Practice Finance September 2018

1. Practice FinanceSeptember 2018 Sarah Fox

2. It is all in the abbreviations • GMS • PMS • PCO • PCN • APMS • QOF • QEF • QI • DES • LES • AFC • BMA • CCG • CQC • GMC • PPG • SCR • MIU • 5YFW

3. Kings fund • https://youtu.be/DEARD4I3xtE

4. Contract types • GMS nationally negotiated • PMS (potentially) locally negotiated (slightly higher earners due to historic funding arrangements) • APMS - allow PCOs to contract with non-NHS bodies, such as voluntary or commercial sector providers, (or with GMS/PMS practices) – e.g Virgin

5. How do we get paid? • Core general practice (essential services) • Additional services • Enhanced Services • QOF including QI • QEF – funding from the CCG • Reimbursements

6. Essential Services MANDATORY – common to all practices Paid as GLOBAL SUM “The management of patients who are ill or who believe themselves to be ill, with conditions from which recovery is generally expected, for the duration of that condition, including relevant health promotion advice and referral as appropriate, reflecting patient choice wherever practicable” “The general management of patients who are terminally ill” “Management of chronic disease in the manner determined by the practice, in discussion with the patient”

7. Additional Services Normally expected of practices, but in theory can opt-out • Cervical cytology • Child health surveillance • Maternity Services • Contraception services

8. Enhanced Services • Directed Enhanced Services • Local Enhanced Services

9. Direct Enhanced Services • National Specifications • No one practice has to do To include: • Childhood vaccinations • Flu/pneumovax • Extended hours • Learning disabilities • PCN

10. Local Enhanced Services • OPT-IN – respond to specific local requirements. • Local terms, conditions and standards • Possibly, innovative services for piloting and evaluation

11. QOF Points/£ reallocated over the years

12. QOF

13. QOF - QI • 2 new Quality indictor standards in 2019/20 • End of life • Looks at improving the quality of end of life care from beginning to end, including follow ups with family/carers • Prescribing • Looks at improving the quality of prescribing and monitoring

14. QEF • Agreement for additional payment from the CCG • Localised to each CCG • CCG can set the requirements and the amount attached • Practices can decide how they achieve the requirements • Engagement • Prescribing • Target on conditions e.g. asthma, dementia • Cost savings e.g. referrals

15. Reimbursements • Rent – paid notional rent for use (owned) or cost rent based on valuation by district valuer (leased) • 100% business and water rates. • Personal administered drugs and dressings • Computer hardware (supplied by CCG)

16. Other income streams Teaching and training (GP registrars, medical students) NHS related work (GPwSI, CCG) Private income (reports, medicals, private travel, TWIMC letters, cremation fees) Research

17. Expenditure – Discussion Point What costs are involved in the running of a GP surgery?

18. Expenditure How is expenditure broken down? • Ancillary staff wages (reception, secretary, etc) • Brought in GP costs (locums) • Medical sundries and clinical waste • Depreciation • Finance • Medical sundries and clinical • Out of hours opt out costs • Premises running costs • Professional expenses • Administration costs • Other expenses • Other staff costs

19. Expenditure

20. PCN – Primary Care Network • Part of the long-term plan for General Practices • Practices working together to provide care • To solve the issue of access • To solve the recruitment crisis • Funding to employ staff • Pharmacist – year one • Social prescriber – year one • Paramedic – year 2 • Physiotherapist – year 3 • Significant other – year 4

21. Discussion point • Pro’s and con’s of working at scale • Patient care • Management Is bigger always better?