA is usually undertaken when an event is considered to be significant in patient care or the management of the practice. It is good practice to incorporate SEA into regular practice meetings.
The following questions need to be answered on the event:
What happened and why?
What was the impact on those involved (patient, carer, family, GP, practice)?
How could things have been different?
What can we learn from what happened?
What needs to change?
1. Diagnose
There are many tools for evaluating an existing process including:
Process Mapping
Fishbone Diagrams
Significant Event Analysis
Process Mapping: Mapping processes from beginning to end can be a useful way to review and improve them (e.g. the patient journey from making contact to seeing the GP, the repeat prescription process – from the patient requesting it to it arriving in the pharmacy). The mapping process can identify which activities in the process work well and which activities need to be removed or redesigned. It can also be used to map the flow of patients or information through a process and identify if there is a more logical sequence of activities.
Process maps can be created on a computer or hand drawn, however one of the best ways to map a process is using post-its, as it can be difficult to get it right on paper the first time around.
See a detailed guide to process mapping using post-its from the RCGP here.
Fishbone Diagrams: Also known as cause and effect analysis or Ishikawa diagrams.
The problem (effect) you are trying to identify the causes of go on the right hand side – creating the head of the fish.
The major potential cause categories create the spine – you can use ones that are relevant to the situation or use generic ones such as: environment, people, equipment, methods, materials.
Discuss each category and list all cause ideas as sub-branches off the spine.
Ask ‘why does this happen?’ and consider from all perspectives (patient, GP, nurse, receptionist).
This will create the layers of causes that will help to identify the root cause of the problem.
Once you have the diagram, you can decide which cause to tackle first.
Significant Event Analysis (SEA): SEA is usually undertaken when an event is considered to be significant in patient care or the management of the practice. It is good practice to incorporate SEA into regular practice meetings.
The following questions need to be answered on the event:
What happened and why?
What was the impact on those involved (patient, carer, family, GP, practice)?
How could things have been different?
What can we learn from what happened?
What needs to change?
1. Diagnose
There are many tools for evaluating an existing process including:
Process Mapping
Fishbone Diagrams
Significant Event Analysis
Process Mapping: Mapping processes from beginning to end can be a useful way to review and improve them (e.g. the patient journey from making contact to seeing the GP, the repeat prescription process – from the patient requesting it to it arriving in the pharmacy). The mapping process can identify which activities in the process work well and which activities need to be removed or redesigned. It can also be used to map the flow of patients or information through a process and identify if there is a more logical sequence of activities.
Process maps can be created on a computer or hand drawn, however one of the best ways to map a process is using post-its, as it can be difficult to get it right on paper the first time around.
See a detailed guide to process mapping using post-its from the RCGP here.
Fishbone Diagrams: Also known as cause and effect analysis or Ishikawa diagrams.
The problem (effect) you are trying to identify the causes of go on the right hand side – creating the head of the fish.
The major potential cause categories create the spine – you can use ones that are relevant to the situation or use generic ones such as: environment, people, equipment, methods, materials.
Discuss each category and list all cause ideas as sub-branches off the spine.
Ask ‘why does this happen?’ and consider from all perspectives (patient, GP, nurse, receptionist).
This will create the layers of causes that will help to identify the root cause of the problem.
Once you have the diagram, you can decide which cause to tackle first.
Significant Event Analysis (SEA): SEA is usually undertaken when an event is considered to be significant in patient care or the management of the practice. It is good practice to incorporate SEA into regular practice meetings.
The following questions need to be answered on the event:
What happened and why?
What was the impact on those involved (patient, carer, family, GP, practice)?
How could things have been different?
What can we learn from what happened?
What needs to change?
2. Improve
Below is a simple approach to improvement. The PDSA cycle is a recognised, structured approach to improvement through planning and testing change.
PLAN – develop a plan to test the change
DO – test the change
STUDY – learn from what happens
ACT – determine what happens next
A. PLAN
In the planning stage you set the objectives of the new process, choose the measures to evaluate the effectiveness of the change and brainstorm ideas for process improvement.
Objectives: What are we trying to accomplish?
Do you want to improve the quality, responsiveness, dependability, flexibility of the process?
Do you want to make the process more cost effective?
Clear objectives ensure that everyone is on the same page moving forward. Objectives should be SMART (specific, measurable, achievable, relevant and time-bound). You need to ensure your objectives answer the questions:
What?
By how much?
By when?
Why?
See here for more detailed information on performance objectives.
Measures: How will we know that a change is an improvement?
What are you going to measure to know if your change is working?
The measures should be directly related to your objectives.
You need to collect data on your measures before the change, so you have a baseline to compare it to.
