1. Show me the money! Dr Elliot Singer & Julie Freeman
No magic wand!
Don’t lose it – track it and preserve it
Wherever possible increase it!
We make no promises!!

2. Format of todays session
Overview
Where does the money come from?
Am I getting what I should get?
Current problems & solutions
Income
Retaining and maximising income
Discussions and Q&A

3. Where does the money come from?
NHS Budget 2014/15
£96.48bn
Tackled in the RCGP Compendium of Evidence 2012

4. Additional Funds
Add in available and real term growth, surplus drawdown, surplus carried forward, winter pressure (non-recurrent) and annually managed expenditure/technical, the total funding is;
£98.42bn

5. Money Trail £96.48bn Primary Care £12.02bn (12.46%)
Primary Care (other Budgets) £0.28bn
Primary Dental Services £2.7bn
Community Pharmacy Services £2.0bn
Primary Ophthalmic Services £0.5bn
Primary care IT services £0.2bn
Primary Medical Services £6.4bn (6.63%)

6. The London Picture Total Primary Care Budget London 2014/15
£ bn
Approximate Primary Medical Services London Allocation
£ bn
This funding supports a population of 8.17 million patients (2011 consensus) and 1537 GP Practices.

7. Do not pass go, do not collect £200…
GMS Contracts
Loss of MPIG
PMS Contracts
Review to be completed by 31/3/16
Core funding equivalent to GMS
PMS premium services/KPIs available to all practices
Money will be re-invested in primary care within the locality (does not mean GP)

8. Any Good News?
General election coming up, politicians can’t allow General Practice to collapse
Autumn budget announcement Dec14 regarding investment in the NHS
£2bn/year for frontline services (£700m already previously announced)
£1bn from banking fines to be spent over next 4yrs to improve GP and relieve some pressures on hospital services.

9. Any other sources? PM Challenge
CCGs – new investment for services delivered in primary care
Public Health – reviewing enhanced services may offer higher rates or new services
Federations – may win bids so may offer work and remuneration to practices
New Primary Care Investment Fund - Premises
Of course the converse can be true as well:
More work can be included. Less money attached, more KPIs and more constraints for the same or less £
Decommissioning of services
Procurement tenders go to other providers
TIP – When offered, check out the details- how much will it cost you to deliver and how much will you earn?.....

10. Discussion 1
Has your practice considered the implications of reduction to GMS/PMS budgets?
Are you working with your accountants to develop a contingency plan of how you are going to manage this reduction in income?

11. Am I getting what I should get?
Problematic since NHSEL took over from PCTs
Several payment streams:
NHSEL ( Flu & Imms)
CCG PH
New National Remittance Advice
CQRS - IMPORTANT
This was when the problems really started occurring
Instead of one payee there are now a minimum of three
Even at NHSEL – the vacs and imms payments take a different route to other payments
No one consulted on the new remittance advice style and arguably no one tested it before its release
There is no way changes can be made to a National system
CCG payments are often very unclear and not listed on Open Exeter ( in the separate payments item)
An area to try and improve on!
CQRS – Frequent changes to what it will automatically extract - PMs need to be mindful of these
LwLMCs needs to see if it can create a way of staying abreast and communicating to practices

12. Problems: Impact on cash flow waiting for payments
Additional accountancy costs
Poor communications – could tell practices when payments are ‘likely’ to be made
KPIs are different in every borough; causes confusion and delays
KPIs based on averages; often delayed because all returns need to be in before the average can be calculated
Payments made on a pro rata basis before analysis can cause unforeseen claw backs and are difficult to track
Monthly data showing the percentage of suppliers paid within 5 days of the Department of Health receiving an invoice. Average 97/98%!
Government departments aim to pay all valid invoices within 5 working days of receipt.
NHS?

13. NHSE Payment steps
Automatic payments made by NHSE and / or Practices submit their claims
NHSEL assign code, authorise the payment and sent to
FHS providers (PCSS/ SBS) who process the payment
Payment date appears on Open Exeter
Money ££ appears in the bank with the date of when the actual payment has been made NB
Advise to wait a few days before trying to reconcile payments
the financial process will not change even under co-commissioning

14. Solutions: Influence the way the remittance advice is used
Understand the Coding used
Organise and track the payments due
Know who to contact where
Direct your queries to the right organisation
Use our generic to log issues:
Lw LMCs taking practice feedback to try and effect change Finance working group/ add.
RESOURCE PACK
Links to a coding glossary
Link to GP payments schedule
Practice manager organiser (Practice Payments Tracker) for practice specific payments
Finance contact list across London (NHSEL) – assigned finance personnel per borough
CCG /PH contacts need to be obtained locally – sector teams
Contact SBS - phone – see our guide 2

15. Maximising Profits / Minimising Expenditure
Loss
Profit
Expenses
Staff
Practice
Income
Contract value
Additional Services

16. Maximising Income What Can Practices do? GP Resilience Guide
Complete the financial guide template
Review the skill mix in practices
Consider additional sources of income and whether or not these are cost effective
Consider sharing some expenses with other local like minded practices (Federate?)

17. What Financial Planning?
Discussion points to consider
What financial planning occurs in your practice?
Who is responsible for this?
What income/expenditure reviews have been undertaken in past 12 months?

18. Due Diligence Basic business principle
an investigation of a business or person prior to signing a contract, or an act with a certain standard of care. It can be a legal obligation, but the term will more commonly apply to voluntary investigations.
SWOT analysis (strengths, weakness, opportunity, threat)
Part of this will include a financial analysis
In essence how much will it cost the practice to run/offer this service, what remuneration is the practice receiving for this.

19. Minimising Expenditure
REVIEW,
REVIEW

20. Practice Financial Analysis Template
Developed by Londonwide LMCs
Available on website
Aim is to undertake a relatively simple analysis of the practice financial situation and to consider methods of minimising expenditure and maximising income.

21. Questions from the floor
What’s been most / least useful today ?

22. Julie Freeman Director of Primary Care Strategy South sector London Julie.Freeman@lmc.org.uk
Elliott Singer
Medical Director
NE London & GP Support