In the daily rush of running a GP surgery, it’s easy to lose sight of where the money goes. Budgets arrive, expenses mount, and by the end of the quarter, many practice managers are left wondering how financial breathing space vanished. While rising patient demand and workforce shortages often take centre stage in discussions about pressure on general practice, the more silent and insidious challenge is the steady erosion of practice finances by a multitude of hidden or overlooked operational costs.
Take energy, for example. Most surgeries, like any business, are responsible for their own utilities. Unlike households, they are not protected by a price cap. Many practices are still trapped in energy contracts signed during the peak of market volatility in 2021–2023. Unbeknownst to some, those contracts often include hefty commissions paid to brokers — commissions that were never transparently disclosed at the point of sale. These hidden fees, quietly baked into inflated unit rates can result in thousands of pounds in annual overspend. The worst part is that many practices don’t even know they’re being overcharged.
The pressure extends to the buildings themselves. Estates costs — including rent, service charges, cleaning, maintenance and compliance with regulations are steadily increasing. For practices that lease their premises, there’s often little room for negotiation. Even those who own their property are finding that routine upkeep and statutory checks (like fire safety and legionella) now come with growing costs and shrinking support. Compounding the issue is the inconsistency in estates reimbursements. Delays, disputes, and opaque processes from commissioners often leave practices out of pocket for months at a time.
Another area of hidden cost lies in indemnity and legal exposure. While the NHS Clinical Negligence Scheme for General Practice covers much of the core risk, many surgeries still need to pay for additional indemnity — especially for non-clinical staff in extended roles or for services that fall outside the core contract. Add to that the legal expenses tied to employment disputes, GDPR compliance, and property matters, and it’s easy to see how even the most prudent practices can be caught off guard by unexpected costs.
Digital transformation has also come with a financial sting. While many cloud-based systems and platforms offer clear benefits, the growing stack of software subscriptions — known as “Software as a Service” (SaaS) — is eating into budgets in small, regular bites. Video consultation platforms, appointment triage tools, patient messaging apps, and data security services all carry subscription fees. Each might only cost £50 or £100 a month, but across an entire practice, these subscriptions can quietly add up to tens of thousands of pounds per year. Many of these tools were adopted out of necessity, with little time for negotiation or evaluation during the pandemic — but they’ve since
become fixed costs in a world of fixed income.
What links all these costs together is not their individual scale, but their cumulative effect. No single category of expense is unreasonable on its own. But when operational costs (energy, estates, indemnity and IT subscriptions) all rise simultaneously — and when core funding remains frozen — practices are left with little room to invest, innovate or even stay afloat. The painful truth is that general practice is being run like a business — but without the commercial tools to succeed. Surgeries can’t increase their prices, shop around for better-paying clients, or defer services. Instead, they are expected to stretch a fixed pot of money across an ever-expanding workload, all while absorbing rising costs that would bring most small businesses to their knees.
To protect the future of general practice, the conversation needs to move beyond headline funding and workforce numbers. It’s time to examine the finer print of where money is being lost — and above all, practices must start looking at how to bring money back into the coffers. This means going beyond cost-cutting and exploring potential avenues for reclaiming funds — including investigating whether they were mis-sold business energy contracts or overcharged on broker commissions. With hundreds of millions of pounds potentially lost across the sector through opaque energy deals, now is the time to scrutinise old agreements, seek specialist redress where appropriate and recoup funds that rightfully belong to the frontline. (2025)