There are 3 types of measures:
Outcome – impacts on patients and stakeholders
E.g. number of days to next appointment
Process – is the process performing as planned?
E.g. average daily GP hours available for appointments
Balancing - collect information on unintended consequences or negative impacts of change
E.g. ‘Are there less available appointments overall because GP appointments are being booked by patients online for things that could have been managed by the receptionist?’
Noting negative comments from patients on a new process can also be considered a balancing measure.A simple spreadsheet can be used to record data, or give the relevant staff member a document to record on (which can be transferred to a computer at a later date if necessary).
Ideas: What changes can we make that will result in improvement?
Consider all the ideas generated by the team and select those you would like to test.
You may choose to make several changes to make the new process a success.
Focus on:
Improving the overall experience for patients
Consider the whole process from start to finish – not parts of the process in isolation.
Map the patient journey through the entire process.Improving the flow of patients through the process
Increase speed and efficiency.Improving the flow of information through the process
It is critical that information is transferred in a clear, timely and accurate manner in every step in the process.Reducing waste
One way to reduce waste and improve flow is to reduce the amount of steps in the process, thus reducing staff time spent on the process and delays between steps.Reducing failure demand
Managing demand is one of the most pressing issues currently in General Practice. The nature of healthcare is generally reactive, you wait for patients to become ill or require services and react accordingly. One way to reduce demand on the service is to ensure there is as little ‘failure demand’ as possible.
Failure demand is ‘avoidable contact’ – unnecessary demand created by the practice’s failure to do something for the patient. Or in many cases, the failure to appropriately communicate with patients. By improving the service processes you can reduce failure demand, improving patient satisfaction, capacity and staff morale, and also reducing operating costs.
Driver Diagrams
A driver diagram is useful tool to show what changes will likely cause the desired effects and achievement of your aim. The drivers are the areas/factors you need to change to see improvement. The change ideas are the things that you can do differently that will impact on your drivers.
Download templates:
By the end of the planning stage, you should have a plan that includes:
Who will be responsible for the change
When will it be carried out and over what timeframe
How the measurements will be conducted
B. DO
In the doing stage, you carry out the test on a small scale, documenting any problems and unexpected outcomes. Collect data on your measures.
C. STUDY
Evaluate the effectiveness of the change by analysing the data collected.
D. ACT
Tweak the process and start the cycle again. Don’t be afraid to scrap the change and start over either – not all ideas work, but you can always learn from the process.
2. Improve
Below is a simple approach to improvement. The PDSA cycle is a recognised, structured approach to improvement through planning and testing change.
PLAN – develop a plan to test the change
DO – test the change
STUDY – learn from what happens
ACT – determine what happens next
A. PLAN
In the planning stage you set the objectives of the new process, choose the measures to evaluate the effectiveness of the change and brainstorm ideas for process improvement.
Objectives: What are we trying to accomplish?
Do you want to improve the quality, responsiveness, dependability, flexibility of the process?
Do you want to make the process more cost effective?
Clear objectives ensure that everyone is on the same page moving forward. Objectives should be SMART (specific, measurable, achievable, relevant and time-bound). You need to ensure your objectives answer the questions:
What?
By how much?
By when?
Why?
See here for more detailed information on performance objectives.
Measures: How will we know that a change is an improvement?
What are you going to measure to know if your change is working?
The measures should be directly related to your objectives.
You need to collect data on your measures before the change, so you have a baseline to compare it to.
There are 3 types of measures:
Outcome – impacts on patients and stakeholders
E.g. number of days to next appointment
Process – is the process performing as planned?
E.g. average daily GP hours available for appointments
Balancing - collect information on unintended consequences or negative impacts of change
E.g. ‘Are there less available appointments overall because GP appointments are being booked by patients online for things that could have been managed by the receptionist?’
Noting negative comments from patients on a new process can also be considered a balancing measure.A simple spreadsheet can be used to record data, or give the relevant staff member a document to record on (which can be transferred to a computer at a later date if necessary).
Ideas: What changes can we make that will result in improvement?
Consider all the ideas generated by the team and select those you would like to test.
You may choose to make several changes to make the new process a success.
Focus on:
Improving the overall experience for patients
Consider the whole process from start to finish – not parts of the process in isolation.
Map the patient journey through the entire process.Improving the flow of patients through the process
Increase speed and efficiency.Improving the flow of information through the process
It is critical that information is transferred in a clear, timely and accurate manner in every step in the process.Reducing waste
One way to reduce waste and improve flow is to reduce the amount of steps in the process, thus reducing staff time spent on the process and delays between steps.Reducing failure demand
Managing demand is one of the most pressing issues currently in General Practice. The nature of healthcare is generally reactive, you wait for patients to become ill or require services and react accordingly. One way to reduce demand on the service is to ensure there is as little ‘failure demand’ as possible.
