Reducing pressure on medical practices

15th September 2023

Is your medical secretary overwhelmed? Simon Brignall pinpoints the key warning signs to watch for and offers a check list for you to assess why your practice might need help.

There is little doubt that, from all the reports we have been receiving, it is a good time to be in private practice.

At Civica Medical Billing and Collection, we partner with more than 1,800 consultants, groups clinics and hospitals, and many are seeing record activity levels, all underpinned by a 50% increase in self-pay activity.

The knock-on effect of increasing NHS waiting times has driven demand in the private sector and this can create a virtuous circle as patients relate their positive experiences to friends and family.

Surge in activity

A recent YouGov survey suggested one-in-eight Britons used private healthcare in the past year, with a third having used it for the first time. The survey also noted they had an average spend of £500 which, while not an amount affordable to all, is less than many would imagine.

This surge in activity, while a boon to consultants recovering from the pandemic, is putting considerable stress on administration teams across the private sector. Hospital administration staff along with medical secretaries are all feeling the strain.

I have had many conversations with consultants whose complaint is that they do not think their cash flow reflects their increased activity.

Here are some early warning signs to look out for and some suggestions of what you can do.

Rising debt

When a practice is struggling to manage increased patient activity, the first task to be set aside is the reconciliation and chasing of outstanding debts.

A medical secretary is tasked with acting as a receptionist, medical PA, billing clerk, theatre manager, insurance guru and credit controller alongside managing their consultant. The increase in self-pay patients means more and more time must be spent chasing patients and taking payments.

Insurance companies are also harder to reach to resolve problems, which means many secretaries feel they are struggling just to keep up.

Added to this, many secretaries work for more than one consultant and are likely to be seeing similar increases in activity across all their practices. What was manageable before can now prove to be challenging and even impossible.

As a rising tide lifts all boats, it is more important to focus on aged debt rather than payments received. Increased demand will lead to more being invoiced each month, which is why tracking aged debt as a percentage of income is a more reliable guide.

Invoice delays

Another good indicator that a practice is getting into difficulties is if it starts to fall behind on invoicing.

This will not only impact the business’s cash flow but also be a sign that the practice’s administration is unprofessional. That can result in bad reviews. As this does not show up as part of your aged debt, it is a good idea to check how up to date your practice is with this task.

It is vital to raise invoices in a timely manner because this is the first step in the payment pathway for all patient types. For insured patients, remember to consider the nuances of each private medical insurer and the correct Clinical Coding and Schedule Develop¬ment group (CCSD) codes combined with the relevant fee schedule.

Delays not only will impact all subsequent steps in the payment cycle but can often increase the likelihood of losses or bad debts. At Civica Medical Billing and Collection, we have a bad debt rate of less than 0.5% and often this can be as low as 0.3%

Lack of visibility

Where a practice has inadequate infrastructure and relies on the medical secretary to provide reports, delays in the provision of accurate information can also be a warning sign.

It is self-evident that if a practice has no access to this information, then it is impossible to have a robust and effective chase procedure.

Our clients have access to a dashboard displaying key performance indicators as well as reports showing the following data at both a summary and granular level: invoices raised, payments received and aged debt.


While not a warning sign per se, every business sector is finding recruitment challenging. We know the healthcare sector is no exception and finding a person with the skill set required to complete all these tasks as well as fit them all into a working week is not easy.

It can be an impossible task for one person to cope with once a practice starts to see exponential growth. The secretary is so busy dealing with the medical side of things in many practices now that the billing and collection function gets neglected.

Administration staff can be reluctant to put their hand up and ask for assistance until it is too late. Often this results in previously unknown problems being discovered, including lost income.

When a secretary has been with the practice for some time, they can appear to have everything under control. But when they leave or retire, the impact on the practice can be devastating, particularly financially.

Common mistake

Many consultants make the common mistake of assuming their secretary would not welcome support provided from out¬sourcing work to a medical billing and collection company.

This is rarely the case, and when private practices take the plunge, it often leaves the medical secretary free to focus on the high-value tasks aligned to the patient’s clinical journey.

This not only brings financial improvements to the practice but also to the patients’ experience. Secretaries who support multiple practices find they are freed up to take on more activities they enjoy.

Our account managers ensure they form a strong partnership with medical secretaries so they can work as team and deliver care in line with your objectives.

So streamline your day-to-day operations, maximise revenues, and grow the practice – leaving your secretary free to focus on the patients without finance issues clouding the relationship.

Give your practice a review using the check list in the box above.

Simon Brignall,

Director of Business Development,

Civica Medical Billing and Collection

If any of your answers to these questions are a cause for concern, then I suggest you take steps to address them. Quite often the best solution is to reach out to a medical billing and collection company who can offer both expertise and functionality.

This article was originally produced for Independent Practitioner Today.