2018/19 CONTRACTUAL CHANGES UPDATE

The negotiated changes to the 2018/19 GMS contract have now been published. The financial changes are fairly minimal, as follows: -

1. The global sum increases by 3%, from £85.35 per weighted patient to £87.92 per weighted patient.

2. The out-of-hours deduction from the global sum increases by around 2%, from £4.19922 per weighted patient to £4.281704 per weighted patient.

3. Although additional funding has been allocated to the QOF on a national level and the headline “payment per point” appears to have increased, the real value of QOF points to individual practices will remain practically unchanged, at £22.1418 per point per 1,000 patients (subject to adjustments for disease prevalence).

4. Payments for achieving childhood immunisation targets have been reduced, by 9.634% for 2-year-old immunisation payments and by 1.5625% for 5-year-old immunisation payments.

5. There have been changes to the target groups for vaccinations and immunisations for meningitis, hepatitis B and PCV.

6. Certain payments for vaccinations and immunisations will increase by 2.65%, from £9.80 per vaccination to £10.06 per vaccination. This increase applies to vaccinations for meningitis B, meningitis ACWY, meningitis C completing dose, rotavirus, shingles, hepatitis B, HPV completing dose and MMR for those aged 16 and over.

7. There will be no increase to the payments for seasonal influenza, childhood influenza, pneumonia or pertussis, which will all remain at £9.80 per vaccination; or for PCV, which will remain at £15.02 per vaccination.

8. Seniority payments will decrease by a further 19% for each level of payment. This is part of the programme designed to phase out all seniority payments by 31st March 2020.

9. The amount that may be claimed as reimbursement for sickness and maternity cover will increase by 1% to £1,751.52 per week from the third week onwards. For paternity leave and for the first 2 weeks of maternity leave, the reimbursement will also increase by 1%, to £1,143.06 per week.

10. All GMS practices will receive a payment in respect of transition to the NHS e-Referral Service equal to 17p per patient.

If you would like to discuss the impact on your practice finances of any of the above issues, please contact Andrew Goddard by telephone on 01704 215450 or by e-mail to andrew@forshaws.org.uk.

Spring Budget Statement 2018

Please click here our summary of the key contents from the Spring Statement 2018.

After two full Budgets in 2017, this Spring Statement was a less dramatic affair, with no announcements of tax changes. These will come in the Autumn Budget.

The Chancellor launched a number of consultations and other papers about future proposals. The subjects ranged from ways to squeeze more tax from international digital businesses to a proposal for extending entrepreneurs’ relief to some shareholders whose holdings drop below the qualifying 5% level. He has also been mulling the possibility of lowering the VAT threshold.

Our summary includes a useful recap of the key changes for the forthcoming 2018/19 tax year that have already been announced and passed into law.

April will see the usual changes to the income tax rates and allowances as well as national insurance contributions. This year there will also be a cut in the dividend allowance and some special new tax rates for Scottish taxpayers. The tax increases on company cars may look relatively modest, but their cumulative impact could be significant for some people.

Many employees will see the extra net income from the tax changes eaten up by their higher minimum auto-enrolment pension contributions. The lifetime allowance for pensions has been raised. Less welcome for some will be the changes to employee termination payments and the new rules for enterprise investment schemes.

If you have any questions about how the Spring Statement affects you, please get in touch.

Spring 2017 Budget

Click HERE for your copy of our summary of the key announcements in the Chancellor’s 2017 Spring Budget statement. We hope you find it useful and interesting.

Chancellor Philip Hammond’s first, and last, Spring Budget was delivered at a pivotal moment for the UK as it readies itself to begin the process of leaving the EU. The Chancellor will announce a second Budget in the autumn as the Treasury changes to the new financial cycle from 2018. However, his first offering of 2017 contained several significant measures:

  • The dividend allowance will be cut from £5,000 to £2,000 from April 2018.
  • Self-employed workers will see their Class 4 national insurance contributions (NICs) increase by 1% to 10% in April 2018, with a further percentage point rise to 11% from April 2019. The government had previously announced that Class 2 NICs will be abolished from April 2018.
  • The individual savings account (ISA) allowance will rise to £20,000 in April 2017 as previously announced.
  • The Chancellor confirmed the launch of a new NS&I investment bond from April 2017 that will pay a 2.2% rate over a three-year term on deposits of up to £3,000.

