With the nights now beginning to draw in, the reality of the cost-of-living crisis is looming large over general practice. With charges for heating, lighting, and overall maintenance of our premises going up, coupled with the impact of inflation on pay, the promised staff pay rises and the difficulty of balancing the books ever more challenging, and with all the usual winter pressures now around the corner…something has got to give. Our ever-popular Practice Index panel members, and Institute of General Practice Management (IGPM) directors, Robyn, and Nicola, return to discuss their own concerns, the approaches they are taking in their own practice areas, and share their thoughts about the key considerations for primary care, as a whole.   Introduction (9 secs) What has Nicola been up to since our last conversation? (22 secs) And what’s keeping Robyn busy right now? (43 secs) What are the challenges of the cost-of-living crisis at practice level? (59 secs) Balancing staff pay rises (2 mins 35 secs) Maintenance of buildings and services and rising utilities costs (4 mins 37 secs) Travelling, home visits, and fuel charges (5 mins 25 secs) Staff turnover (6 mins 39 secs) Patient health and wellbeing and the potential for a further increase in demand (8 mins 3 secs) Implications for GP Partners (9 mins 47 secs) Sustainability of the practice as a business (11 mins 43 secs) Is there any support available? (13 mins 4 secs) Action from the Institute of General Practice Management (14 mins 2 secs) Making the primary care voice heard (15 mins 14 secs)   For all enquiries about the Practice Index / Ockham podcast, please contact James Dillon here or Ben Gowland here