The new contract has brought many changes but GPs must not neglect the tried and tested financial checks, says Dr John Couch
‘If possible, compare your income categories to other practices'
With all the changes resulting from nGMS it has been easy for GPs to take their eye off the ball regarding the financial basics. Also, PCT payments regularly contain mistakes. So it is worth reintroducing some time-honoured checks into this brave new world.
Set up a review
Appoint a finance review team. Normally this will be your practice manager, finance partner and bookkeeper (if separate). Have a clear agenda, asking the following questions.
•Are income levels in each category rising or falling?
•Are we making appropriate claims or invoicing correctly?
•Are the claims systems robust?
•Do we have a regular and active system for checking payments and chasing late ones?
•Are we being paid at the market rate?
Core budget, MPIG and growth money
These remain a contentious area for GMS practices. It is difficult to compare old figures with new, and difficult to trust PCT figures with headlines showing practices being under- and overpaid. Make sure you get a breakdown of your budget every year and ensure employers' superannuation is included.
Ask your accountant to check your MPIG annually. If you do not have a specialist medical accountant the LMC may be able to help. Check your monthly payment carefully and if it seems wrong, ask the PCT why.
PMS practices also need to check things carefully. Early this financial year our PCT moved minor surgery and IUCDs from PMS core budgets to enhanced services. It then deducted the total annual amount from a single month PMS payment, creating cash-flow problems. We negotiated a repayment with monthly deductions.
Your QOF monthly payment should be based on 60 per cent of your 2004/5 score multiplied by the 2005/6 points value (approximately £41 per GP with average list per point) divided by 12. The balance will be paid in April/May 2006. Check this. Use this opportunity to check your performance at the halfway point. You can still catch up.
Claims need to be made quarterly and are paid the following month. You must check claiming is watertight. Ideally all services should be computer coded to allow easy searches. Do not miss the claims deadline. Ensure also that you are maximising the agreed services. Increasing vaccination numbers, IUCDs or INR patient numbers will all increase payment.
Seniority payment increments now start earlier and rise annually. Much tighter checks are required. A spreadsheet with all principals' details is extremely useful here.
Drugs reimbursement/prescribing fees
Look at the complete cycle. You will almost always find problems. Better stock control, more accurate recording and claiming plus careful checking of PPA and prescribing payments will improve income.
Sickness and maternity locum payments
PCTs will only reimburse these if an external locum is employed, so do not cover the extra yourself unless you have no choice. However, rules on average list size and length of time off still apply to sickness locums, so check with your PCT before running up external locum costs. When making a claim send it monthly.
GP registrar training grant and salary/
Errors are most likely when registrars change over, at pay rises and when defence body fees and motoring reimbursement are due. Audit claims carefully.
Medical student/PRHO training fees
Practices that take medical students or pre-registration house officers can claim a fee. Get the correct form in advance.
Complete it at the end of the training. Check that payment is made.
If you own your premises are you overdue for the triennial review? PCTs sometimes forget to send the forms. Do you always accept the district valuer's figure? You could be losing thousands by not using an independent valuer to argue your case. Is your building well maintained and presented? Your reimbursement could be affected if not.
If you rent premises, is your PCT reimbursing 100 per cent? Will they fund any rent increase in the same way?
Rates/water rates/waste disposal
These should be paid directly by the PCT.
Rental of rooms to third parties
When did you last review the amount? Is it time for an increase? Check also that payments are being made promptly.
Private charges to patients
Check that all GPs are charging patients for approved private items such as private certificates, travel insurance claims, travel vaccinations. Check that you have tight systems for collecting and recording the money. The BMA is no longer able to publish annual fees but you can still increase fees yourself.
Check when this was last done and increase them at least by inflation. Find out what other practices are charging to ensure you are not too far out of line. Make this an annual exercise.
Private fees from organisations
Check your claims and chase late payments regularly. Fees for both PMA reports and examinations have risen considerably in recent years. If any company offers a lower fee refuse the service. Check fees for letters to solicitors and employers – when were they last increased? Charge by length of letter and get written agreement to the fee in advance. Remember you are charging for your professional opinion as well your time. Check that all cremation fees are recorded, and chased.
Some fees are notoriously difficult to get promptly – particularly fees from social services for reports on the elderly, medicals for adoption or fostering and sectioning under the Mental Health Act. Did you know there is a fee of over £3 for providing a notifiable disease certificate?
Many practices do sessions for private companies or as GPwSIs. Is the pay adequate? Most private work should pay at least £100 per hour. The BMA can advise. Try to negotiate an annual review. You might also like to review what other private work is available in your area.
There are a number of other fees that you may be due. These include appraisal monies and a variety of incentive schemes. Ask the PCT if there are any others that you haven't claimed but could!
Keep up the good work
If possible, compare your income categories with other practices. Many medical accountants produce league tables that can highlight areas where you might improve. With the next few years of NHS pay rises likely to be limited to cost of living only, our efficiency and enterprise will be the best way to keep income rises at a higher level.
John Couch is a GP in Ashford, Middlesex
20 must-do financial checks
•Set up a review team to monitor your practice's efficiency
•Check your core budget/MPIG/growth money
•Check your QOF payments
•Check your QOF points performance at the halfway point
•Check your enhanced services claiming system
•Check seniority payment increments
•Check everything relating to drugs reimbursement
•Check maternity, sickness and locum payments
•Check GP registrar training grant and salary/expenses reimbursement
•Check you receive the correct fee
for medical student/PRHO training fees
•If you own your surgery, are you overdue for the triennial review?
•Get your surgery valued at its true worth
•If you rent your premises, ensure 100 per cent reimbursement
•Check rates/water rates/waste disposal are being paid by the PCT
•If you rent out space in your building, maximise rent
•Ensure rent is paid promptly
•Check all private fees are received
•Chase poor payers
•Ask the PCT if there are any fees you could have claimed but haven't•Compare your earnings with other similar practices