The global sum – how to check that it is right
The first batch of payments under new GMS have shown inconsistencies and miscalculations of the global sum, says accountant Richard Vickery
During February and March this year my company checked many practices' global sum equivalents (GSE).
We concluded that while the basic method of calculating the
sum did not vary, there were a considerable number of omissions and errors in many of the spreadsheets.
Some of the variables are settling down a bit now, but even though we have final figures for the 2003/4 year for superannuation contributions, these are really only a rough guide as the new system will be based on superannuable profits and not superannuable income as before.
PCOs have generally been basing figures on the year to June 30, 2003, with uplifts for inflation and the increase to 14 per cent for employers' contributions. Superannuation contributions continue to be a headache.
Of course we all know that the basis for the MPIG is practice income on a cash basis for the year ended June 30, 2003, but in some circumstances there will be valid reasons to expand parts of the make-up. Our recalculations have resulted in some significant increases to GSEs.
The adjustments following our detailed checks amounted to more than £90,000 for one five-partner practice, and numerous five-figure adjustments were necessary.
The Department of Health has directed that PCOs ensure all budgets are agreed and correct payments made by June, so it really is important to ensure your global sum is right.
Checklist for assessing accuracy
Accurate patient numbers at
March 31, 2004
It is absolutely vital to ensure that growth is included as this is the last chance for GSE to be increased for growth. Post April 1 list size increases only affect global sum not GSE.
Fees and allowances excluded
from the baseline figure
Childhood immunisations and pre-school boosters come under a directed enhanced service. The budget should include these but will continue to be paid quarterly on an actual basis. Check you are paid in accordance with your claim each quarter.
Asthma and diabetes management come under the quality indicators.
With regards seniority, check each partner's NHS service. The reckonable service column on the worksheet should be completed. Check the amount in the right-hand column – some versions of the worksheet leave this as zero!
Resources adjustment to GSE
This has been fixed at 99.56 per cent by the department and applied nationally. Check it has been applied.
The TRs in the baseline year should have been deducted from the GSE, to be replaced with a five-year average figure. Check the five-year average figure has been added to the global sum.
Check this agrees to the quality points submitted by the practice. Check also the basic rate of £75 per patient has been adjusted to reflect the list size relative to the national average. The monthly quality payment should also include preparation money.
If arrears payments (such as maternity claims) were received after the baseline period, but were in respect of the baseline year, then PCOs can be persuaded to increase the baseline figure. Our experience is that only where arrears payments have been made will this be possible.
Opt-outs for out-of-hours and additional services
Many practices have not opted out as early as April 1, 2004, so an adjustment for the period of not opting out in 2004/5 should feature in the budget.
GP vacancies in the baseline period
A full-time GMS partner for the year to June 30, 2003, was worth £19,931 in allowances and fees (see SFE appendix D). You will only be able to claim this increase for agreed partner vacancies in the baseline year.
This needs to be looked at closely. There is a potential overfunding issue surrounding the increase in employers' contributions to 14 per cent. Most PCOs increased the employer's part of superannuation payments when computing budgets but the department has also directed PCOs to increase GSEs by 8 per cent to cover the rise.
At the time of writing there is still no clear guidance of how superannuable profits will be certified and by whom. Estimates should be carefully reasoned. Some PCOs are now basing their estimates on the 2003/4 final figures of contributions, plus some inflationary factors and sometimes an estimate for anticipated increases in GP profits expected under nGMS.
However the estimate is arrived at, beware of lower contributions leading to a lump sum catch-up payment becoming due after the year-end. It is not clear whether the employers' 14 per cent contribution on any increase will be funded by the PCO (or any decrease clawed back).
The above is not an exhaustive list, but highlights some problem areas to look out for.
Richard Vickery is a senior manager with PKF Medical Services Group and can be contacted on 01483 564646 or by e-mail at firstname.lastname@example.org
Case history Dr Cornel Fleming
A little while ago I received an impressive looking spreadsheet which I was told in a covering letter would give me a breakdown of my prospective earnings. Everything looked fine until I started checking the figures carefully. The spreadsheet said I had 30 patients in old people's homes, nursing homes and mental health hostels whereas I knew the true figure was 115. Think of the difference in earnings a discrepancy of this size represents.
The spreadsheet also recorded that I was opting out of out-of-hours. In fact I had not come to any decision about this.
I telephoned the finance department and in reply to my questions about the source of their information, I was told it all came from the Department of Health. Now how on earth would the department know how many nursing or old people's home patients I have?
I have now received a revised figure which I am assured is accurate, lots of corrections having been made. But I have not received, and I want to see, an updated copy of the original spreadsheet to compare things and see what really has been altered. An official at the finance department says he cannot produce such a document even though he admits that lots of doctors are asking for it.
Can anyone blame GPs for having doubts about the accuracy of the calculations relating to their earnings. All I can say is, check things as carefully as you can.
Cornel Fleming is a GP in north London