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

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.

AISMA Doctor Newsline Summer 2014

The Association of Independent Specialist Medical Accountants Summer 2014 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

Annual Spring Seminar Series

Last week, Forshaws celebrated the end of another very busy year with their Annual Spring Seminar, with this year's focus on 'Changes in the 2014 Contact and Pension Changes'. GPs gathered from across the North West to listen to keynote presentations from partners Michael Solomon and Andrew Goddard, and the evening concluded with a lively Question and Answer session. For further information on topics covered, contact Andrew Goddard at Forshaws directly on 01704 215450.

Forshaws Spring Seminars April 2014

We are delighted to announce that we will be hosting two seminars in April 2014, providing an in-depth analysis of the 2014 Contract and Pension Changes.

Our seminars will be based at the Ramada Hotel, Southport, on 1st April 2014 and Preston Post Graduate Education Centre, Royal Preston Hospital, on 8th April 2014.

Please click here for our invitation, and contact details to book your place at either or both seminars.

We look forward to seeing you, and hope that you will find the event to be an enjoyable and informative experience.

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Breaking News

Technical Partner, Andrew Goddard, has been invited to address a meeting of practice managers in Liverpool on 15th January 2014. The presentation will cover the implications to GP practices of the automatic enrolment process for staff pensions.


Details of the revision to G.P contract for 2014/15 have now been released and these are summarized below:-

Publications of GP earnings
All practices will publish GP NHS net earnings in 2015.


341 points from QOF will be retired in England.

NHS Employers said of these, 238 points will be reinvested into core GP funding.

The remaining 103 points will be reinvested elsewhere in the contract with 100 points used to fund the new Enhanced Service for Avoiding Unplanned Admissions and Proactive Case Management and 3 points to fund improvements to the Learning Disabilities ES.  

Planned changes in QOF thresholds from April 2014 will be deferred for one year.

Enhanced Service – avoiding unplanned admissions and proactive case management. 

The introduction of a new ES, for one year, aims to improve services for patients with complex health and care needs, who may be at high risk of unplanned admission to hospital, In particular, to:

•    Provide timely telephone access, via ex-directory or bypass number, to relevant providers to support decisions relating to hospital transfers or admissions, in order to reduce avoidable hospital admissions or A&E attendances.

•    Case manage vulnerable patients (both these with physical and mental health conditions) proactively through developing, sharing and regularly reviewing personalised care plans, including identifying a name accountable GP and care coordinator.

•    Improve access to telephone or, where required, consultation appointments for patients identified in this service. 

•    Review and improve the discharge process, sharing relevant information and whole system commissioning action points to help inform commissioning decisions.  
•    Undertake internal reviews of unplanned admissions/readmissions.

The ES will be funded using the funding from the QP scheme in QOF (100 points) and the funding from the discontinued Risk Profiling Enhanced Service (£42m).


Seniority payments will cease on 31st March 2020.

In the meantime, those in receipt of payments on 31st March 2014 will continue to receive payments and progress as currently, but there will be no new entrants from 1st April 2014.

It is intended that there will be a 15% reduction in spend each year. Any money released will be reinvested in core funding. 

Named GP for patients aged 75 and over

As part of the commitment to more personalised care for more patients with long term conditions all patients aged 75 and over will have a named accountable GP. 

Quality of out of hours services 

GP practices who have opted out of Out of Hours services will have to monitor the quality of those services and report any concerns they may have. 

Friends and Family Test 

It will be contractual requirement for practices to undertake the Friends and Family Test from December 2014.

Choice of GP Practice

From October 2014, all GP patients will be able to register patients from outside their traditional practice boundary areas without any obligation to provide home visits for such patients. NHS England will be responsible for arranging in-hours urgent medical care when needed or near home patients who register with a practice away from home. 

Patients needing access to a practice clinician after assessment

Where a patient has been assessed as needing contact with a practice clinician, the practice will ensure that when the patients contacts the practice, a practice clinician will agree appropriate next steps having regard to the patient’s condition and circumstances. 

CQC Inspections 

When the CQC’s new inspection arrangements are introduced, practices will be required to display the inspection outcome in their waiting room(s) and on the practice website. 

Patients and information 

During 2014/15 all practices will:

•    Use the NHS number in all clinical correspondence 

•    Provide the ability for all patients to book appointments online 

•    Allow all patients to order repeat prescriptions online

•    Update the Summary Care Record daily 

•    Transfer patient records using GP2GP facility 

•    Allow patients to access online the data continued in their Summary Care Record

Enhanced Services 

•    The Patient Participation scheme will continue for another year with the requirement to carry out a local survey removed due to the introduction of the Friends and Family Test.