Failure demand is ‘avoidable contact’ – unnecessary demand created by the practice’s failure to do something for the patient. Or in many cases, the failure to appropriately communicate with patients. By improving the service processes you can reduce failure demand, improving patient satisfaction, capacity and staff morale, and also reducing operating costs.
Driver Diagrams
A driver diagram is useful tool to show what changes will likely cause the desired effects and achievement of your aim. The drivers are the areas/factors you need to change to see improvement. The change ideas are the things that you can do differently that will impact on your drivers.
Download templates:
By the end of the planning stage, you should have a plan that includes:
Who will be responsible for the change
When will it be carried out and over what timeframe
How the measurements will be conducted
B. DO
In the doing stage, you carry out the test on a small scale, documenting any problems and unexpected outcomes. Collect data on your measures.
C. STUDY
Evaluate the effectiveness of the change by analysing the data collected.
D. ACT
Tweak the process and start the cycle again. Don’t be afraid to scrap the change and start over either – not all ideas work, but you can always learn from the process.
2. Improve
Below is a simple approach to improvement. The PDSA cycle is a recognised, structured approach to improvement through planning and testing change.
PLAN – develop a plan to test the change
DO – test the change
STUDY – learn from what happens
ACT – determine what happens next
A. PLAN
In the planning stage you set the objectives of the new process, choose the measures to evaluate the effectiveness of the change and brainstorm ideas for process improvement.
Objectives: What are we trying to accomplish?
Do you want to improve the quality, responsiveness, dependability, flexibility of the process?
Do you want to make the process more cost effective?
Clear objectives ensure that everyone is on the same page moving forward. Objectives should be SMART (specific, measurable, achievable, relevant and time-bound). You need to ensure your objectives answer the questions:
What?
By how much?
By when?
Why?
See here for more detailed information on performance objectives.
Measures: How will we know that a change is an improvement?
What are you going to measure to know if your change is working?
The measures should be directly related to your objectives.
You need to collect data on your measures before the change, so you have a baseline to compare it to.
There are 3 types of measures:
Outcome – impacts on patients and stakeholders
E.g. number of days to next appointment
Process – is the process performing as planned?
E.g. average daily GP hours available for appointments
Balancing - collect information on unintended consequences or negative impacts of change
E.g. ‘Are there less available appointments overall because GP appointments are being booked by patients online for things that could have been managed by the receptionist?’
Noting negative comments from patients on a new process can also be considered a balancing measure.A simple spreadsheet can be used to record data, or give the relevant staff member a document to record on (which can be transferred to a computer at a later date if necessary).
Ideas: What changes can we make that will result in improvement?
Consider all the ideas generated by the team and select those you would like to test.
You may choose to make several changes to make the new process a success.
Focus on:
Improving the overall experience for patients
Consider the whole process from start to finish – not parts of the process in isolation.
Map the patient journey through the entire process.Improving the flow of patients through the process
Increase speed and efficiency.Improving the flow of information through the process
It is critical that information is transferred in a clear, timely and accurate manner in every step in the process.Reducing waste
One way to reduce waste and improve flow is to reduce the amount of steps in the process, thus reducing staff time spent on the process and delays between steps.Reducing failure demand
Managing demand is one of the most pressing issues currently in General Practice. The nature of healthcare is generally reactive, you wait for patients to become ill or require services and react accordingly. One way to reduce demand on the service is to ensure there is as little ‘failure demand’ as possible.
Failure demand is ‘avoidable contact’ – unnecessary demand created by the practice’s failure to do something for the patient. Or in many cases, the failure to appropriately communicate with patients. By improving the service processes you can reduce failure demand, improving patient satisfaction, capacity and staff morale, and also reducing operating costs.
Driver Diagrams
A driver diagram is useful tool to show what changes will likely cause the desired effects and achievement of your aim. The drivers are the areas/factors you need to change to see improvement. The change ideas are the things that you can do differently that will impact on your drivers.
Download templates:
By the end of the planning stage, you should have a plan that includes:
Who will be responsible for the change
When will it be carried out and over what timeframe
How the measurements will be conducted
B. DO
In the doing stage, you carry out the test on a small scale, documenting any problems and unexpected outcomes. Collect data on your measures.
C. STUDY
Evaluate the effectiveness of the change by analysing the data collected.
D. ACT
Tweak the process and start the cycle again. Don’t be afraid to scrap the change and start over either – not all ideas work, but you can always learn from the process.
3. Implement
If you are seeing successful and sustained improvement, you can make the change ideas you have successfully tested part of business as usual. The way to do this is by amending policies and procedures in addition to using quality control methods. Key to success is appropriate training and communication with staff and patients.
