Ten Shades of NHS GP Practice Income –
(Last Updated December 2018)
Generating income for family doctors has become more and more difficult since NHS England and other local NHS organisations, such as Clinical Commissioning Groups have tightened their belts and the economic climate has cooled. Gone are the days of generous cost rents, fundholding and prescribing savings and new growth money from PMS contracts. Instead, it’s a case of watching the pennies to keep the pounds. So where can that extra income from? Where Indeed?
1. Service Charges
Are you letting NHS Professionals or Health Related Services use your rooms for clinics and patient groups without charge? Do you own your premises? Remember you are paying for lighting, heating, cleaning and security and there are also the costs running a reception. Do you allow use of a telephone, a photocopier and the internet for emails and searches. Whilst the local health organization might not like coughing up, a contribution toward the running costs of your premises it can be a worthwhile and legitimate extra income. What you must not do is charge a RENT! However, do you have rooms that you can ‘rent ‘ for meetings or for as consulting rooms for out reach clinics, that you are not reimbursed rent and rates. ? Is there space for a small pharmacy – it might need to be open longer hours than your surgery. Can you provide accommodations for an out of hours service, or offices for a GP Federation? Remember though that you can levy a ‘service charge’ but not a rent or hire charge. If you lease NHS Premises you WILL be levied a service charge. It’s strange that often there are protests when you try to put the boot on the other foot.
2. Avoiding VAT
There is a great deal of publicity these days about Tax avoidance schemes but one legitimate way of avoiding tax is to use trades people for carrying out surgery maintenance and repairs who are not registered for VAT? This might include your gardeners, cleaners, joiners, plumbers, painters and electricians. Remember VAT is running at 20% and that would be a significant saving.
3. Buying Groups
Getting together with other local practices, the CCG, the Local Medical Committee to buy next year’s flu vaccines or your travel vaccines might benefit from bulk buying savings. The same might apply to buying ‘horridly expensive’ printer cartridges and general stationery. Restrict buying to black cartridges; ban the use of colour! Coffee, tea and sugar can be quite an expense too! Do you need really water fountains and water dispensers when there is simply a designated cold water tap for drinking water? What about that fish tank and the flowers you buy to freshen up the waiting room. Do you need those? Times are tight! Changing energy suppliers is a popular use of a buying group. Just be careful about the cash flow if money is owed by any outgoing energy supplier.
4. Private Fees
Be consistent about what you charge for copy records, medical, and reports. However, this area of income has been devastated by the GDPR legislation. Remember too that the BMA fees are only recommendations. You can set your own fees and review them annually. For instance you might charge £150 for a medical report with an examination whilst you may have been offered far less. You can no longer charge for Copy records. but for insurance reports and medicals it is up to you. Some Practices offer a Yellow Fever Centre service. Do not accept at face value any offer to pay a fee without setting your own fee.
5. Utility Services
Looking at a Monopoly Board is a reminder of the services you pay for those utility companies that are constantly pestering you to switch to. Water, Electricity, Gas, Telephones etc. If you have the time and patience to deal with these often high pressure sales people you might benefit from using a comparison web site and trying out a new supplier. See what your local colleagues are doing at your Practice Managers Group. Look for long term fixed rates.
6. Avoid Leases
I continually see examples of long term leases entered into to provide equipment for use in a surgery. Probably the most expensive is the telephone system, then check in screens and photocopiers. I also found a case of a franking machine that cost as much to rent as was spent on stamps each year. You don’t have to lick self-adhesive stamps! When considering a lease of equipment look very carefully at the cost and maintenance of the equipment over the period of a lease and compare. You might be surprised that it is cheaper to buy.
7. Professional Fees
Shop around the Defence organisations before your GPs pay their annual professional indemnity fees. Group schemes including all of the members of the practice can save some pennies. Some organisations offer free membership for the practice manager. Some doctors choose not to join the BMA as they see it as an unnecessary expense but it is a good idea for at least one GP to be a member in the practice.
8. Staff Costs
Staff Costs are always a major practice expense and although there have been wage freezes in the NHS those practices that adopted the Agenda for Change pay scales have taken the biggest hit. The NHS Agenda for Change system of staff pay is not used widely these days in general practice. Are you still paying rates of pay that were enhanced from fundholding money? If you are, are the duties now carried out worth that salary. Are you still using uprated Whitley Council pay rates? If you are, it is likely that your staff will be keeping track with NHS pay rates but not totally. My calculations suggest at least a 10% drift away of NHS pay. Saving staff costs is not an easy one. However avoid unnecessary overtime or additional hours payments. A recent survey suggests that on average practice managers are working at least one extra day per week, but are they being paid for it? Why not use fixed rather than incremental pay scales when you employ new staff, but make sure you keep track with the National Living Wage.
9. Enhanced Services
Whilst the purse strings have been tightened in NHS quarters there is still the odd opportunity to generate a worthwhile income from Enhanced Services Practices should look carefully at whether the effort involved produces a worthwhile income and remember it does actually cost to provide a service – it is not just extra income. .
10. Being Meticulous
Dotting the i’s and crossing the t’s when making claims can be time consuming but can find things that have been missed. It’s also important to constantly check that you have actually been paid.
Robert Campbell is a retired practice manager who now works as a consultant for practices who need a helping hand.
Last Updated December 2018