•    The Extended Hours Access scheme is extended for another year with a number of flexibilities included to allow practices to work together to provide the most appropriate service for their patients.

•    The Dementia, Alcohol and Learning Disabilities schemes will be extended for a further year with some changes made. 

It has been agreed that the Patient Online (£24m) and Remote Care monitoring (£12m) ES will cease on 31st March 2014 and the associated funding reinvested into core funding. 

GP pay and expenses

The GPC and NHS England will separately submit evidence to the Doctor’s and Dentist’s Review Body (DDRB) in relation to the 2014-15 uplift to the GMS Contract.

If you would like to discuss any of the points raised above, please contact our team on 01704 215450.

VAT and Health Centre Rents

As you may be aware, following the abolition of Primary Care Trusts, with effect from 1st April 2013 responsibility for the administration of LIFT buildings occupied by GP practices passed to Community Health Partnerships Limited (“CHP”), a company owned by the Department of Health.

Where CHP has issued demands for rent or service charges to GP practices, they have added VAT to the amounts that were previously charged without VAT by PCTs.

CHP originally claimed that the addition of VAT was a consequence of the properties having been transferred into a separate company. This is not the case, as VAT is only applicable to commercial rents if the landlord chooses to elect to make it so. CHP have now issued a “Statement on Value Added Tax for General Practice Tenants”, in which they acknowledge that the addition of VAT is a consequence of CHP having chosen to “opt to tax” the properties in question. The Statement claims that CHP’s reason for doing so was to avoid “a very significant unrecoverable tax bill for the NHS”.

The consequences of the option to tax exercised by CHP will depend on the terms of the lease. It is our understanding of the law that, unless the lease specifically states that the rent and other charges stated therein are inclusive of VAT where applicable, the tenant is required to pay the VAT resulting from an option to tax in addition to the rent and other charges. In respect of GP practices, the effects will be as follows :-


VAT will be added to the rent. Where the practice pays this amount, the cost will therefore increase by 20%. In the case of GMS practices, NHS England should increase the amount that is reimbursed to the practice to cover this cost; GMS practices in this position should contact their Local Area Team to confirm the arrangements for this increase in reimbursements.

For PMS practices, the situation is not so clear, as PMS baselines are often inclusive of premises funding. Where premises funding is separate to the baseline, the practice will be in the same position as GMS practices (see above). However, where the baseline is inclusive of premises funding, NHS England may take a hard line and refuse to increase funding to reflect the VAT on the rent; PMS practices in this position should in the first instance contact their Local Area Team in order to ascertain whether additional funding will be forthcoming.


In many cases, the landlord insures the property and passes on the cost to the tenants (i.e. to GP practices). Technically, this recharge is not a charge for insurance (as the landlord is not insuring the tenants, just passing on the cost) but an additional payment under the lease. Consequently, VAT will be added to the insurance charge. The cost will therefore increase by 20%.

Rates and water charges

If the landlord is liable to pay the rates or water charges and then recharges the tenants, VAT will be added in the same way as for insurance. Recovery of the VAT on the rates or water charges will then be subject to the same considerations as recovery of VAT on the rent (see above). If full reimbursement is not possible, it may be more beneficial to arrange for the Local Authority or water company to assess and bill each tenant individually for rates or charges, as a direct charge to the tenant will not be subject to VAT.

Service charges

The impact on service charges is a little more complex. The landlord will be able to recover any VAT charged by its supplier but will apply VAT at 20% to the amount that it charges the practice. Where the landlord is paying the full rate of VAT (e.g. to contract cleaners or pest control companies), the net cost to the tenant will not increase. However, where the landlord is paying the reduced rate of 5% (e.g. for heat and light) or no VAT at all (e.g. payments to cleaners employed directly), the net cost to the tenant will increase.

Dispensing practices

For dispensing practices, which will be registered for VAT, some or all of the additional VAT charge will be recoverable, dependant on the partial exemption fraction.

Should you require further advice in respect of the above and the impact on your practice, please contact Andrew Goddard on 01704 215450.

AISMA Doctor Newsline Summer 2013

The Association of Independent Specialist Medical Accountants Summer 2013 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


  • Are you struggling with Real Time Information?
  • Is it taking up more time than you anticipated?
  • Are you daunted by the auto-enrolment introduced by the government for workplace pensions?

If YES; and you would like any help or advice on Real Time Information or Auto-enrolment or if you would like us to take over your payroll please contact Andrew Goddard or Laura Johns


Childcare Vouchers And Salary Sacrifice

It has become common for employees with children in nurseries to request that they receive some of their salary in the form of childcare vouchers, so as to save Tax and National Insurance. This is usually done by way of the employee making a salary sacrifice.