If you have any questions about the summary’s contents or how any aspects of your tax and financial planning may be affected by the Budget, please get in touch with us to discuss them.

2017/18 CONTRACTUAL CHANGES UPDATE

The negotiated changes to the 2017/18 GMS contract have now been published. The changes proposed are as follows :-

 1.       The global sum increase is intended to cover increasing practice expenses and deliver a 1% pay uplift. This will include :-

a.       £58.9 million added to contract funding to cover the estimated cost of increased population growth;

b.       £3.8 million added to contract funding to recognise increased superannuation costs of 0.08% from April 2017.

c.       £2.0 million added to contract funding to recognise the increased workload resulting from the requirement to bag and label patient records.

d.       £1.5 million added to contract funding to recognise the increased workload resulting from the workforce census, completion of which will become a contractual requirement.

 2.       The Avoiding Unplanned Admissions DES will be discontinued on 31 March 2017. The funding currently attached to that service (£156.7 million) will be added to the global sum.

 The DES will be replaced by a contractual requirement for practices to focus on the management of patients with severe frailty. Details of the work that will be required have been published by the GPC.

 3.       From 2017/18 CQC fees will be reimbursed to practices in full on submission of paid invoices to NHS England or their CCG (under delegated commissioning).

4.       £30 million is to be paid to practices to cover increases in medical defence fees for GMS work. This will be paid to practices on the basis of actual (not weighted) lists. The GPC has stated that “GP principals must ensure that the appropriate amount of funding reaches their salaried GP colleagues” and that locum GPs may need to increase their rates to take account of this.

 5.       Payments under the Learning Disabilities DES will increase from £116 to £140 per health check.

 6.       From October 2017 new conditions will be introduced into the Extended Hours DES which will mean that practices which close for a half day each week will no longer qualify to deliver the DES.

 7.       There will be changes to the target groups in respect of seasonal influenza, childhood seasonal influenza, shingles, meningitis and pertussis vaccinations.

 8.       Sickness cover reimbursement will cease to be discretionary and will become an entitlement. The qualifying criteria based on list size will also be removed and existing GPs within the practice will be able to provide the sickness cover (as is already the case for maternity cover). The amount payable for sickness cover will increase to £1,734.18 per week from the third week onwards.

 9.       Maternity cover reimbursement will no longer be subject to a pro-rata application.

 10.   The GPC and NHS Employers have now agreed contractual changes that will help to identify patients with a non-UK issued EHIC or S1 form by means of a self-declaration form. New recurrent investment of £5 million will be added to global sums to support the associated administrative workload.

 11.   From July 2017 all practices will be contractually required to allow collection of data relating to the National Diabetes Audit and to a selection of agreed indicators no longer in QOF and retired enhanced services.

If you would like to discuss the impact on your practice finances of any of the above issues, please contact Andrew Goddard by telephone on 01704 215450 or by e-mail to andrew@forshaws.org.uk.

 

Forshaws Spring Seminar March 2017

We are delighted to announce that we shall be holding our Annual Spring Seminar at the Ramada Hotel, Southport, on Tuesday 14th March 2017. Click HERE for your invitation.

Please ring Anne Nightingale on 01704 215450 to book your place. We look forward to seeing you and we hope that you will find our Seminar to be enjoyable and informative.

FORSHAWS SPRING SEMINAR MARCH 2016

We are delighted to announce that we shall be holding our Annual Spring Seminar at the Ramada Hotel, Southport, on Tuesday 22nd March 2016. Click HERE for your invitation.

Please ring Hugo Castle on 01704 215450 to book your place. We look forward to seeing you and we hope that you will find our Seminar to be enjoyable and informative.

Budget July 2015

We have pleasure in attaching our summary of the key announcements in the Chancellor’s 2015 Summer Budget statement, which can be found by clicking here. We hope you find it useful and interesting. 

Following the Conservative victory in the general election, the new government announced shortly after that there would be a second Budget in July – and here we are.

