“Time to evolve into a business” Got to change. Charles Rippin and Turner

Why change: Forced to by Government: IR35, tax becoming digital (from April 2019) Got to address decreasing cashflow: MPIG and Seniority decreasing while costs have increased more than rate of inflation, not to mention employers superannuation (no help from the new contract !) From a personal; point of view, better off financially as a salaried or locum GP without responsibilities Operational concerns, such as staffing, PCSE (capita) Outside threats, such as lack of new GP’s entering the profession and Babylon New rules for NHS Pension and No Goodwill on retirement!

WELCOME TO PRIMARY CARE LADIES AND GENTLEMEN!

Constant theme – We are not businessmen (Never been trained) Some GP’s actually feel uncomfortable in talking about profits Forget about profits and look at the LIABILITY situation Capita (say no more) - have come across practices whereby superannuation deductions still made for salaried GP’s who have actually left (One GP practice owed £210K) CQC alert – NHS provides are being forced to provide financial viability statements (signed off by banks or accountants and will encompass GP practices. WAKE UP QUICKLY !

UNDERSTANDING FINANCE MEANS UNDERSTANDING THE ACCOUNTS! - Do not panic You are paying for these so do not ignore it Its important you know where the figures come from………

PROBLEM IS THAT THE SAME FINANCIAL MODEL HAS NOT CHANGED IN OVER 40 YEARS! Accountants – Do they really understand the system (QOF prevelance) Accountants – See you on a quarterly basis Accountants – Same advice over the last 30 years (Have not moved on) Look at structure of Baylon!

TIME TO TAKE CONTROL Get yourself a BUSINESS MINDED SPECILAIST MEDICAL ACCOUNTANT (you will need support at an early stage) Get a system that you are comfortable with and can track income streams Appreciate that drawings are not the same as profits Understand the concept of PROVISIONS (PCSE have given practices the biggest headache ever!) Appreciate the simple concept that if chase that extra buck you will pay more tax and superannuation unless YOU ADAPT (look at Babylon)

Question – if you could turn the clock back is this really how you would run a business Charles Rippin and Turner

NHS PENSION - Mechanics Ever wondered about the mechanics of the superannuation scheme for partners? Estimate of pensionable profits form – by end of February Deductions shown as payments on account on open exeter statements. Over and under payments via pension certificates and would appear in March open exeter statements Charles Rippin and Turner

NHS PENSION Scheme – Great scheme ……Really?! Good old days 14% employers 6% employee contributions View of pensions – retirement or a top up! Now contributions on a tiered system – more you earn more you pay Pre April 2015 benefits spread over 40 years now 60! Annual allowance tax charge; Lifetime allowance tax charge; Can’t transfer to trust; Live to 111 to use up fund – Use it or Lose it! PCSE and Capita issues Charles Rippin and Turner

Profitability and Cash flow Need to provide breathing space but how: Improve areas under your control – QOF Instead of mad rush for points between January and March, focus on prevalence; Average loss for a practice of 3,500 patients per year is approximately £70K. How to calculate lost prevalence – from CQRS summary. Why does it arise – not coding properly; How and when – through exception reports on EMIS, System 1, Vision Who helps – your accountant on a quarterly basis. Charles Rippin and Turner

THE FUTURE of primary care (Babylon) Babylon – Fulham practice grown from 4,500 patients to well over 26,000! Business model on what patients want – convenience Talk to an app, but not all patients can join. Babylon model relies on registering as many HEALTHY patients as possible, rather than being paid for work actually done! Can’t take on Babylon by yourself (collaboration with other practices) Tax structure – Ltd company hold IT property rights charges NHS Practice

Current set up provides opportunities Partners having a stake in their own building; Building CA’s allowable – between 20% - 30% of cost QOF Prevalence – Coding! Pharmaceutical vending machines Charles Rippin and Turner

Expect more from your accountant Timely honest advice; Really understands the practice; Overall message – Your Practice is a Business!

Thank you for listening Charles Rippin and Turner; Established 1948 in BMA building; Acting for over 200 practices Associate partner of Londonwide LMC; USP – Approachable, knowledgeable Understand your clients needs Contact: 0208 420 0540 Mobile: 07947166544 vijay@charlesrippin.co.uk