If you wish for a process to be actioned in a specific way it may be more useful to write out a written step-by-step procedure (e.g. investigation result review, clinical procedures). The most important thing is to document them in a way that is easy to understand and works for the practice.
Standard Operating Procedures
The ISO defines a procedure as a ‘specified way to carry out an activity or process’. Procedures are essentially written steps to complete a process in a specific way. A standard operating procedure (SOP) is a document that provides clear-cut directions and instructions as to how staff must go about completing certain processes.
When creating or reviewing SOPs, ask the following questions:
Are the instructions clear and concise?
Are the steps sequential?
Have staff been adequately trained in the process?
Has the process/procedure changed in practice without updating the SOP?
Are all staff members aware of the SOP?
Are responsibilities clearly defined?
What checks are involved or do more need to be introduced?
Is it consistent with best practice?
Is it being implemented consistently by all staff members?
Does it make best use of staff time?
Does it make best use of IT?
Does it overly rely on an individual staff member?
Does it achieve the objective(s)?
See here for more detailed information on SOPs & a downloadable SOP template.
See here for more detailed information on objectives.
4. Sustain
There is no point in going to all that effort to improve the process if people just slip back into old habits (which happens very easily). It is important to continue monitoring the process and evaluate its effectiveness over time. You can do this by continuing to measure the change until it is fully ingrained.
You may also consider sharing your changes with colleagues if something worked particularly well. An easy way to do this is by creating a forum post on GP Practice Ally. You can use the format:
Problem
Change
Teething Issues
Success Tips
SOPs - In Detail
Below are lists of potential SOPs you may wish to have in your practice. These can be compiled into role specific operations manuals. (Practice management related processes are covered here. Specific processes for different areas of practice management may be outlined further in each section, e.g. financial control processes are referred to in the Financial Management section.)
This list is not exhaustive – there are many more processes you may wish to document and there are many below that may not be necessary to include. You don’t need to have all of them, you can prioritise the most important ones for your practice and pick some to get started with. Set yourself a goal of completing a certain number per month.
It is worth noting that an SOP for administrative tasks can be a simple list of steps to complete a task, or guidelines on what to do in a given situation. However it is worth having something documented, as it makes training in a new staff member much easier or in the event of sudden absence it makes it much easier for someone else to pick up the workload.
There may be some overlap between clinical and administrative SOPs, if you consider a process from start to finish in your procedure.
For example:
Your CDM review procedure may involve admin at the recall stages and nurses/GPs at the review stage. It is important to include copies of all relevant SOPs in each role operations manual.
You can use the below blank SOP template to start. Remember, your SOPs don't have to be too complicated - they just need to describe the step-by-step process.
Template:
Reception/Admin SOPs
Housekeeping
Opening up practice
Closing down practice
General – toilets, waiting areas
Waste/recycling
Security/AlarmsAnswering phones
Conduct
Screening/Triage
Emergency calls
Answering machine/automatic phone system
Lunchtime procedure – emergency phoneBooking appointments
Notes on appointments for HCP
Appointment Types - notesPatient check-in
Accounts
Charging
Invoicing
Taking Payments
Daily takings reconciliationDocument/Communication Control
Post
Fax
Emails
SMS
Scanning
Shredding
Adding medical records to patient file
Exporting medical records
Social welfare certs/illness certs
Repeat prescriptionsIn Practice Communications
Tasks
Instant messaging/whiteboardGMS Panel
Expiry
Applications
Over 70
Under 6
Updating patient change of address on PCRSInvestigation results – phone inquiry
Booking transport
Stocking stationary/forms
Typing/Dictaphone
Referrals – email/fax (Diagnostics etc)
SMS
Checking SMS sent
Sending bulk SMS
SMS consentOOH Report Integration
Clinical SOPs
Blood test
Download test results – Healthlink
Investigation results
Wound dressing
Suturing
Removal of sutures
Injections
Childhood immunisation
Cervical smear/HPV testing/sample
ECG
24hr ABPM Application & Removal
Ear syringing
Cryotherapy
Occupational Health - Annual Medical
Occupational Health – Preplacement Medical
Chronic Disease Management Review
Cycle of Care - Diabetic
Cycle of Care - Under 6 Asthma
Cycle of Care - 2/5 year check
Repeat prescription – refill request
Maintenance of emergency equipment
Sterilisation of emergency equipment
Warfarin Management
Treatment room restocking
Hazardous waste
Sharps/needle sticks – prevention & injuries
GP SOPs
Medicolegal reports
Driving License Medical
Implanon insertion & removal
Mirena insertion & removal
Toenail Removal
Minor Surgery
Reporting to Public Health
Mental Health Act Procedure
ANC
Objectives - In Detail
"What are we trying to accomplish?"
