Staying in Control When the Rules Keep Changing

For practice managers, few things are more frustrating than spending months perfecting a financial plan, only to have it derailed by an unexpected policy change

It’s every practice manager’s worst nightmare – or at the very least, it ranks high on the list of things you hope never happen. Picture the scene: you’ve spent weeks, maybe months, pulling together a robust financial plan. Every line has been checked, every allocation carefully prioritised, and there’s a contingency fund set aside for the inevitable unexpected costs. The spreadsheets balance, the income streams are accounted for, and every pound has a purpose. You’ve dotted every “i,” crossed every “t,” and navigated the usual bumps in the financial road with the precision of someone who knows their practice inside out.

And then it happens. Out of nowhere, a policy change is announced. Perhaps it’s a national NHS directive that shifts funding allocations, a local ICB decision that impacts service provision, or the sudden delay – or even defunding – of a project you’ve already committed resources to. Maybe it’s a new contractual change that reshapes the landscape of your financial planning entirely. Whatever form it takes, the effect is the same: the goalposts have moved, and months of careful work suddenly need to be reworked.

Even the most vigilant practice managers can be caught off guard. And while experience and resilience help, no amount of planning can completely shield you from the impact of decisions made outside the practice. The important thing is to regroup quickly and move into action – after allowing yourself a well-earned vent and a restorative cup of tea, of course!

Now, Soon and Later

When change strikes, the first step is to break it down: what needs attention now, what can wait until soon, and what sits firmly in the later category. Are there immediate adjustments needed to keep the practice running smoothly day to day, or will the change bite harder in the next financial year? Can certain costs or commitments be phased in gradually rather than absorbed all at once? By separating the urgent from the important, you’ll gain a clearer picture of the immediate risks and create breathing space to plan calmly for the longer-term implications.

Must-Haves, Nice-to-Haves and Don’t-Needs

Every practice budget has its non-negotiables – the must-haves that keep patient care safe and effective. Beyond that are the nice-to-haves: valuable, but not essential if sacrifices must be made. And finally, the don’t-needs: items or projects that, while good in theory, can be paused or cut without undermining core service delivery. When the financial rug is pulled, this hierarchy helps you find wiggle room. Asking questions such as “Does this directly benefit patients?” or “Could this be delayed six months?” can highlight where savings can be found without compromising the practice’s core mission.

Understanding the Ripple Effect

No policy change happens in isolation. A shift in funding or contractual terms often creates ripple effects across other areas of practice life. For example, a new staffing requirement could impact training budgets, while a cut in estates funding might delay essential building work that, in turn, increases maintenance costs later. One change may even trigger another at regional or national level, meaning today’s adjustment evolves into tomorrow’s bigger challenge.

That’s why it’s vital to think beyond the immediate impact and consider the knock-on effects. A simple way to do this is through “if this, then that” scenario planning. For example:

• If funding for admin support is reduced, then GP time may be diverted to non-clinical work, impacting capacity.
• If estates projects are delayed, then repair costs may escalate further down the line.
• If utility costs spike, then energy-saving measures may need to move from “nice-to-have” to “must-have.”

By mapping out these scenarios in advance, you can anticipate risks, plan contingencies and avoid being caught off guard twice. When the goalposts shift, the only option is to reset your aim. Policy changes and funding surprises will always test your patience – particularly after the effort of building a watertight financial plan. What matters is meeting them head-on, recalibrating quickly and ensuring that no matter how the rules of the game change, you remain firmly in control of your next move.