Family Doctors Conference September 2014 GP Finance Update Richard Apps, ACA Head of Northern Medical Services, Baker Tilly This uses a slide layout which has a fixed image. To see instructions to change slide layout see slide 5

Threats to your practice profits Where is Primary Care at the moment?

Threats to your practice profits Glass? What Glass?? Help! Someone’s stolen my glass!

GMS contract changes and PMS reviews GMS practices are now seeing the Correction Factor (MPIG) phased out over seven years from 1 st April 2014 Many practices will lose from this – but not all! Those practices that were no longer receiving Correction Factor payments will in fact do better from this change PMS contracts have the equivalent of a Correction Factor built into them, often part of what is termed the “PMS premium” by the DOH. A national review of PMS contracts is now underway and from 1 st April 2015 ‘Equitable Funding’ (sic) is phasing out the PMS premium. Those practices currently benefitting from the PMS premium are likely to see it disappear. Proposals phasing out over 4 years or longer, contingent on extra work being carried out or taken away immediately.

GMS contract changes and PMS reviews By April 2020 there will be no differentiation in the basis of funding between large and small practices The Global Sum of a practice with 6,000 patients operating from two small surgeries will be one quarter that of the neighbouring practice that looks after 24,000 patients from a single building The costs of running those surgeries will not be linked in the same way though The smaller practice cannot use doctors and staff as efficiently as the larger practice – smaller practices need to be more creative to flourish A small branch surgery will struggle to be financially viable if it is not a dispensing practice.

GMS Indicative changes Example GMS Practice List size 7,500 patients MPIG £105,000 Summary of MPIG, QOF Points movement and seniority phase out changes. Contract year2014/152015/162016/172017/182018/192019/202020/21 Contract changes33,000(8,250)(8,625)(8,475)(8,250)(8,700)(8,775) QOF changes(42,750) Seniority phase out000000(22,500) (9,750)(8,250)(8,625)(8,475)(8,250)(8,700)(31,275) Increase/(decrease) on 2013/14 position(9,750)(18,000)(26,625)(35,100)(43,350)(52,050)(83,325) Enhanced services - extra costs(5,000) Staff payrises - say(3,000) Other costs - say(1,500) Pension costs 1.2% - say(5,000)1,000 (24,250)(26,500)(30,125)(38,600)(46,850)(55,550)(86,825)

What you must do Although there are threats to your practice profits, there are things you can do to overcome them: GMS contract changes and PMS contract reviews Stop chasing unprofitable income Ensure sufficient management time Partnership disputes CASH IS KING Build a financial forecast for the next 7 years now. Understand what that means in cash flow and then plan your strategy to cope and thrive. Make decisions based on CASH not just PROFIT and NEVER on INCOME

Family Doctors Conference September 2014 GP Finance Update Richard Apps, ACA Head of Northern Medical Services, Baker Tilly This uses a slide layout which has a fixed image. To see instructions to change slide layout see slide 5