Do you want to improve the quality, responsiveness, dependability, flexibility of the process?
Do you want to make the process more cost effective?
Performance objectives normally define the strategic priorities of an organisation and influence their process design. Key performance objectives include:
Quality
Speed
Dependability
Flexibility
Cost Effectiveness
When redesigning a process with a particular performance objective in mind, it is useful to look at the potential impact on the other performance objectives, as sometimes performance in one can only be achieved by sacrificing performance in another.
For example:
If the flexibility of the process is increased will that slow down the process and also increase the cost associated with it? Or if the cost is reduced by cutting back staff hours, will that increase risk by impacting the quality and safety of patient care and reducing the practice’s ability to adapt to changing circumstances?
It is important to consider what is most important to the patient when designing service processes, as each performance objective can increase patient satisfaction in different ways, which encourages patients to return (or at minimum not complain).
Each performance objective is explored in more detail below in the context of service processes, however, the same objectives can be applied to any process in the practice.
For example:
You may want to improve the speed of the STC claiming process to increase staff productivity and thus reduce costs.
Quality patient care is often defined as healthcare that is safe, effective, patient-centred, timely, efficient and equitable. Quality is arguably the most important performance objective for General Practice, so must be considered when striving for performance in the other objectives. It is critical that patient safety is not compromised in pursuit of any other objective.
Quality can mean:
Patients receive the appropriate treatment
Treatment is carried out in the correct manner
Patients are consulted and kept informed
Staff are courteous, friendly and helpful
Risk is reduced
Benefits:
Quality leads to stable and efficient processes, reducing costs and increasing dependability. (However, an over focus on quality can lead to long wait times and higher costs.)
Quality service can also reduce failure demand. Failure demand is ‘avoidable contact’ – unnecessary demand created by the practice’s failure to do something for the patient.
Quality from the patient perspective can be seen as consistently conforming to patient expectations, which has become increasingly complex. In this light, what the practice believes is a quality service may not be perceived as a quality service by the patient. It is important to identify what matters most to the patient to try to meet their expectations, where possible. When it is not possible to meet their expectations, these expectations need to be managed (see above).
Service quality factors can be used to understand the nature of patient expectations and perceptions. These include:
Access
Aesthetics
Attentiveness/helpfulness
Availability
Care
Cleanliness/tidiness
Comfort
Commitment
Communication
Competence
Courtesy
Flexibility
Friendliness
Functionality
Integrity
Reliability
Responsiveness
Security (including confidentiality)
You can use these factors to create a patient satisfaction survey, to gather data on patient expectations and perceptions in each area. This can form the basis of process improvement plans.
Note: It can be argued that public services cannot always meet everyone’s expectations, so while this is a worthwhile exercise, it is also important look at the other performance objectives to form process improvement plans.
Speed refers to the amount of time elapsed between the patient requesting services and receiving them. It includes the ability of the practice to respond promptly to patient service requests, with minimal waiting and queuing time. Where appropriate, fast response and throughput increases value for patients. Fast response is aided by efficient flow of information and decision making. A key requirement for prompt service is effective communication between everyone involved. Timely transfer of information can greatly reduce risk in the practice. This is where effective IT communication systems within the practice are
essential.
Speed can mean:
Waiting times for treatment and services are kept to a minimum
The time for investigation results to be returned is kept to minimum
Information is passed to the right person in the practice in a timely manner
Patients receive communications from the practice in a timely manner
Benefits:
Speed can reduce risk by ensuring that issues are dealt with promptly.
Increasing speed often means reducing the number of steps in a process, which can boost productivity through less wasted effort and reduce costs.
Dependability is judged over time and refers to reliability and consistency of the practice and its staff to deliver services on time or as promised. Patients will rate the practice’s performance by how much they trust the staff to deliver services and information in a timely manner. Clear and detailed processes are key to ensure that the system is not overly reliant on one staff member.
Dependability can mean:
The number of appointments that are cancelled or rescheduled by the practice are kept to a minimum
Keeping to appointment times
Investigation results or paperwork items are returned as promised
Benefits:
Saves time and money that would otherwise be spent solving problems.
Creates stability by reducing disruption and building trust with patients.
Flexibility refers to the practice’s ability to adapt to changing circumstances with minimum disruption to the rest of the service. It includes the ability to deliver new or modified services, adjust capacity to demand, adjust facilities/equipment to treatment requirements and change the delivery method or timing of the service. It can also include the willingness or ability of a staff member to amend or alter the service to meet the needs of the patient.