The employer saves Employer’s National Insurance but incurs administration charges, so the exercise is usually roughly cost-neutral for the employer and is done to help the employee.

It has come to our attention, however that schemes of this nature can be costly to the employer where the employee subsequently takes a period of maternity leave that is either unpaid or paid only at the SMP rate. The vouchers cannot be withdrawn at this stage because they represent a benefit in kind and withdrawal of a benefit during maternity leave would be regarded as discrimination. However, a salary sacrifice cannot be applied to nil pay or SMP. The employer would therefore end up bearing the full cost of the childcare vouchers for the period of maternity leave. The situation in respect of contractual maternity pay would depend on the exact wording of the contract.

Due to the above, all employers should consider the potential cost very carefully before making a childcare voucher scheme available.

If a scheme is already in place, consideration should be given to withdrawing it. However, legal advice should be taken before withdrawing the scheme, particularly where vouchers are currently being provided to one or more employees, in order to avoid breaching employment law.

Financial Training for Registrars.

Forshaws are pleased to offer Tailored Training Sessions for Registrars in the North West, offering advice on understanding accounting in a medical setting, with a focus on personal tax. We believe that this is an important introduction to the financial aspects of general practice, for which they would otherwise receive no formal training. Course organisers who may be interested in arranging sessions should contact us by e-mail to or by telephone to 01704 215450.

Forshaws Spring Seminar Series

Over 200 GPs attended Forshaws Spring Seminar Series at locations across Merseyside and Lancashire, benefiting from valuable presentations on Pensions, Maximising Profit and Use of Limited Companies to Minimise Tax, followed by Extended Question and Answer Sessions with our Expert Medical Team.

Community Infrastructure Levy

For many years, property developments have potentially been subject to two taxes levied by local authorities as part of the planning process – Planning Application fees and Building Regulations fees.

Since 2010, local authorities have been allowed to charge a third tax, the Community Infrastructure Levy, on new property developments and extensions in excess of 100 square metres.

It has been left up to each local authority to decide whether to introduce a Community Infrastructure Levy, the type of property to which it will apply and the rate to be charged.  Details are expected to be announced over the course of 2013.

Due to the discretion given to local authorities, the rates of Community Infrastructure Levy may vary substantially from place to place.

A window of opportunity exists in those areas where the Levy has not yet been introduced to avoid liability if planning permission can be obtained before the levy comes into effect.

Four New DES for 2013/14


Target - Identify patients at risk of dementia, offer cognitive checks, refer to memory services, offer health checks for carers.

Payment - 37p per patient as upfront payment (£2,587 for average practice), then a share of £21m national pot, averaging £3,367 dependent on number of checks carried out.

Risk profiling and care management

Target - Scan lists each quarter for patients at risk of emergency admissions, develop case management plans to reduce risk.

Payment - 74p per registered patient (£5,175 for average practice).

Remote care monitoring

Target - Select a long-term condition and plan to introduce a remote monitoring service in April 2014.

Payment - 21p per patient (£1,478 for average practice).

Improve patient online access

Target - Introduce electronic booking of appointments and repeat ordering.

Payment - 28p per patient (£1,970 for average practice), plus flat rate of £985.

Total earnings     £15,562

Next Seminar - Preston - 23rd April BOOK NOW!

Focus on Pensions

  1. What do the changes in the NHS contract mean for you?  Profit, Cash Flow & Drawings
  2. The latest changes to NHS pensions & the impact for you
  3. Tax implications of the changes in the Pension Annual Allowance & the Lifetime Allowance
  4. Are Limited Companies the way forward? 


Tuesday 23rd April, 2013


6pm    Buffet supper

7pm    Seminar – with 8.30pm finish


Michael Solomon, FCA & Andrew Goddard, ACA

Plus Tax Surgery with Nick Dolphin, Tax Manager


Preston Post Graduate Education Centre, Royal Preston Hospital, Sharoe Green Lane, Preston PR2 9HT

Who should attend?   

GPs, salaried doctors & locums.  Practice Managers welcome too

Cost  FREE

Booking a place Reserve your place now – call Tom Baybutt on 01704 215450 or email:

Upcoming Seminars - Watch this space

Following the huge success of last week's Spring Seminar 'Real Practice Problems' in Southport, the Forshaws team have been invited to repeat the programme in Preston, Liverpool and Doncaster.  

Dates and times to follow shortly.   Please email for advance booking details.