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Is your practice being paid for the work it does? A beginner’s guide

by in Accounting

Claiming for the work the practice carries out is not always straightforward and it’s easy to miss a payment. Deborah Wood, Vice Chairman of the Association of Independent Specialist Medical Accountants, offers this checklist to help managers keep on track.

1 Know your sources of income

The way in which GP practices are paid is ever changing. New organisations are being introduced and the practice’s income may now come from many different sources.

Keep a list of all the services that the practice provides, to whom and at what price. Check that the income is being paid to the practice in a timely fashion.

2 NHS contract income

NHS contract income consists of GMS/PMS monthly income; aspiration and achievement payments under the Quality and Outcomes Framework (QOF); seniority payments (identified separately until March 2020); reimbursements for certain premises costs; and enhanced services paid by NHS England.

GMS contract payments are calculated based on a fixed price (for 2019/20 £89.88) per weighted patient. These are paid monthly and are recalculated at the beginning of each quarter for updated list size changes.

PMS contract payments vary enormously across the country and it can be particularly difficult to check what the payments cover as much of the detailed information has been lost over time. For 2019/20 an uplift of £0.53 per weighted patient has been applied to the amounts paid prior to 31 March 2019 to reflect comparative changes with the GMS contract.

Be aware of the local arrangements for the redistribution of PMS funding. There may come a point where it would be beneficial to move back onto a GMS contract.

3 Enhanced services income

Enhanced services paid by NHS England will be paid as part of the monthly GMS/PMS payment. Those paid by the CCG may be paid as part of the monthly contract payments or separately, with the local authority responsible for public health payments.

Some locally commissioned enhanced services are also now delivered through Federations or Provider organisations who may pay the practice for their share of the services provided.

Ensure that all staff involved in enhanced services are aware of which services the practice has signed up for; what the criteria is to achieve maximum payment and, very importantly, how to make a claim.

A robust system is required to ensure that the correct claims have been made and that the practice is paid in a timely fashion. Ideally these can be invoiced and monitored via the practice’s accounting software package.

4 Monitoring NHS contract and enhanced services Income 

A good way to monitor NHS income is to download the monthly statements from Open Exeter, either as csv files into an excel spreadsheet, or by making use of the practice accounting system. Many accounting packages now include facilities to import the monthly statements directly from the monthly Open Exeter statements. If the practice system allows this feature reports can be run to show income month-by-month and category-by-category. Keeping track of these income reports will reveal what has been paid each month. This then needs to be compared with the amounts due.

A Calculating Quality Reporting Service (CQRS) achievement report can also be run that will enable the practice to track Enhanced Services activity through to payment. Auto extraction of data by the General Practice Extraction Service (GPES) doesn’t always work!  To ensure payment is received, pay particular attention to the payment and validation terms. Ensure everyone understands and uses the designated clinical codes as required.

Where a service is supported by CQRS, practices are required to manually enter achievement on CQRS using the relevant clinical codes within their clinical systems until data can be automatically collected from practice systems by GPES.

Don’t forget to keep up to date with contract changes to see what new sources of income are available and how they can be claimed. For 2019/20, practices are now able to claim for primary care network (PCN) participation, but from July 2019 some of the previous extended hours access funding moves into the PCN contract.

There have also been changes to the vaccination and immunisation programmes which are detailed in the Statement of Financial Entitlement (SFE)

5 Private sources of income

GP practices have many other sources of private income available to them. Some practices may actively seek outside sources of income such as private schools or prison work. Other practices will be able to generate income from their own patients through insurance reports, cremations fees, and other similar forms.

While these may not be significant sources of income, all staff should be aware of when a fee should be charged. Ideally payment in advance should be requested from the patient and requests from insurance companies or solicitors invoiced and paid before the work is carried out. Most accounting packages will allow practices to raise invoices and monitor outstanding amounts.

Remember practices have a statutory right to charge interest at 8% plus Bank of England base rate and debt recovery charges for late paid invoices.  Although the implementation of GDPR regulations around patients obtaining their personal information free of charge may have curtailed some of these private fees, there are still opportunities for charges to made.

Deborah Wood is a member of the Association of Independent Specialist Medical Accountants

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