In the past six months Brian Jones has delivered more than £1m of financial efficiencies for the Partnership of East London Co-operatives (PELC), enabling vital funds to be redirected towards the frontline care of patients. In this article, Brian details the process he has followed and the impact it is having, including practical hints and tips that practices can use to save time and money.
When I joined the PELC in 2018 it was very clear that immediate changes were needed; despite the dedicated work of our staff, our spending and outgoings were unsustainable and morale was low as we were unable to reinvest our profits into improving our service offering. As a not-for-profit, delivering NHS integrated urgent care services to more than two million people across East London and West Essex, we simply could not afford to continue on this trajectory.
In order to deliver savings successfully, my number one rule is to ensure your staff are part of the journey.
However, it was not as simple as locking myself away to make decisions on behalf of our workforce that would, ultimately, impact their day-to-day. Any pursuit of cost-savings should not be done in isolation, or in a way that can be perceived as a ‘top down approach’; this can destabilise your workforce as people naturally feel unsettled and nervous about their job security.
In order to deliver savings successfully, my number one rule is to ensure your staff are part of the journey. Senior leaders within any practice should remain positive about the process, providing reassurance about the future, particularly as the practice landscape is changing at such a pace, with the emergence of technology and increased scrutiny on measurable targets.
Change at the PELC has been successful because we engaged our people in the process, being open and honest about the need to reduce our overheads and reposition the organisation; this has enabled us to invest in delivering high quality, safe services for the future.
Solid staff engagement
Our staff were hardworking and dedicated, and focused on delivering a high-quality service to our patients. However, we needed to focus time and energy on specific areas, such as medicines management. In advance of starting this journey I met with staff to explain the strategy that we would be pursuing and the rationale for it – that, ultimately, reducing overheads would enable us to redirect those savings towards improvements.
By having this early discussion, staff felt part of the process, affording them the opportunity to produce additional ideas to reduce costs. Despite pursuing a significant financial recovery programme, the most recent staff survey has produced some unexpected results; high levels of staff satisfaction and recognition that they felt valued by the management. These were some of the highest levels of staff satisfaction we have achieved in our 14-year history.
With limited contractual information, the fastest way we were able to determine potential areas of savings was by simply spending a few hours reviewing our bank statements. This gave us an immediate snapshot of our suppliers and the costs attributable to each, providing us with an understanding of where to focus our time.
Whilst it may be obvious, it is critical that practices are claiming all the income to which they are entitled; at a time when the majority of commissioners are themselves struggling to achieve a balanced budget, it’s unlikely that they will inform you of any discrepancies. This is a clear illustration of why you have to interrogate performance information regularly.
Practices also shouldn’t be afraid or embarrassed to renegotiate with suppliers; we pursued an approach of informing them what we were willing to pay, versus what they were charging us. There are numerous websites available where you can benchmark a vast array of different services which we used as a baseline for conducting negotiations.
Using this approach we were able to reduce costs across a number of areas, ranging from consumables through to software – all without the requirement for us to extend our existing contract periods.
Retail inspiration
We also used a similar approach, widely seen across the retail sector, which involved liaising with our landlord to obtain a rent reduction at our corporate offices. Initially hesitant, the landlord eventually agreed a compromise, enabling our organisation to achieve a real terms rental and service charge reduction.
The process of delivering financial efficiencies is, typically, focused on identifying and achieving savings, but new ways of working can also reduce costs. For example, although still relatively new in general practice, an increasing number of practices are now offering patients ‘virtual appointments’, with evidence showing that the ‘DNA’ rates of this appointment-type are amongst the lowest across the NHS.
Workplace change doesn’t need to have a negative impact on morale. In our case, whilst undoubtedly there were pressures of managing an increased workload, there was also an upbeat vibe across the organisation. Our staff felt listened too and, in turn, understood the journey we needed to go on, and engaged.
Embarking on an efficiency programme can be daunting, but it can also be a lever to effective change whilst still managing short term priorities, with strategic goals and long-term vision.
It’s a balance between understanding the positive economic aspects of change in conjunction with social aspects of workforce engagement. Leadership provides the key to facilitate and realise cost savings within a stable environment. Once balance is achieved, it then provides a platform for growth, and sustainable development, and produces the foundations on which the organisation can build.
Ultimately, it came down to two things: collaboration and engagement.
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