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How to... boost income from GMS and PMS

Maximising all forms of income is important for any business and is imperative for GPs since there will be no pay award this year – Dr James Gillgrass offers some practical advice

Maximising all forms of income is important for any business and is imperative for GPs since there will be no pay award this year – Dr James Gillgrass offers some practical advice

Following the announcement in March that the Review Body had recommended a zero per cent pay award for GPs for 2007/8, maximising GMS or PMS income has taken on a new significance. It is now more important than ever that practices look at how to maximise all income and review expenses.

Maximising GMS/PMS income is not just about ensuring that the right monies are paid. It is also about ensuring that all opportunities for increasing income are considered and taken advantage of where appropriate. But it is important to balance the financial rewards against the effort and expense involved.

Know the GMS contract

An understanding of the GMS/PMS contract, the Statement of Financial Entitlements, the GMS/PMS regulations and related documents is essential. A member of the practice, usually the practice manager, should have a thorough working knowledge of these documents and know how to access them. Your LMC can guide you if you have problems.

This exercise will also give you an understanding of how practice income is made up – it is derived from a number of areas in addition to the global sum and minimum practice guarantee or PMS baseline budget. Examples include enhanced services, QOF payments, PCO-administered funds, premises, dispensing and incentive schemes.

Practices also need to be aware of the monies for which a specific application to the PCT is required. There must be a robust system for claiming all monies, not just private fees, and the system needs to be checked regularly to ensure that all claims have been made and paid. Including a reference number on the invoice or claim can be helpful in sorting out any queries that might arise.

The monthly statement

The monthly statement from the PCT should detail the baseline budget for PMS practices and the calculation of the global sum for GMS practices. There should also be details of other GMS/PMS sums that are due, and a list of deductions made by the PCT.

If the monthly statement does not give adequate information, or you do not understand it, ask the PCT for an explanation. Two areas to consider when thinking about maximising GMS/PMS income are increasing your list and boosting QOF pay. Remember that for each additional patient the practice will receive about £57, but this will be affected by the global sum calculation. For PMS practices the sum might be quite different depending on the contractual arrangements negotiated with the PCT.

QOF points are valued at £124.60, but for both GMS and PMS the overall income will be affected not just by achievement but also by prevalence. Remember also that PMS practices are docked 109 points automatically. In busy practices a balance needs to be struck between taking on additional patients and carrying out the work necessary to score well in the QOF. Four years into the QOF your practice should have systems to ensure that income in this area is maximised with minimum effort. Policies should have been written for the organisational indicators and will need to be checked just once a year to make sure they are up to date. Routine collection of patient data, regular monitoring of data collected and recorded, and an efficient call and recall system will all contribute to maximising income and allow a practice to concentrate on other areas for generating GMS/PMS income such as a bigger list.

Other opportunities

Consider all other opportunities. These include the provision of enhanced services, particularly local enhanced services. The latter generate extra income and at the same time, by offering extra services, you can attract new patients to increase your list further.

Practice-based commissioning, although often poorly resourced and supported by PCTs, might be another option to think about, perhaps as a longer-term mechanism for increasing income rather than one for seeing immediate gains. Commercial enterprises are quick to invest in areas that will maximise income. Seizing commercial opportunities like this is a mindset often alien to general practice. Entrepreneurial projects are often looked on with disdain by less forward-thinking practices. Yet we all have much to learn from successful businesses and the way they develop. We should not be afraid to introduce proven processes from the commercial sector as we strive to maximise GMS and PMS income.

Finally, the practice's annual accounts are an important tool in assessing a practice's financial performance. Ask your accountant to provide comparative figures if possible to allow you to check your income against other practices. Be aware though that differences may be explained by the global sum formula rather than your failure to ensure that all GMS income has been collected.

Dr James Gillgrass is chief executive of Surrey and Sussex LMCs

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