Charles Rippin & Turner The financial climate for general practices is not looking very encouraging, due to new pressures, which makes it all the more important for GPs to seek advice and guidance from their accountants on keeping practice finances strong.
GP contacted 22 firms of medical specialist accountants and asked about the services they provided to GPs (see page 46). The accountants also gave their views on the biggest challenges for practices.
Specialist firms agree annual fees for a package of services provided during the year. The annual fee always covers certain standard services such as the annual accounts preparing the partnership tax return and tax computation.
What else is included in the package varies considerably from firm to firm.
For example, some firms include both the GP partners' personal tax returns and annual certificates of NHS pensionable income in the annual fee; some include the partners' tax returns, but charge an additional amount for the certificate and some make a separate charge for both.
Variables like these make a meaningful comparison of fees difficult. However, the firms did provide a typical annual fees quotation for a four, full-time partner practice excluding items for which there are additional charges.
If partners have to pay extra for their own tax returns, this can push up the overall cost considerably. One firm charges £280 to £420 for a partner's tax return while another's fee per pensionable income certificate is £195.
List of services
As a rough guide it appears that the annual basic fee for the example practice for those firms excluding both partners' returns and the certificates ranges from £3, 513 to £7,050 including VAT. GPs pay for their returns and certificates on top of this. With firms that do not charge extra fees for these items the annual cost range is £4,700 to £7,320.
Practices need to check for themselves exactly what services are included within the standard charge.
The specialist firms gave their views on the biggest challenges facing GP practices in the next five years. Fourteen of them cite increasing competition from private companies.
‘There will be increased activity from private providers and the market will revolve around income per patient, as supermarkets and low cost franchises move in to take a share of the NHS budget,' predicts Paul Kendall from Cumbria firm Dodd & Co.
Laura McKeown, who owns the Cheshire firm Birch Littlemore & Co says: ‘Learning to operate practices as businesses which now face competition is something new for all GPs to grasp.'
PKF's national director of medical services Valerie Martin says that the NHS is going through the biggest changes of the last 20 years.
‘The growing commercialisation of the NHS means that GPs need specialists advice to deal with these changes and the likely changes in funding arising from a new competitive market,' she said.
In a similar vein, Laurence Slavin from London firm Ramsay Brown and Partners says the biggest challenge for GPs is the rise of private providers, which is part of a government push to save money by moving away from GMS/PMS contracts.
Rod Hood from Sheffield firm Gordon & Hood says that to prosper, many practices need to utilise nurses, nurse practitioners and other staff to cover much of the care previously solely provided by GPs.
‘The numbers of GP partners will reduce with many more salaried GPs,' he says. ‘GP partners' roles will change to that of clinical directors, acting as trouble shooters for consulting nurses.' Mr Kendall adds that the status quo of most GPs being partners in their own practice will come to an end.
Ten of the firms warn that practices will face difficulties maintaining current profit levels. Robert McKerral, a partner with Glasgow based firm Bannerman Maclay Johnstone says: ‘There's a risk of reducing profits if salaries and other costs are not constrained as income levels stabilise or possibly decline.'
Other challenges ahead mentioned by the firms include GPs retiring and difficulty in recruiting replacement partners, having appropriate premises, retaining staff and difficulties making practice based commissioning work. Find out if your accountant has his or her finger on the pulse by asking about challenges ahead for your practice.
Details of the specialist accountancy firms GP spoke to, page 46
SPECIALIST MEDICAL ACCOUNTANCY FIRMS
|Name of firm||Main Uk areas covered||Number of GP clients||Standard fees, including personal tax returns||Extra charge for GP pensionable income certificates||In-house financial services team|
Bannerman Johnstone Maclay http://www.bjm-ca.co.uk
|Scotland||88 practices, 490 GPs||Yes||Yes||Yes|
|Birch Littlemore (0161) 929 1100||Not stated (based in Cheshire)||Six practices and other GPs||No||No||No|
|Charles Rippin & Turner http://www.charlesrippin.co.uk||South East England||76 practices, 274 GPs||Yes||Yes||No|
|Condie & Co** www.thefinancialcentre.co.uk||Fife, Lothian, TaysideLanarkshire,Forth Valley, Borders||87 practices, 460 GPs||No||Yes||Yes|
|Dodd & Co http://www.doddaccountants.co.uk||Not stated (based in Cumbria)||96 practices, 577 GPs||Yes||Yes||Yes|
|Foxley Kingham Medical http://www.fkca.co.uk||Bedfordshire, Buckinghamshire, Herts,Northamptonshire, Warwickshire||40 practices, 180 GPs||Depends on fee basis selected||Depends on fee basis selected||Yes|
|Gordon & Hood http://www.gordon-hood.co.uk||Midlands, Northern England||80 practices, 550 GPs||No||Yes||No|
|Hillier Hopkins LLP www.hillierhopkins.co.uk||London, Home Counties, Hertfordshire||12 practices, 108 GPs||No||Yes||Yes|
|Honey Barrett http://www.honeybarrett.co.uk||East and West Sussex, Kent, Surrey||28 practices, 110 GPs||Yes||No||Yes|
|Lentells www.lentells.co.uk||South West England||54 practices, 300+ GPs||Yes||No||No|
|Moore and Smalley LLP http://www.mooreandsmalley.co.uk||North West England, East Midlands||67 practices, 260+ GPs||Yes||No||Yes|
|Myers Clark http://www.myersclark.co.uk||London, South East England||14 practices, 50 GPs||Yes||Yes||Yes|
|Ogilvie Booth Coles http://www.ogilviebooth.com||London, South East England, South Yorkshire||17 practices, 90 GPs||Yes||Yes||Yes|
|Philip J Gorrod (01986) 875354||Hampshire, Suffolk||20 practices, 90 GPs||Yes||No||No|
|PKF (UK) LLP http://www.pkf.co.uk||Offices throughout England,Wales, Scotland, Northern Ireland||520 practices, 2,000+ GPs||No||No||Yes|
|Ramsay Brown and Partners http://www.ramsaybrown.co.uk||South East England||500 practices, 2,500 GPs||Yes||Yes||Yes|
|RMT http://www.r-m-t.co.uk||North East England, Humberside, Lincolnshire||132 practices, 500 GPs||No||No||Yes|
|Sandison Easson & Gordon http://www.medicount.co.uk||Central and Northern England||180 practices, 725 GPs||No||Yes||No|
|Tenon http://www.tenongroup.com||South England, East Midlands, Yorkshire, North East England, Lancashire, Scotland||252 practices, 1,200 GPs||No||Yes||Yes|
|Williamson West http://www.williamsonwest.com||Home Counties, Midlands||300 practices, 1,500 GPs||No||No||No|
|Winter Rule http://www.winterrule.co.uk||Cornwall, Devon||40 practices, 150+ GPs||Yes||Yes||Yes|
|Wylie & Bisset www.wyliebisset.com||West Scotland, Lanarkshire||31 practices, 99+ GPs||Yes||No||Yes|