Maxine Pott FCA

Director of Healthcare GroupRMT Accountants & Business Advisors Ltd

SPECIALISTS IN GP PRACTICE FINANCE

www.rmthealthgroup.co.uk

General Practice Management Conference Nottingham 4 June 2015

RMT Healthcare Group

Experts in Practice Financewww.rmthealthgroup.co.uk

Specialist division focussing on the health sector:

• GPs Care Homes• Locums Nurseries• Dentists Opticians• Pharmacies Veterinarians

Our Credentials• Experience within medical sector in excess of 25 years• Founder members of AISMA• Contributor to Medical Press and National Seminars• Expert team of 20+ dealing with in excess of 100 GP practices and over

1,000 other healthcare professionals• Part of a full service Practice

Maxine Pott FCA – Director of Healthcare Group & Corporate Finance Tel: 0191 256 9580Mobile: 07977 446 872Email: maxine.pott@r-m-t.co.ukWeb: www.rmthealthgroup.co.ukWeb: www.r-m-t.co.uk

The Practice/Business Manager

Overview

• National context – direction of travel• GP Practice finances – current and future, challenges

and initiatives• Opportunities arising for GP Practices – survive and

thrive!

The National Picture

The five year forward view• Need for radical change– Health and wellbeing gap– Care and quality gap– Funding and efficiency gap

• Additional government funding• Public and private collaboration

The National Picture• Finances remain tight £30bn gap• Budget pressures are expected to continue

Solution?

GP Practices are central to success in all 3 areas!!!

PatientDemand Resources

ReduceDemand

How?

Preven

t Poo

r Health

Empo

wer Patient

s

Engage Co

mmunities

Why?

The Current Situation

• GMS vs PMS – ongoing debate

• Costs increasing & erosion of income

• Reducing drawings & cash flow management concerns

• Increasing work pressures – bureaucracy vs patient care

• MPIG straight line loss over seven years

• Seniority lost over six years, nothing for new starters

• Lack of new partners & succession issues

• Outdated premises

Financial Top Tipsa) Carry out a strategic reviewb) Prepare a detailed budget and cash flow for 2015/16 and use to monitor during yearc) Look to maximise incomed) Review and control costse) Look to achieve the right partner/staff structuref) Review financial and other proceduresg) Choose the right accounting software for the practiceh) Review superannuation and seniority paymentsi) Keep partners capital / current account balances in linej) Ensure partnership agreement is up to date

Maximising Income• Do you claim for everything you can claim for? • Are you recording all necessary information?• Do you randomly audit to ensure you are actually claiming for everything

you think you are?• Do you do comparisons during the year to compare income levels with

prior periods rather than waiting for the year end.• Do you have a robust process for identifying and objectively appraising

enhanced services?• Are you doing all you can do — e.g. extended hours?

Maximising Income – Let’s get specific

Core fundingIncrease list and check weighting factor data

SeniorityEnsure seniority payment consistent with reckonable years of service per the SFE

Enhanced ServicesMake enhanced services work and pay....

- What is the workload and who will do it?- Do we have the skills already?

- Or do we need to train up? Cost?- Will other services suffer if we take this on?- Do we want to be involved in this type of service?

Maximising Income – continuedQOF• Less points available but review disease registers • Consider a Quality Management team• Points and prevalence data

Other NHS Income• Ensure Golden Hello claimed for new partners if available• Consider becoming a training practice• Consider outside appointments

Non-NHS Income• Maximise variety of sources from list (see following slides)• Consider renting out surplus space to other healthcare professionals

Minimising Expenditure

6 main headings• Staff costs• Medical expenses• Premises costs• Admin costs• Finance costs• Depreciation

Financial Forecasting

• A key element of every practice financial strategy• Key to profit maximisation• Ensures income is received / maximised• Enables costs to be monitored• Ensures sufficient cash is held

by the practice to meet future costs

Financial Forecasting - continued

• Enables partners drawings to be set at a sustainable level• Enables financial decisions to be made during the year — NOT

just at the end• Detailed budgets and cash flows should certainly be compiled

for the next year — ideally for the next 3 years• Involvement of practice manager and finance GP• Update forecasts and monitor during the year

• Promotion of GP services• Alternative sources of income (linking with secondary care?)• Consolidation + Collaboration• Corporate and private competition• Multi-speciality community providers (MSPs)• Integrated primary & acute care systems (PACs)• Creating viable small hospitals• Enhanced health care homes

VANGUARD SITES ANNOUNCED MARCH 2015!