Flexibility can mean:
Introducing new services, like CDM or COVID vaccines
Adjusting staff schedules to accommodate COVID vaccine programmes
Switching to phone consultations during the pandemic
Increasing the ways patients can contact the practice
Having sufficient equipment/stock readily available to treat emergencies
Benefits:
Improves response time (e.g. by adjusting staff schedules might mean you can administer vaccines to more patients sooner).
Reduces time and money wasted waiting for service/resource adaptations.
Maintains dependability by keeping things on schedule by minimising disruption.
Agility is the combination of all five performance objectives, particularly flexibility and speed. Being agile means that the practice can cope with
unexpected events and respond effectively to uncertainty.
Cost effectiveness means appropriately minimising money spent on staff, facilities, technology, equipment and supplies while maintaining the level of service or increasing the productivity of these resources at no extra cost.
Productivity can be improved by making better use of resources, such as refining processes to involve less staff time.
Lowering costs and reducing waste (of staff time, materials or underutilisation of facilities) is a universally attractive objective but it is important to consider patient safety and quality of patient care when reviewing costs.
All of the other performance objectives influence cost, so it is possible to improve cost performance by improving performance on the other objectives.
Evaluating the overall performance of a new process
You can use the below simple framework to propose or note any changes to performance objectives. You may see no change in some of the objectives. Use the comments section to note any concerns or areas where you may need a balancing measure.
The example below is for the introduction of an online booking system – the main advantage of this process is that patients spend less time waiting on the phone.
For example:
You may want to improve the speed of the STC claiming process to increase staff productivity and thus reduce costs.
Quality patient care is often defined as healthcare that is safe, effective, patient-centred, timely, efficient and equitable. Quality is arguably the most important performance objective for General Practice, so must be considered when striving for performance in the other objectives. It is critical that patient safety is not compromised in pursuit of any other objective.
Quality can mean:
Patients receive the appropriate treatment
Treatment is carried out in the correct manner
Patients are consulted and kept informed
Staff are courteous, friendly and helpful
Risk is reduced
Benefits:
Quality leads to stable and efficient processes, reducing costs and increasing dependability. (However, an over focus on quality can lead to long wait times and higher costs.)
Quality service can also reduce failure demand. Failure demand is ‘avoidable contact’ – unnecessary demand created by the practice’s failure to do something for the patient.
Quality from the patient perspective can be seen as consistently conforming to patient expectations, which has become increasingly complex. In this light, what the practice believes is a quality service may not be perceived as a quality service by the patient. It is important to identify what matters most to the patient to try to meet their expectations, where possible. When it is not possible to meet their expectations, these expectations need to be managed (see above).
Service quality factors can be used to understand the nature of patient expectations and perceptions. These include:
Access
Aesthetics
Attentiveness/helpfulness
Availability
Care
Cleanliness/tidiness
Comfort
Commitment
Communication
Competence
Courtesy
Flexibility
Friendliness
Functionality
Integrity
Reliability
Responsiveness
Security (including confidentiality)
You can use these factors to create a patient satisfaction survey, to gather data on patient expectations and perceptions in each area. This can form the basis of process improvement plans.
Note: It can be argued that public services cannot always meet everyone’s expectations, so while this is a worthwhile exercise, it is also important look at the other performance objectives to form process improvement plans.
Speed refers to the amount of time elapsed between the patient requesting services and receiving them. It includes the ability of the practice to respond promptly to patient service requests, with minimal waiting and queuing time. Where appropriate, fast response and throughput increases value for patients. Fast response is aided by efficient flow of information and decision making. A key requirement for prompt service is effective communication between everyone involved. Timely transfer of information can greatly reduce risk in the practice. This is where effective IT communication systems within the practice are essential.
Speed can mean:
Waiting times for treatment and services are kept to a minimum
The time for investigation results to be returned is kept to minimum
Information is passed to the right person in the practice in a timely manner
Patients receive communications from the practice in a timely manner
Benefits:
Speed can reduce risk by ensuring that issues are dealt with promptly.
Increasing speed often means reducing the number of steps in a process, which can boost productivity through less wasted effort and reduce costs.
Dependability is judged over time and refers to reliability and consistency of the practice and its staff to deliver services on time or as promised. Patients will rate the practice’s performance by how much they trust the staff to deliver services and information in a timely manner. Clear and detailed processes are key to ensure that the system is not overly reliant on one staff member.
Dependability can mean:
The number of appointments that are cancelled or rescheduled by the practice are kept to a minimum
Keeping to appointment times
Investigation results or paperwork items are returned as promised
Benefits:
Saves time and money that would otherwise be spent solving problems.
Creates stability by reducing disruption and building trust with patients.
Flexibility refers to the practice’s ability to adapt to changing circumstances with minimum disruption to the rest of the service. It includes the ability to deliver new or modified services, adjust capacity to demand, adjust facilities/equipment to treatment requirements and change the delivery method or timing of the service. It can also include the willingness or ability of a staff member to amend or alter the service to meet the needs of the patient.
