Maxine Pott presentation from the General Practice Management event. Nottingham. 04/06/2015

1. Maxine Pott FCA
Director of Healthcare Group
RMT Accountants & Business Advisors Ltd
SPECIALISTS IN GP PRACTICE FINANCE
www.rmthealthgroup.co.uk
General Practice Management Conference
Nottingham 4 June 2015

2. RMT Healthcare Group
Experts in Practice Finance
www.rmthealthgroup.co.uk
Specialist division focussing on the health sector:
• GPs  Care Homes
• Locums  Nurseries
• Dentists  Opticians
• Pharmacies  Veterinarians

3. 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 9580
Mobile: 07977 446 872
Email: maxine.pott@r-m-t.co.uk
Web: www.rmthealthgroup.co.uk
Web: www.r-m-t.co.uk

4. The Practice/Business Manager

5. Overview
• National context – direction of travel
• GP Practice finances – current and future, challenges
and initiatives
• Opportunities arising for GP Practices – survive and
thrive!

6. 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

7. 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!!!
Patient
Demand Resources
Reduce
Demand
How?
Prevent
Poor Health
Empower
Patients
Engage
Communities
Why?

8. 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• Outdated premises

9. Financial Top Tips
a) Carry out a strategic review
b) Prepare a detailed budget and cash flow for 2015/16 and use to monitor
during year
c) Look to maximise income
d) Review and control costs
e) Look to achieve the right partner/staff structure
f) Review financial and other procedures
g) Choose the right accounting software for the practice
h) Review superannuation and seniority payments
i) Keep partners capital / current account balances in line
j) Ensure partnership agreement is up to date

10. 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?

11. Maximising Income – Let’s get specific
Core funding
Increase list and check weighting factor data
Seniority
Ensure seniority payment consistent with reckonable years of service per the SFE
Enhanced Services
Make 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?

12. Maximising Income – continued
QOF
• 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

13. Minimising Expenditure
6 main headings
• Staff costs
• Medical expenses
• Premises costs
• Admin costs
• Finance costs
• Depreciation

14. 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

15. 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

16. • 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

17. • 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

18.  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 - continued
Non NHS Income

19. 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

20. New Initiatives
Premises
• 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

21. New Initiatives - continued
People
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

22. 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?

23. Calm and in Control

24. Appendices
Features of High-Earning Practices
Features of Low-Earning Practices
The Perfect Practice

25. 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.

26. 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.

27. 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

28. Maxine Pott FCA
Director of Healthcare Group
RMT Accountants & Business Advisors Ltd
E: maxine.pott@r-m-t.co.uk
DDI: 0191 256 9580
M: 07977 446 872
Contact Us

29. Thank you for listening
Questions?