The Future Development of Primary Care - opportunities

• Community hospital appointments• CCG/NHS trust appointments• Training income• Reimbursement of premises costs (rates, water)• Notional or cost rent• "Improvement" grants• Golden Hello

No longer automatic — needs to be evidence of recruitment difficulties (implemented 1st January 2015)

Opportunities - continued

acupuncture sessions minor surgery - non GMS authorship fees minor surgery - vasectomies bail hostel fees monitoring - anticoagulant, methadone etc benefits agency work NHS direct fees biopsy clinics NHS direct posts blue badge examinations NHS trust board fees character references NSPCC committee fees - BMA occupational health committee fees - GMSC passport counter signature committee fees - MDU CCG board fees committee fees - RCGP CCG compensatory allowance coroners court reports and attendance CCG meeting fees court of protection reports and certificates pilot licence reports and examinations court reports and attendance fees police training centre retainer cremation fees private consultancy work data collection private medical examinations & reports deputising income - cooperatives private prescriptions deputising income - Healthcall private vaccinations - Yellow fever, travel etc deputising income - rotas public health appointments directorships - ambulance trusts reports - department of social services directorships - co-operatives reports - insurance companies directorships - deputising companies reports - solicitors drug company - research retainer - air force drug company - trials retainer - airports

Opportunities - continuedNon NHS Income

Opportunities - continued hire of rooms - NHS retainer - army hire of rooms - other health professionals retainer - commercial hospice appointments retainer - industrial hospital work - NHS bed fund retainer - local authority hospital work - NHS casualty service retainer - navy hospital work - NHS clinical assistant retainer - nursing homes hospital work - NHS practitioner retainer - police hospital work - private retainer - prison hypnotherapy sessions retainer - residential homes impotency clinics retainer - retail independent tribunal service retainer - school insurance reports retainer - university lecturing fees retainer - young offenders life assurance reports review panel - disciplinary LMC chair/ secretary shotgun licence certificates local initiatives - diabetes, smoking, IHD etc. sick notes locum work sports - event attendance McMillan service sports - football club doctor medical audit advisory group work sports - injury clinics medical research ethics committee sports - rugby football club doctor medicals - government departments summative assessments medicals - health authority teaching fees - medical school medicals - local authority undergraduate training medico legal work visiting medical officer - local authority mentoring fees vocational training course organiser minor surgery - excess over GMS war pension domestic visits

Non NHS Income

New InitiativesPremises• Recognition of huge historic underfunding in GP premises

– GPs invited to submit bids using money from £1bn building fund announced last year – 4 year period £250m tranches.

• Purpose – Make improvement to existing premises– Building new ones

• Success Factors– Capacity to do more– Provide value for money– Improve access to services for the frail and elderly

New Initiatives - continuedPeople

NHS England providing £10m to expand General Practice – focus on areas where difficulty recruiting

• Recruit• Retain• Return

Develop roles of other Primary Care Staff• Nurses• Pharmacists• Associate physicians

Strategic planning

Consider six key questions• What do we want to do?• What have we done well in the past?• What must we do well to succeed?• What could we do?• What might we do?• What should we do?

Calm and in Control

Appendices

Features of High-Earning PracticesFeatures of Low-Earning Practices

The Perfect Practice

Features of High-Earning Practices• Stable partnership (low turnover of partners).• Partners work as a team, trust each other, plan ahead, and meet regularly.• Partners have similar philosophies in terms of the dichotomy between money and patient

care.• Top rate databases on patients and treatments.• Pro-active rather than reactive teams.• Good managers of time.• GPs with high list sizes.• Well organised GPs with strong staff teams and good skills mix amongst them.• GPs who delegate well to nurses, health visitors etc.• GPs who work long hours, have low deputising costs, and high level of non-NHS earnings.• GPs who have the ability to dispense.• PMS GPs who have taken advantage of growth funding and freed up time to perform more

lucrative tasks.• GPs who are heavily involved with their NHS Board.• GPs with the most competent and skilled practice managers and specialist accountants.

Features of Low-Earning Practices• Practices involved in partnership disputes.• GPs with inadequate resources, such as staff, equipment and space. Such GPs often have the

wrong staff mix or have a loyal contingent of staff who have been promoted over the years but do not necessarily have the relevant skills.

• Badly organised practices with poor internal controls.• GPs who are bad managers of time.• GPs who work as individuals and not as a team.• New practices with low list sizes.• Practices in very deprived areas.• GPs who value 'time off' way over and above money, who incur very high deputising costs.• GPs with poor patient data, either through neglect or poor skills

mix amongst the staff.

The Perfect Practice• Focussed by a strategic plan Fully matched skills, with division of

duties• Well organised An executive/strategic practice

manager• Correct skill match Audit – and willing to follow up• Fully embraces IT Employ enough staff to meet the

highest• Strong data management targets – and train them• Focus on quality A balance of services and skills• Diversity of services Strong financial monitoring and

control• Outside sources of income Proactive• Protected time

Maxine Pott FCADirector of Healthcare GroupRMT Accountants & Business Advisors Ltd

E: maxine.pott@r-m-t.co.ukDDI: 0191 256 9580M: 07977 446 872

Contact Us

Thank you for listening

Questions?