Are you paid for all your patients?
GPs earn more under the new contract, but there are more individual payment categories and these need to be checked on a regular basis unless you want to risk losing income, says Dr John Couch
A few months ago I pointed out that the new GP contract, far from making administration and finance easier, had actually made life more complicated. There are now more individual payment categories from only three years of nGMS than under the old GMS after 40 years' evolution. Errors occur regularly, so checking systems remain vital.
List size remains the most important element of our payment system. Few practices agree exactly with the PCT list total, so it is important to produce your own count every month. Luckily, computers can do this at the click of a mouse, but the information gleaned is only as good as the humans inputting the initial registration and deregistration details. You should therefore audit data input regularly and be especially vigilant with new staff.
Decide on a level of difference that should trigger close contact with the PCT registrar. I suggest that you do this at no more than a 1 per cent variance, and at a lower level if there is a clear rising variance.
An electronic list-matching exercise should produce the names of patients for whom you are not receiving payments. To justify the time this will take, it may colour your thoughts to remember that each patient should be earning your practice around £90 per annum.
One major problem with the PCT monthly statement is that often several categories are included under one heading. This makes checking and identifying errors much more difficult. Ask your PCT payments section to send more details. One problem we had on receiving these was that the print size was very small – the printout had to be read with a magnifying glass.
Make sure that your checklist spreadsheet is comprehensive and kept up to date. Ideally, this list should include a forecast of payment for each item. This makes error detection much easier.
Checklists only work if more than one person is going to see them, so set up a system of monthly meetings to go through the results. Do not confine this to PCT payments; include private income which, for many practices, forms a significant proportion of income.
Payment errors are more common for certain items, enabling a more focused approach. These include new items, such as new enhanced services, non-standard items, such as attending PCT groups, and items that change during the year, such as seniority.
There should be a fixed process to resolve detected errors. The first part of this process is to double-check for errors at your end. Was a claim made? Were the figures you sent to the PCT correct?
Once you are confident of a PCT error, contact them to discuss and rectify the problem. Agree a timescale for resolution and watch carefully for this. Unfortunately delays prove all too common, so record them for further contact when necessary.
Finally, do foster relationships with the PCT, especially given recent reconfigurations and changes in staff. Keep a list of important names and contact details. Who authorises particular payments? Who actually makes them? Remember that PCT staff are under the same pressures as we are. A friendly, diplomatic approach is more likely to achieve results than an aggressive one.
John Couch is a GP in Ashford, Middlesex