Some of George Osborne’s most significant announcements included:

  • Dividend tax credit will be abolished from April 2016 and there will be a new dividend tax allowance of £5,000 a year. In addition, there will be new dividend taxes.
  • Private landlords’ wear and tear allowance will be replaced in April 2016 with a deduction for the actual cost of replacing furnishings.
  • The NIC employment allowance of £2,000 will rise to £3,000 from April 2016, but will not be available for single director/employee companies.
  • Non-UK domiciled individuals who have been resident in the UK for at least 15 of the last 20 years will be treated as UK domiciled for tax, including inheritance tax, from April 2017.
  • The government will be consulting on radical reform of the system of tax relief for pensions.
  • The introduction of the secondary market in pension annuities has been postponed until 2017.

If you have any questions about the summary’s contents or how any aspects of your tax and financial planning may be affected by the Budget, please get in touch with us to discuss them. 

AISMA Doctor Newsline Spring 2015

The Association of Independent Specialist Medical Accountants Spring 2015 Newsletter is here and available for download here.  If you would like to be included on our email list to automatically receive the AISMA newsletter every quarter plus regular updates from the Forshaws specialist team, please contact info@forshaws.org.uk

Budget Summary 2015

We have pleasure in attaching our summary of the key announcements in the Chancellor’s 2015 Budget statement which can be found here. We hope you will find it useful and interesting.

 The imminent election formed the backdrop to Budget 2015. Many of the proposals will not take effect until later in 2015/16 or the following tax years. If there is a change of government, some of them won’t survive.

 Among the measures to hit the headlines were:

 · Help for savers. The new personal savings allowance will be worth up to £200 a year for people with savings income – except for 45% taxpayers. The introduction of a tax relief for peer-to-peer lending losses will please those who are in this rapidly expanding market.

· A special new ISA for investors who are first time home buyers and use their savings to purchase a home. The government will top up their savings by up to £3,000 on savings of up to £12,000.

· Good news and bad news for pensions. The lifetime allowance is to be cut yet again; but people will have the freedom to sell their pension annuities if they wish, though whether the protections for such sellers will be adequate is a moot point.

There was a raft of other measures and the usual crop of anti-tax avoidance proposals.

 If you have any questions about the summary’s contents or how any aspects of your tax and financial planning may be affected by the Budget, please get in touch with us to discuss them.

Implications of the 2015 NHS Pension Scheme for GPs and other High Earners

The 2015 NHS pension scheme creates implications for GPs and other high earners who have taken out Enhanced Protection, Fixed Protection 2012 or Fixed Protection 2014. Details of the implications are given in more detail here.

We would advise you to let each GP have a copy of this and if they would like to discuss the implications further, please contact Andrew Goddard or Nick Dolphin on 01704 215450.

If you have employees who may be affected, and require further assistance, they would need to seek independent financial advice.

 

Publication of GP Earnings

The GPC have now issued initial guidance as to how this will work.

For 2013/14, HSCIC will publish details of the gross payments to practices in respect of Global Sums, MPIG, QOF, Enhanced Services etc. These figures may well be misinterpreted by the media and the GPC have advised practices to contact their LMC’s if they need help in this regard.

From 2014/15, Practices will be required to publish on their websites, within one year of the financial year, the number of GPs who have worked at the practice in the year and the mean net earnings of those GPs. This will mean aggregating the figures for partners, salaried GP’s and long-term locums. ‘Net earnings’ means net of partnership expenses but before deducting tax, National Insurance or employee’s superannuation.

One welcome piece of news is that income and costs relating to premises will not be included in the published figure, although the definition of these costs is still unclear.

NHS England are expected to publish guidance on how mean net earnings are to be calculated. It is to be hoped that these guidelines will be published in time for any additional data gathering that may be needed to be done at the same time as the preparation of the 2014/15 accounts.

If you have any queries, please give us a ring on 01704 215450.

PMS Premiums

NHS England’s Area Teams have started sending out letters regarding the review of PMS contracts. Except where local arrangements have already been put in place, these letters include a calculation of each practice’s “PMS Premium” and a request that the practice justify this premium or return to GMS (thereby losing the premium).

