© PKF (UK) LLP Maximising Profits Paul Ellis Partner 26 March 2009

© PKF (UK) LLP Background information Profitability decreasing –No/minimal contract increases –Static or declining private income –Continuing cost increases Increasing commercial pressure –Increase in private organisations entering the market –Private companies with bigger profits and resources Can buy in necessary skills Can fund property/equipment –Opportunities through APMS tenders –Switch in focus from secondary to primary care

© PKF (UK) LLP Background information cont… Consequences of not adapting –Taken over by another organisation –Loss of patients leading to loss of profit –Inability to attract/retain quality staff –Worse case scenario – forced into merger –Remember things rarely stand still Risk of inactivity

© PKF (UK) LLP Growing pains Methods of growing –Organic growth –Collaboration –Merger

© PKF (UK) LLP Meeting the challenges – making it & keeping it Maximising profitability Assessing financial viability Service delivery Keeping it

© PKF (UK) LLP Maximising profitability – additional services Extended hours –may cost to provide BUT –consider potential to offer additional services when opening surgery for extended hours Enhanced services –consider all opportunities –prioritise the most profitable services –monitor achievement on target based services Appointment income Training practice Nursing home retainers Social developments Practice website

© PKF (UK) LLP Maximising profitability – additional services Little growth in private work but opportunities may arise Potential to provide additional services to the NHS PBC-commissioner/provider conflict? -slow roll out to date APMS-tender opportunities are arising New pharmaceutical needs assessments May need to work with others to take advantage of some opportunities: –practice joint ventures/group working –formation of a separate entity to co-ordinate and provide additional services from a group of practices –practice mergers to form a larger business entity –working with the private sector.

© PKF (UK) LLP Minimising costs - Drugs Ongoing monitoring essential to ensure: –over ordering and wastage does not occur –purchases are made at the best price –scripts are issued in all cases –monitoring of script receipts v scripts issued Dispensing practices –ensure full VAT claims made –better discounts if order electronically –spread scripts over prescribing doctors –join a buying group –investigate reducing costs of bags, bottles, boxes

© PKF (UK) LLP Minimising costs - staffing Main area of practice expense Staff flexibility and skill mix Recruitment and redundancies Staff subscriptions and training –work load efficiencies –process reviews

© PKF (UK) LLP Minimising costs - Locums Cover –internal locum cover –skill mix Insurance –many practices moving to group policies –annual review –group discounts can make the cost cheaper –may not be immediately advantageous for all partners –reviewing your needs

© PKF (UK) LLP Minimising costs – service contracts It is still possible to find cheaper contracts for services such as: –insurance –power –Telephone Review contracts/costs –changing providers –altering terms/products purchased Use of buying groups or the NHS

© PKF (UK) LLP Assessing financial viability Financial viability –Profitability –Cashflow Working capital requirements Discipline of partner’s funds Appropriate payments on account: –Tax –Superannuation Forecasting peaks and troughs –QOF achievement –Enhanced services –Tax bills

© PKF (UK) LLP Assessing financial viability (continued) Are you a QOF winner or loser? Changes are being made to the prevalence calculations from 1 April 2009 which will either increase or decrease your practice’s QOF income. To find out if you are a QOF winner or loser – go to:- To calculate the amount your practice is likely to gain or lose use the online calculator at:- and search for QOF prevalence calculator

© PKF (UK) LLP Assessing financial viability – budgeting and monitoring Practices with better monitoring systems tend to be the more profitable Consider: –Setting financial budgets and targets –Regular review of financial performance –Assignment of monitoring responsibilities Ensure sufficient time allowed for corrective action if required Cashflow and appropriate action

© PKF (UK) LLP Service delivery Mix of work loads Development of partner interests Use of external consultants PCT liaison Business plan Finding the best partner to move forwards

© PKF (UK) LLP Keeping it! Maximising profit per partner Minimising tax and other personal outgoings Don’t miss out on fees you’ve earned Look for tax savings