As the funds available for GMS and PMS work are squeezed ever tighter, practices should ensure they are running non-NHS services as efficiently as possible in order to maximise profits.
Examples of non-NHS services GPs can charge for include:
• Work linked to adoption and fostering, such as paternity tests (£37.90)
• Filling in certificates or extracts from records, such as character references (negotiable)
• Court and legal work, such as attending events as an expert witness (£65 to £82.25, depending on the location)
• Providing certificates for drivers, such as Series II proforma (£39)
• Providing childminder health forms (£87.50)
• Filling in insurance forms, such as reports for insurance applicants (£100)
All fees are based on BMA-suggested figures. A full and up-to-date list of non-NHS fees is available on PulseToday. Go to http://tinyurl.com/c8us3mu
The following tips will help you check how your practice is performing when providing services such as the preparation of private medical reports:
1 Agree on who gets what
Decide whether non-NHS income is to be kept by the partner carrying out the work, or pooled as part of partnership income. If it is to be treated as personal income, how is the partnership compensated for the use of practice resources (space, staff time, postage and stationery)? Perhaps 10% of the fee should be retained by the practice to cover these costs.
2 Publish fees clearly
Having set the rates, publish a list of charges in a prominent place in reception so there is no doubt what the charges are. If you are a VAT-registered practice, remember to charge 20% VAT on top of the fee where appropriate. See HMRC Notice 701/57 for more information on when it is appropriate to charge VAT.
3 Update your fees each year
Review your charges on an annual basis. It is usually easier to increase the rates by a small percentage each year than to impose a large increase less frequently. Use the annual review to remind the doctors of the rates and to ensure charges are being applied consistently.
4 Don’t leave doctors to chase payment
As far as possible, remove the need to ask for payment in the consulting room. Patients should know how much they are going to be charged for a report before they attend, and the reception staff should deal with the collection of the fee. If it is left to the GPs, some may be reluctant to charge patients. Consequently the follow-up of debts will be haphazard and there will be inconsistency between partners.
5 Charge a fair fee for reports
Set realistic rates for the preparation of reports. If it is going to take 30 minutes to see the patient and complete the report, think how much you would have to pay a locum for 30 minutes’ work and then charge accordingly. Remember to add on an allowance for administrative time and resources.
6 Swap letters for forms
Make sure patients bring the relevant form to be completed to prevent wasting time chasing up for this afterwards. If a patient asks the practice to write to a third party such as a travel insurance company or solicitor, do not agree to this. There is always a form to be completed which will clarify exactly what the report should cover, and which will help the doctor to avoid the danger of disclosing too much, or irrelevant information.
7 Don’t be undercut by insurance companies
Do not feel pressurised by insurance companies to accept a fee if this is inadequate for the work involved. Either decline the work or agree in advance a more realistic fee. Trying to agree an increased fee after the event is a fruitless exercise, so you need to assess the time likely to be involved at the outset. The provision of electronic notes may seem straightforward, but it still takes time to ensure they are up to date and that any confidential information is edited out.
8 Charge for private prescriptions
Non-dispensing practices will need to make a charge for private prescriptions, although dispensing practices may decide to offer this free of charge if they can make a profit on the drugs supplied.
9 Use the skills you already have
Make use of partner specialties since these can generate useful income as well as ensuring professionally rewarding work. If you have an occupational health specialist, can you establish a relationship with local larger employers to provide occupational health services?
10 Say no to (some) private work
Do not automatically carry out all private work. For example, countersignature of passport application forms may not be work worth doing. It is difficult to charge an appropriate rate since no specialist medical knowledge is required. The forms are often bounced for minor infringements such as signatures not being kept within the pre-printed box, and the disclosure of the GP’s own passport number on the form may create a risk of identity fraud.
Finally, as with any additional source of income, consider whether what you keep after tax is worth the time and effort. If your total taxable income is between £100,000 and £116,210, your personal allowance will be reduced by £1 for each additional £2 you earn, which means you retain only 38% of what you earn after income tax and national insurance have been deducted.
Luke Bennett is a partner at Francis Clark LLP, a member of the Association of Independent Specialist Medical Accountants (AISMA)