1. Practice Finance

2. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Overview Independent Contractors Permanent nationally-determined contract until PMS

3. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Important History 1948 Formation of NHS 1966 GP Contract 1990 New GP Contract 1990 NHS Trusts 1992 Fundholding 1998 Primary Care Groups 1998 PMS Pilots

4. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Sources of information SFA (Red Book) Medeconomics AISMA guide Accountant Library

5. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Doctors and Dentists Review Body Advises Government on what average Doctor should earn Government allocates a non-cash-limited budget for GMS activity If budget exceeded nationally, Government adjusts next years pool

6. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Partnership A group of Doctors working together Usually in the same or linked premises Co-operating in on-call and rota arrangements Assuming responsibility for one anothers patients in absence Pooled resources and expenses

7. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Premises Partnership finds appropriate premises from which to practise (LHA to approve) May be purpose-built Finance Partners finance Private Finance Initiative Health Centres

8. GP Registrar TutorialDr Andrew Mowat18 th June 2001 General Medical Services Independent contract Nationally-negotiated Within DDRB framework 24hr care responsibility Statement of Fees and Allowances (SFA)(Red Book) Payments on quarterly cycle

9. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Personal Medical Services Employed contract fixed-term Payment system bases on central budget based on previous GMS activity, with additional development money Contract: initially to be locally-negotiated, but now centrally-imposed without national bargaining or safeguards Pension rights as yet unclear Potentially big winners and big losers

10. GP Registrar TutorialDr Andrew Mowat18 th June 2001 NHS Income Allowances Fees per patient Item of Service Reimbursement Dispensary Cost-Rent Scheme

11. GP Registrar TutorialDr Andrew Mowat18 th June 2001 NHS Allowances Basic Practice Allowance Seniority Allowance Quality Allowance Postgraduate Education Allowance Out of Hours Allowance Other Designated Area Assistant Associate

12. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Fees per patient Capitation 3 bands ( 75) Deprivation Child Health Surveillance Target Payments Cervical Cytology, Childhood immunisations Health Promotion Asthma, Diabetes

13. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Items of Service Maternity Care Contraceptive Services Out-of-Hours consultation Vaccination/Immunisation Temporary Resident

14. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Reimbursement Cost-Rent Scheme Rent & Rates Maternity Locum Fees

15. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Dispensing Income Can dispense for patients >1 mile from chemist in non-urban area Get paid: Cost of Drug LESS Discount (NHS assumes discount 9%) PLUS Container Allowance AND Dispensing Fee

16. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Cost-Rent Scheme Partners own building Partners need loan to pay builders etc Cost Rent Scheme provides parameters for paying loan interest on certain things – fixed room sizes, purposes etc Variable interest rate different borrowing rate from cost-rent rate

17. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Private (non-NHS) Income Legal & Insurance Work Local Authority Work Work for Private Business Use of Premises Private Patients hobby/work/driving medicals travel health services

18. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Expenses Include Staff Costs All drugs and equipment used Heat/Light/Water Financial Accountancy, Banking Administration: Telephone Postage Important that DDRB gets accurate view of what expenses are incurred Beware netting- out

19. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Taxation Income Tax Schedule E Schedule D Value Added Tax (VAT) Capital Gains Tax (CGT) Inheritance Tax

20. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Schedule E (PAYE) Can claim as an expense against tax the cost of buying or maintaining any item used wholly and necessarily for business. i.e. any item without which you cannot carry on business

21. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Schedule D (Self-Employed) Can claim as an expense against tax the cost of buying or maintaining any item used wholly or exclusively for business. i.e. any item used wholly or mainly (in which case you claim a proportion of the tax) within the business

22. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Tax Payment Tax calculated on whole-year basis Two payments made: January and July Each payment consists of an actual amount plus an estimated on account payment Practice will probably set aside money

23. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Retirement GPs can retire from age 50 onwards Early retirement will mean reduction in pension Age 50 multiply by 0.599 Age 55 multiply by 0.754 Age 59 multiply by 0.943 Can buy added years superannuation

24. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Added Years Allows GP to buy added years of benefits to increase up to maximum 40 years at age 60 Pay fixed percentage of NHS Superannuable income every year Price according to age

25. GP Registrar TutorialDr Andrew Mowat18 th June 2001 NHS Pension Scheme Basic contribution 6% NHS income per year Benefits: Lump Sum 4.2% Annual Pension 1.4% Ill Health Retirement pension Death benefit Widow(er)s pension Childrens allowance

26. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Pension Pension calculated on whole-career earnings Different portions are pensionable (superannuable) to different degrees Dynamised upwards to represent career earnings at current prices 4.2% lump sum 1.4% per annum

27. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Profits and Losses Business makes a profit Profits divided among stakeholders partners profit-share staff Partners take drawings in anticipation of profits Losses equally shared

28. GP Registrar TutorialDr Andrew Mowat18 th June 2001 Equity Business has assets Premises Stock Equipment Furnishings May require capital investment Equity Partners draw more than non-equity partners

29. GP Registrar TutorialDr Andrew Mowat18 th June 2001 What to look for … Check Partnership Agreement property ownership equal division of profits? Inspect Accounts: ?recent (less than 18m old) assets > liabilities parity profit share regular sustained drawings (may need to ask) expenses <50% of turnover