Balancing Act: How GPs Decide Which NHS Services to Provide

Balancing Act: How GPs Decide Which NHS Services to Provide

General practitioner (GP) surgeries have traditionally signed up to provide most services offered by the NHS and local authorities, including minor surgery, sexual health services and flu vaccines. However, with ongoing budget pressures, difficulties recruiting enough GPs and nurses, and limited space in many older buildings, practices are now carefully evaluating whether each service is financially viable for them to deliver.

When analysing potential new offerings, GPs conduct in-depth analysis of the costs involved, including:

  • Time per procedure, factoring in setup time, actual appointment length, cleanup time, and administrative tasks like booking appointments and filing notes. Finding efficiencies like block booking sessions for the same type of appointment can improve productivity.
  • Overhead expenses like higher utility bills, additional insurance premiums, hiring security staff for night or weekend opening hours.
  • Staff costs, accounting for base pay, overtime, employer pension contributions, National Insurance costs, and required holiday and sick pay. Administrative staff time spent booking appointments and managing patient notes must also be costed. If less experienced and cheaper staff like nurses can assist with certain routine tasks, it can lower the total cost.
  • Opportunity cost – given limited rooms and staff availability, GPs must consider whether they could provide higher profit services in the same slots taken up by the new offering.

The flu vaccine is a prime example. The £9.58 reimbursement fee often does not fully cover the staff time and overhead costs to provide the shots. The vaccine appointments take up staff time that could be used for more lucrative private services.

However, GPs can’t make decisions solely based on profitability. They must balance the finances with patient care and access. If a service provides significant value for patients and is unavailable elsewhere locally, practices may decide to provide it despite losing money. Their responsibility is to sustain their business while still meeting community healthcare needs.

Overall, GP surgeries increasingly analyse services with a business mindset – maximizing limited resources while maintaining quality care. Careful evaluation allows them to tailor service offerings to both serve patients and ensure the viability of their practices. The balancing act between affordability and patient benefit is an ongoing challenge.

Written by Laura Barnwell, Healthcare Director

For more information, please contact Laura Barnwell on

Disclaimer. This article has been prepared for information purposes only. Formal professional advice is strongly recommended before making decisions on the topics discussed in this release. No responsibility for any loss to any person acting, or not acting, as a result of this release can be accepted by us, or any person affiliated with us.

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