How to campaign against funding cuts: Calculate how big the problem is
In the first of five articles, Dr Naomi Beer of the Jubilee Street Practice describes how struggling practices can predict losses from the MPIG to help in their fight to survive
Our practice serves one of the most deprived populations in the country and after we lost nearly £220,000 in funding this year, because of a reduction in MPIG payments, we had to pay to run our practice from our savings account and were forced to set a ‘red-button day’ for closure earlier this year.
As we began to realise it would be impossible for us to survive, we held an emergency partners meeting in April and decided to launch a Save Our Surgery (SOS) campaign.
In this campaign we pulled out all the stops, getting our patients involved, organising rallies and speaking with national newspapers and broadcasters. After a hard slog, we have finally seen some movement from NHS England. It is early days, but we hope this campaign will provoke managers to give us the support we so desperately need.
As Pulse has shown, there are many other practices in a similar position. By sharing what we have learned, I hope to show in this article series the steps you can take to launch a successful campaign to save your practice.
If you are worried that the viability of your practice is threatened, work out what the funding problems will be long term.
Our practice regularly undertakes one and seven-year financial forecasts and we knew that without MPIG, the practice would not be able to keep operating. But until we figured out what the precise figures would be for this year’s cut in MPIG payments we did not know what the damage would be.
For instance, average net remuneration for GPs is around £89,000. We calculated that ours used to be around £79,000 and this year we projected it would fall to £45,000.
We used the BMA’s ready reckoner for practice funding to figure this out – for more information, watch the video created by our practice manager Virginia Patania below.
She has also produced a video specifically for practices that have lost MPIG income, featured below.
With estimates of your projected list size for this financial year, QOF income for last year, estimates for maximum income from 2013/4 DESs, global sum, the out-of-hours deduction and net global sum, the tool will estimate what your profits (or loss) will be for 2014/15. Bear in mind that rapid list growth may create a discrepancy that makes you appear to have been overpaid. (Also, the ready reckoner does not factor in the loss of seniority payments.)
Estimate your target income for this year from the ready reckoner, the value of other work (non-NHS income, any enhanced services) and the costs of staffing and cover, expenses and bills. Then work out the difference between estimated target income and estimated costs.
We also run profit margin forecasts for all enhanced services and summarise which work creates the best value for the practice. Some services will subsidise others, but you need to know which ones you might need to cut if you are struggling financially – particularly after this financial year.
It will also help to produce charts in case you need to show NHS managers (the local area team or NHS England) that demand and rates of consulting are going up.
Keep track of true monthly income and costs during the year to check the forecast is accurate.
Dr Naomi Beer is a GP in Tower Hamlets, east London