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Gold, incentives and meh

Does it all add up to the right partnership for you?

With enhanced services going to tender soon, Dr John Couch shows how to have all your elements in place to make a success of your bid

Whether practices were quick off the mark and commenced enhanced services from April or started later, it is important to review the situation now that the 2004/5 year is near halfway. For 2005/6 PCOs can put some enhanced services out to competitive tender. GPs will not always be the preferred provider.

Their aim is to provide the most cost-effective services for local patients. Your aims should be to ensure you are providing a service that matches the contract requirements in all aspects and that you are earning enough profit to make this worthwhile as a business venture. As current providers, practices are in a strong position to win against competition, as long as they can demonstrate a first-rate service.

Any bidding 'wars' are likely to occur between January and March 2005. It is therefore important to have all enhanced service elements in place beforehand. There is much to play for as, if a service is awarded to another agency, it will be much more difficult to win back.

Are you matching requirements?

Recheck the service requirements for each enhanced service provided, as stated in the GMS contract Blue Book and agreement with the PCO. Draw up a written protocol for reference and verification purposes, if not already done. While requirements vary from service to service, there are many common features.

·Computer coding Make sure you are coding all data in such a way that it can be retrieved and audited easily.

·Register Ensure this is complete and up to date. Where relevant state the indication for inclusion, duration of treatment and any target ranges (such as Warfarin testing).

·Call and recall Your system should be comprehensive and effective.

·Professional links Keep contact with any other relevant professionals including secondary care colleagues.

·Referral policies Should be clear for all team members.

·Patient education Provide clear information and links for patients whether new or longstanding.

·Individual management plans Where possible.

·Best clinical practices Especially at initial diagnosis, and make sure of good clinical governance.

·Comprehensive record keeping Essential.

·Audits At least annually. Include adverse events, hospital admissions and deaths where relevant.

·Training All team members to receive adequate initial and ongoing training.

·Annual review To look at statistics, compliance with protocol (all aspects including organisational, equipment, clinical), significant events, training, education.

Troubleshoot any problem areas or missing items from the above as soon as possible. It is also worth having an annual review early, perhaps in January 2005, in order to provide extra ammunition for the 2005/6 bid to continue the service.

Are you being paid correctly?

Practices should be paid quarterly so those starting in April 2004 should have received a payment at the end of June or beginning of July. Depending on the enhanced service the payments may be one or a combination of the following:

·Annual retainer paid quarterly in arrears.

·Payment per patient on the relevant register. This may vary within an enhanced service depending on the level the practice has chosen (for example Warfarin monitoring).

·Payment per consultation or per service provided (eg violent patients, IUCD fitting, influenza/pneumococcal vacs).

·Target based (eg childhood imms).

Practices must make sure they are clear about payment details for each service. Check that a payment has been made for any services provided in the relevant quarter. If not check that a claim form was sent. Next check the payment is correct.

Figures should have been agreed in writing with the PCT when the enhanced service was drawn up. Do not forget to claim a domiciliary fee where relevant (eg Warfarin testing where blood was taken by non-community staff).

The guide figures that were incorporated in the GMC contract Blue Book last year should have been uprated by 3.225 per cent for 2004/5. The same increase should also be applied for 2005/6. In some areas there has been (and continues to be) great difficulty getting funding agreed with PCTs. In some cases no funding at all has been offered, despite clear Department of Health promises last year. These are nationally important issues which are being pursued at the highest levels.

Where payments appear incorrect ask for a breakdown of the figures to clarify errors. If you are paid a retainer fee, was this adjusted according to your practice size? (The Blue Book is not clear on this point.) Make sure your register continues to be accurate. If you are just 5 per cent out when claiming for warfarin monitoring this could cost your practice several hundreds of pounds per year at around £85 per patient.

Making a reasonable profit?

While clinical service for patients is important, on a business level it is just as vital to establish that a reasonable profit is being made. What is reasonable? Overall the average practice's expenses level is approximately 50 per cent of the income generated. In other words, 50 per cent is profit. It should not be too difficult to check. Include all expenses including:

·Staff time (receptionist, clerical, secretarial, nurse/health care assistant)

·Doctor time

·Postage, stationery and leaflets

·Telephone costs

·Consumables (swabs, testing kits, cost of practice-based blood tests etc).

Project your income and expenses figures for a whole year. The table on the right shows an example for warfarin testing.

John Couch is a GP in Ashford, Middlesex

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