The calculation of the “PMS Premium” compares the income that the practice is receiving in 2014/15 with the income that would have been received if the practice has been GMS (based on the weighted list at 01/1/14).

It is important to check that the information shown on this calculation is correct, i.e.:-

•    Weighted list as at 1/1/14
•    PMS funding for 2014/15
•    Basis for the childhood immunisations figure used in the calculation of the theoretical GMS income
•    Basis for any additional services opt-outs shown in the calculation of the theoretical GMS income

Care should also be taken that the appropriate adjustments are made in respect of items of GMS income that may still be included in PMS income in certain contracts but have been unpicked elsewhere (e.g. premises funding, rates reimbursements or the dispensing fees element of PPA claims).

There are also 2 errors in the calculation of the theoretical GMS income that Area Teams are using, which we would advise you to challenge in all cases:-

a)    No account is being taken of the temporary patients adjustment that is paid to GMS practices
b)    The out of hours opt-out adjustment used by Area Teams is £4.02 per weighted patient whereas the true figure would be 5.46% of the Global Sum, i.e. £4.0163. Although this is a relatively small rounding error, it translates as £7 per 2,000 weighted patients and therefore should be challenged.

If you require assistance with checking the calculation of your “PMS Premium”, please e-mail the figures to us.

 

New payments for GPs

New payments will be made to GPs from 5 January 2015 under the out of area registration: in hours urgent primary medical care (including home visits) enhanced service.

Every consultation at the practice (excluding home visits but may include telephone/skype consultations.) is £15.87 per GP (or other healthcare professional as appropriate).

There will be £60 for a home visit.

This enhanced service has been designed by NHS England to support the new out of area patient registration arrangements to extend choice of GP practice.

It seeks to secure access to local GP practices for patients living in the practice area but who are registered with a practice away from home without access to home visits.

All GP practices will be able to register new patients who live outside their practice area without any obligation to provide home visits when the patient is at home, away from, and unable to attend, their registered practice.

NHS England said where GP practices do not wish to participate in this enhanced service then area teams are free to offer the service to neighbouring practices: ‘In those circumstances the national pricing does not apply and is to be agreed locally.’

The enhanced service is intended for use during the period 5 January 2015 to 31 March 2016.

Practices eligible to provide this enhanced service must currently maintain an open list status.

Existing GP health centres, walk-in centres or minor injuries units that already have unregistered patient services included in their current service contract are excluded.

If you would like to discuss this further please contact Andrew Goddard on 01704 215450.

Managing Changes in the Practice Partnership

The Association of Independent Specialist Medical Accountants guide to Managing Changes in the Practice Partnership is here and available for download here.  If you would like to be included on our email list to automatically receive the AISMA newsletter every quarter plus regular updates from the Forshaws specialist team, please contact info@forshaws.org.uk

If you have any queries, please contact Andrew Goddard on 01704 215450.

Revision to GP contracts 2015/16

Changes to the GMS contract in England for 2015/16 were announced on 30 September 2014. The main points were as follows :-

Details of the 2015/16 uplift to the GMS contract are not yet available as the Government’s decision will be made following recommendations from the Doctors and Dentists Pay Review Body in February 2015.