Flexibility can mean:
Introducing new services, like CDM or COVID vaccines
Adjusting staff schedules to accommodate COVID vaccine programmes
Switching to phone consultations during the pandemic
Increasing the ways patients can contact the practice
Having sufficient equipment/stock readily available to treat emergencies
Benefits:
Improves response time (e.g. by adjusting staff schedules might mean you can administer vaccines to more patients sooner).
Reduces time and money wasted waiting for service/resource adaptations.
Maintains dependability by keeping things on schedule by minimising disruption.
Agility is the combination of all five performance objectives, particularly flexibility and speed. Being agile means that the practice can cope with unexpected events and respond effectively to uncertainty.
Cost effectiveness means appropriately minimising money spent on staff, facilities, technology, equipment and supplies while maintaining the level of service or increasing the productivity of these resources at no extra cost.
Productivity can be improved by making better use of resources, such as refining processes to involve less staff time.
Lowering costs and reducing waste (of staff time, materials or underutilisation of facilities) is a universally attractive objective but it is important to consider patient safety and quality of patient care when reviewing costs.
All of the other performance objectives influence cost, so it is possible to improve cost performance by improving performance on the other objectives.
Evaluating the overall performance of a new process
You can use the below simple framework to propose or note any changes to performance objectives. You may see no change in some of the objectives. Use the comments section to note any concerns or areas where you may need a balancing measure.
The example below is for the introduction of an online booking system – the main advantage of this process is that patients spend less time waiting on the phone.
Download a blank template here.
Case Study
Looking at the entire process end-to-end
1. Diagnosing the issues
During the pandemic, Main Street Practice converted one of their waiting rooms into a full time office for two admin staff. The remaining waiting areas were sufficient when COVID numbers were contained in the community, but in November 2021 as numbers rose once again it became a concern to have so many people in the building in close proximity, particularly at peak times.
With 4 GPs and 3 nurses all seeing patients some days, the period between 09.30-11.00 was an area of concern. Phone lines also opened at 09.00, with 09.00-11.00 the busiest time for receiving patient calls. Patients reported that they were unable to get through on the phone and the phone system confirmed that there were a significant number of dropped calls.
The practice had stopped offering non-COVID related GP calls earlier that year, as the GPs found it was mostly double jobbing with most patients being brought in to be seen. Also, the practice sometimes struggled to collect payments for non-COVID related calls due to lack of time available to take card payments over the phone, leading to rising unpaid charges. However, as COVID rates rose again they had to revert to doing some non-COVID related calls, along with the rising number of COVID calls. These calls were being slotted in to the GP diaries where possible, leading to disjointed sessions for the GPs and calls being left until late in the day, potentially risking patient safety.
Reception was also becoming a bottleneck, with people coming from several directions – from the front door to check-in and from treatment rooms upstairs and down the hall looking to pay or book follow-up appointments. The door remained locked to minimise footfall, so reception staff had to physically open the door for incoming patients, meaning they had to step away from the phone or person in front of them. This led to patients feeling frustrated and overlooked on the phone and in the queue at reception.
Issues:
Waiting room space – number of patients waiting at one time (risk)
Queuing time at reception – to pay, to book a follow-up, to check-in, on phone
Reception disruption – getting up frequently to open door, leading to increased waiting times on phone and at reception
Patient frustration – waiting times on phone, at door, in waiting room (COVID worries), after consult at reception to pay/book follow-up
Fully booked – no shows were also an issue
Capacity issues – waiting room, phone, call slots
2. Improve
The practice had to brainstorm how to reduce the footfall and improve phone access during this peak time of 09.30-11.00.
Objectives:
Reduce the number of patients in the building between 09.30-11.00 by at least 50%.
Reduce the number of dropped phone calls by at least 50%.
Reduce the number of new unpaid charges to 1% of all new charges by end of the following month.
Measures:
Outcome: Number of face-to-face appointments available between 09.30-11.00
Outcome: Number of dropped phone calls between 09.30-11.00
Balance: Check if reduction in GP face-to-face appointments leads to high risk patients not being seen in a timely manner and/or high levels of double-jobbing (patients being brought in to be seen anyway).
Ideas discussed below, which the practice tested using PDSA and rolled out.
Blood tests had be completed before the courier arrived every day at 11am, so it was not possible to restructure these appointments, so it was decided that the GPs would only take calls instead of face-to-face appointments between 09.30-11.00. This:
Reduced the number of patients waiting in the building at this time lowering the risk of COVID transmission.
Gave increased structure to the appointment diary, making the day less stressful for the GPs.
