Medical finance expert Katy Drew offers her tips on getting extra income from sources outside your contractual NHS GP services
Against the backdrop of the many changes in primary care, GP practices are having to rise to the challenge of maintaining a successful business. They will be looking to their business or practice manager to boost practice income and find new ways of working while continuing to deliver optimum patient care.
Ensuring all NHS work the practice undertakes is claimed for and making the most of opportunities to maximise income from the GP contract, QOF revenue and enhanced services, is the top priority.
But there are many other areas outside of your NHS contract income streams to generate income.
GP federations are particularly proactive about obtaining new streams of funding for their member practices. But individual practices have options to boost their income through non-core NHS and private work – some of which you may not have considered.
Outlined below are the key areas likely to be most profitable to your practice.
You should consider each approach carefully before making any decisions, to ensure both the financial and patient benefits are sufficient return for the time, money and effort expended.
Lots of practices are already involved in training but others may not have realised the potential for boosting their income and sustainability.
With the increasing number of students entering medical schools, hosting medical students will be a growth area for practices in the near future as these students progress in their studies.
New medical schools opening recently, such as the University of Sunderland, Anglia Ruskin University and a collaboration between the University of Nottingham and University of Lincoln, will mean that the spread of practices by locality that can participate in training will increase.
If you are not already a training practice this is something you can consider. Speak to colleagues to see if you have a GP who is a trainer, or interested in becoming one. Opportunities to provide placements for medical students, FY2s and GP registrars together with providing nurse placements will increase. In addition there are now opportunities to provide Physician Associate placements. As with the traditional placements, these will bring additional funding to participating practices.
Training practices find that their profile and the pool of clinicians available in the future once they have completed their studies.
Generally a training practice provides a fertile environment for other members of staff to bring to the surface additional skills that can further enhance the practice and the staff member personally. This may include the practice manager or clinical team member sharing their skills within the locality or to a wider audience.
Although GDPR has impacted the financial returns in this area it can still be a profitable way for practices to increase revenue streams.
To make the process of producing reports more efficient there are free software packages available which will create a high quality insurance report or response to a Subject Access Request, while saving valuable time redacting and reviewing sensitive and third party information.
Review the fees you charge regularly; you may find you should increase them. The BMA has useful guidance on what reports you can charge for and how to set fees. It is also important to ensure you receive payment for all the reports produced – the easiest way to achieve this is to ask for payment upfront, where possible.
There are a number of additional vaccinations, outside of the routine NHS vaccinations/immunisation schedule, that patients travelling abroad are advised to have and which practices can charge their own patients for, including Japanese Encephalitis, Yellow fever and Rabies.
However, it is important to remember that you are also charging for providing advice about the health risks and diseases that could occur in the area or type of accommodation they are staying in during their holiday abroad. To provide this specialised service would involve having a practice nurse who has been trained in travel medicine. You also need to ensure they have appropriate indemnity cover, especially given this work falls outside the national Clinical Negligence in General Practice scheme.
The development of primary care networks may make this easier to pursue jointly with other practices – training a single nurse to make a clinic available for all patients in the network.
Firstly, a word of caution. If you plan to charge for the use of rooms, please remember to read your lease and also be aware of potential implications on your rent reimbursement from NHS England. Specialist advice should be obtained if you are considering any scheme using an area for which you currently receive rent reimbursement. Furthermore if you own the premises and you are subject to abatement of your rent reimbursement this can also impact your pension.
However, this is still worth considering as there are multiple benefits for your patients, as well as the additional income for the practice. Depending on available capacity, a practice can earn over £20,000 a year from renting out space.
Practices need to firstly look at what spare capacity they have and then with regard to the contract identify whether they are able to host any clinical or non-clinical services based on the type of available space needed. Examples are hosting dental, audiology and pharmacy services.
When deciding on the appropriate rate to charge, the cost of any consumables used should be taken into account.
In some cases renting space to a private provider of wider therapies has extra benefits for the practice as it often frees up GP consultations, while improving the ability of patients to access the support they need without having to travel elsewhere.
If you already have income from an existing sub-lease then, as for fees for medical reports, it is worth ensuring that any lease incremental rent reviews are reviewed and implemented. Most provide for these on a 3- to 5-year cycle.
This can be a lucrative area for income generation. Practices can get heavily involved in particular research projects and even employ staff using the income gained to cover the workload.
Alternatively, for a more modest commitment and income, you can do a simple search for suitable patients and mail-shot.
The Salford Lung Study is an example of a recent ground breaking trial supported by the National Institute for Health Research which involved both GP practices and pharmacies.
Be mindful that certain types of research may be subject to VAT at the standard rate. For the majority of practices this is unlikely to be an issue as the threshold to register is currently £85,000, but advice should be taken from a professional advisor as other sources of non-NHS income may result in you exceeding the registration threshold.
If you are a dispensing practice you will need further advice as certain supplies made by you will be zero rated in this capacity and may interact with potentially standard rated supplies, ie, 20%.
It’s worth looking at your patients’ journey through the practice as there may be opportunities for advertising within your waiting room. Many practices now have a TV screen to call in patients, which you can charge a fee to display adverts on.
However, remember that the changes to the GP contract 2019-20 state that practices will no longer be able to advertise or host private GP providers offering the same core GP services that are offered free on the NHS.
Several of the areas I have mentioned involve developing the skills mix within your existing practice team. Patients will benefit from this, but so will the practice team by developing their skills and boosting personal satisfaction in their roles – thereby helping with staff retention.
In summary, there are many opportunities for a practice to benefit financially from non-NHS work. This enhances and maintains skill sets amongst staff whilst patients also benefit – both those within the practice and the wider community.
However, it is vital not to become distracted from the core services the practice provides by way of the NHS contract.
Katy Drew is primary care development manager at Sandison Easson chartered accountants
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