  • From 1 April 2015, there will be a new contractual requirement for practices who have not opted out of providing out of hours care to ensure that they provide information to the CCG (to be set out by the CCG) to allow the CCG to ensure that they are delivering out of hours care in line with the National Quality Requirements.
  • There will be no reduction in the size of QOF in 2015/16 as the impact of last year’s changes remain to be evaluated. The planned changes in thresholds in QOF from April 2015 will be deferred for a further year. The QOF point value in 2015/16 will be adjusted to take account of population growth and relative changes in practice list size for one year from 1 January 2014.
  • The avoiding unplanned admissions (AUA) enhanced service will be extended for a further year from 1 April 2015, with changes including revisions to the reporting process and changes to the payment structure. 
  • The patient participation enhanced service will end and associated funding will be reinvested into global sum. From 1 April 2015, it will be a contractual requirement for all practices to have a patient participation group (PPG) and to make reasonable efforts for this to be representative of the practice population. 
  • The alcohol enhanced service will end and associated funding will be reinvested into global sum. From 1 April 2015 it will be a contractual requirement for all practices to identify newly registered patients aged 16 or over who are drinking alcohol at increased or higher risk levels.
  • The extended hours and learning disabilities enhanced services will be extended and unchanged for a further year. 
  • GPC and NHS Employers will work with NHS England to establish a consistent set of standards which commissioners (area teams or CCGs on their behalf) will apply for the provision of enhanced minor surgery services.
  • All practices will be entitled to reimbursement of the actual cost of GP locum cover for maternity/ paternity/ adoption leave of £1,113.74 for the first two weeks and £1,734.18 thereafter (or the actual costs, whichever is the lower). Such reimbursement is intended to cover both external locums and cover provided by existing GPs within the practice who do not already work full time.
  • There will be a new contractual requirement for GP practices to publish the mean net earnings of GPs in their practice (to include contractor and salaried GPs) relating to 2014/15 financial year on their practice websites by 31 March 2016. Alongside the mean figure, practices will publish the number of full and part time GPs associated with the published figure. The figure will include earnings from NHS England, CCGs and local authorities for the provision of GP services that relate to the contract and which would have previously been commissioned by PCTs. Costs relating to premises will not be included. This is an interim solution until arrangements are finalised for publishing individual GP net earnings in 2016/17.
  • A named, accountable GP for all patients (including children) who will take lead responsibility for the co-ordination of all appropriate services required under the contract. 
  • Further commitment to expand and improve the provision of online services for patients, including extending online access to medical records and the availability of online appointments. 
  • Changes to registration regulations will allow for armed forces personnel to be registered with a GP practice. 
  • NHS England and GPC will work together on workforce issues including the retainer /returner scheme, the flexible careers scheme, and recruitment problems in specific areas. 
  • GPC, NHS Employers and NHS England will have a broader strategic discussion about the primary care estate, especially to support the transfer of care into a community setting. 
  • NHS England and GPC will re-examine the Carr-Hill formula with the aim of adapting the formula to better reflect deprivation. 
  • No out of hours deduction will apply to funding moving from the MPIG correction factor or enhanced services into the global sum.

 The PMS agreements review was also published in 30 September 2014. The main points were as follows :-

  •  In January 2014, area teams were asked to review local PMS agreements over a two-year period ending in March 2016.
  •  Area teams were previously asked to make local decisions on the pace of change for any redeployment of funding arising from PMS reviews. Without prejudice to agreements that have already been reached with practices, but in the interests of greater consistency for future decisions, area teams should – unless there are compelling reasons otherwise – redeploy any freed-up resources over a minimum four year period (year one being 2014/15).
  •   Any resources freed up from PMS reviews should always be reinvested in general practice services (including, as appropriate, general practice premises developments).
  •  Except with the agreement of all the CCGs involved, PMS resources should not be redeployed outside the current CCG locality (i.e. the CCG of which the PMS practice is a member).
  • Area teams should ensure, wherever possible, that any decisions relating to future use of PMS funding are agreed jointly with CCGs as part of anticipated co-commissioning arrangements.
  • Area teams should ensure that there is a case-by-case review of all affected practices to ensure that they are not serving special populations that merit continued additional funding and that they would not be unfairly disadvantaged by the changes.
  • Any proposals to reduce current levels of PMS funding for any practices should reflect decisions on how the money freed up will be redeployed, including proposals for reinvestment of resources from area team or CCGs to support local improvement and innovation in primary care. This is to ensure that changes to practice funding reflect the overall net impact of any change, and practices don’t have to manage a reduction of funding, before subsequent reinvestment.
  • Where changes to services are proposed which result in different services being available to patients, there is a need to engage with patients and/or patient representative groups, to ensure NHS England complies with its various duties to consider the impact of its decisions on patients. The degree to which area teams should engage depends on the proposal being considered and what is safe and practical within the time and resources available.
  • Where, as a result of PMS reviews, practices are likely to move towards levels of funding equivalent to GMS funding, area teams should consider the potential benefits of practices nonetheless having the option of remaining on PMS agreements as a way of preserving future flexibility.
  • These principles will not apply retrospectively where agreements between area teams and practices have already been made.