The hidden financial cost of inefficient administration

Most practices know their big costs: salaries, premises, supplies and other overheads. What rarely shows up as a single line in the accounts is the money lost through the way administrative work is organised. A missed claim here, a task done twice there, an extra evening to catch up on letters. None of it looks dramatic on its own, but across a year it drains both income and capacity.

The accounts only show what came in, so the income that never arrives, and the paid hours spent on work that only needed doing once, don't appear anywhere. That is why they go unchallenged for years.

Missed income

Income is lost when work is done but not recorded or claimed. Common examples are QOF achievement lost through incomplete coding or registers, enhanced service activity that never gets submitted, and private reports and insurance forms that are completed but not invoiced. Lapsed recalls matter too. Not every recall earns income, but where one is linked to a contractual indicator, a missed recall can mean a missed payment as well as delayed care.

Joined-up recalls also save appointments. A patient who comes in for a flu jab can, in the same visit, have their blood pressure, smoking status, height and weight recorded and be offered other vaccinations they are eligible for, such as shingles. That can cover several QOF areas in one appointment, instead of the patient being booked in separately for each.

Missed claims usually come down to unclear ownership: clinicians assume admin will submit the claim, and admin assume the clinician has coded it.

Duplicated work and administrative overlap

Duplication happens when more than one person handles the same information, or the same task is done in more than one place. It looks different in every practice. It might be a task tracked in both a spreadsheet and the clinical system (such as EMIS or SystmOne), or a piece of work that two people each check because neither is sure the other has done it.

Duplication doesn't always create an immediate extra cost. Often the bigger loss is capacity: paid hours that could have gone on claims, recalls or patient queries. As an illustration only, if two people each spend three hours a week on the same task, at an assumed £15 an hour including employer costs, that is around £4,700 a year spent on work that only needed doing once. It is also why practices so often conclude they need more staff, when the hours may already be there.

Avoidable overtime and locum or agency costs

When admin backlogs build, clinicians stay late to clear results, letters and prescriptions, and admin staff build up overtime or flexi hours. Poor rostering leaves gaps that get filled with short-notice locum or agency cover at premium rates.

This spend is visible, but rarely traced back to its cause. It gets treated as a staffing problem when the real problem is the process.

The hidden cost of under-supported staff

Promoting from within is often the right decision. Long-serving staff bring local knowledge, relationships and loyalty that are hard to replace. The cost comes when a role grows and the training and support don't grow with it.

In Sansos's work with practices, this is often a major root cause of the other problems in this article. A long-serving member of staff promoted into a coordinator or management role has usually learned the job by doing it, not by being shown what good looks like. They may never have seen a claims reconciliation, a workload audit or a rota built around demand, so a task done twice or a claim never submitted looks like normal practice to them. That is a gap in leadership and support, not a failing of the individual.

We also regularly find two people effectively doing one job. Partners are often comfortable with this because neither salary looks high. But the combined cost can be similar to that of one properly qualified person, who may deliver the same skills and accountability for a similar cost. This isn't about cutting headcount. It's about whether the practice is getting the skills and accountability it is paying for.

Indirect costs

Some costs never appear as money at all. Constant pressure drives burnout, sickness absence and turnover, and every leaver brings recruitment and training costs. Weak reminder systems push up DNAs, wasting clinical time that has already been paid for.

How to spot the hidden costs

You do not need a full audit to start. These checks group into three areas.

• Income - Compare last quarter's activity against claims, payments and invoices, including enhanced services, QOF and private fee work. Audit coding and recalls in two or three high-value QOF areas.
• Capacity - Chart overtime, flexi hours and locum spend month by month over the past 6 to 12 months. Time the five most frequent admin tasks for one week, noting who does them and how long they take. Track DNA rates by clinic type and session.
• Staff and roles - Look for jobs shared between two people, and compare their combined cost with a single qualified post. Check that job descriptions for key roles reflect the work now being done, and that each role has a training plan to match.

Where to start

Hidden admin costs rarely come from one big failure. They come from small gaps repeated every day. Many of the fixes need little extra spending, and they give you back both income and capacity. What they do need is someone to take responsibility for how the work is organised and follow through on the findings.

This week: choose one high-value QOF area for a coding check, pull the last six months of overtime and locum spend, and ask your team which three admin tasks they repeat most often. That will show you where to start.

If the same gaps keep appearing

Most of this can be done in-house. Outside help is worth considering if audits keep finding the same gaps, if nobody has the time to lead the work, or if a merger, partnership change or CQC inspection makes the timetable tight. If you do bring someone in, ask for a diagnostic first, measurable outcomes, and a plan that leaves your team able to keep the changes going. Be wary of any engagement that produces a report but doesn't change how work gets done.

You can also explore more practical insights from Sansos.