Reduced the number of people presenting to reception and the door, meaning the receptionist had to step away from the desk less and had more time to deal with the patients in the queue or on the phone.
The number of patients waiting on the phone was still an issue during this time period, as the front desk receptionist still had to answer the door frequently. It was decided to divert the phones to the back office and have two admin staff answer the phone during this period, so that the front desk receptionist could deal exclusively with patients at reception.
This increased patient satisfaction as it reduced waiting times on the phone, outside the door and at reception.
Additionally, it was decided to introduce a ‘pay-before-seen’ policy to reduce the number of people required to pay in person at reception. The practice used their practice management system to send a payment link to private patients at the time of booking.
Overall patients noted that they were happy with this system as it was convenient for them to pay online and knew it would reduce their time spent waiting after their appointment.
Those that were unable or didn’t want to pay online were offered the option to pay in person before their appointment, which still reduced the number of times the patient need to present to reception.
This system also reduced the number of no-shows, as people were more likely to show up when they had already paid.
Processes involved:
Appointments – scheduling & types available
Patient attendance – check-in, waiting, queuing
Answering phones
Patient accounts - charging/payments
3. Implement
The practice formalised the new processes with new SOPs and ensured that all staff were trained appropriately. They also communicated the changes to patients through their website, phone queuing message and
posters in the waiting areas.
4. Sustain
The practice continued to collect data on the measures to ensure the processes were still effective. They also analysed the impact on their performance objectives (below).
Kick Start Your Year!
New Year, New Momentum: Setting Your GP Practice Up for Success
Check out the recording of our webinar from January 2025.
Members found last year’s Kickstart webinar invaluable for staying ahead of key updates and identifying practical strategies to improve efficiency and workflow. With even more updates and a focus on 2025’s priorities, this year’s session will equip you with the tools and insights to streamline operations, enhance patient care and unlock growth opportunities.
How We’ll Help You Achieve This:
Keep you up to date with key 2025 changes, including updates to minimum wage and sick pay legislation.
Help you identify strategies to improve efficiency in finance, planning, demographics and communication.
Enhance workflows through the use of IT tools, SOPs and nurse-led programmes.
Show you how to maximise GP Practice Ally resources to manage your workload and increase capacity.
Unlock opportunities for growth through networking and updated programmes tailored to your practice needs.
Kick Start Your Year: Where to Focus Your Energy in 2024
Check out the recording of our webinar from January 2024.
2023 was a challenging year nationwide for General Practice, as many practices tried to find their new normal post-COVID. I know a lot of practice managers and GPs feel like they are just about managing to keep it all together, never mind having time to think ahead! January is a time full of intention setting, but most people don't even know where to start when the mountain looks so big! Rather than starting with a drastic overhaul of everything in one go, we thought it would be a good idea to point out some small changes you can make that could have a large impact!
We will cover:
Keeping your practice demographics up-to-date
Managing appointments
Active communication
Credit control & budgeting
This webinar will also cover key changes in employment legislation for 2024:
Statutory Sick Pay Scheme
Minimum Wage
Enhanced Reporting Requirements
Summer Strategy: Smarter Workflows, Clinics & Cashflow
Summer Strategy: Smarter Workflows, Clinics & Cashflow
Let’s be honest – there’s rarely a true quiet period in general practice anymore!
But summer brings its own set of challenges: staff on leave, unpredictable demand, and slower cashflow, all while trying to keep things running smoothly.
This practical session with Siobhan O'Neill is designed to help you get ahead of the pressure and make the most of the season. You’ll learn how to streamline day-to-day workflows, adapt clinic plans to fit changing demand and protect income with smart, focused strategies.
We’ll look at how to:
Pinpoint the most valuable GMS & PCRS income opportunities over summer
Activate effective recall strategies for smears, immunisations & chronic disease reviews
Allocate summer roles clearly across admin, nursing & GP teams
Review claims to ensure every euro earned is captured
Clean up patient records & age banding using your practice software
Whether you’re trying to lighten the load or finally make space for things that keep getting pushed down the list, this session will help you step back, take stock & build a confident, clear plan for the months ahead.
Inclusion in Irish General Practice 101
Check out the recording of our webinar 'Inclusion in Irish General Practice 101' from 14th November 2023.
Download:
Shape the Year Ahead: Practical Planning for a Healthy Practice
Join Rachel and Siobhan for a practical session on planning the year ahead. They will walk practice managers through a clear, structured way to map out the next twelve months so the practice feels organised, steady and easier to guide.
You will learn how the core steps of yearly planning fit together, how to link long-term aims to quarterly, monthly and weekly work and how to break broad goals into priorities you can actually deliver. They will show simple review habits that keep progress moving without pressure and help you make confident decisions about what matters most as the year unfolds.