AISMA Medical Newsletters

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Autumn 2016 - Fraud! Check Your Using Effective Protection

Hot on the heels of our last issue’s alert about fraud threats from outside the practice, AISMA members have been busy preparing more detailed advice. Here we outline key areas to protect yourselves from threats from within – adapted from the Association’s new Guide to Preventing Fraud in Medical Practices
AISMA Doctors Newsline Autumn 2016

Internal financial controls in some practices are so poor they are leaving themselves open to financial loss through insider fraud. A small minority of insiders will commit fraud if the opportunity arises. Thankfully rare, these cases can cause catastrophic financial loss. People who commit fraud inside a medical practice may be sophisticated criminals who target practices with poor financial controls. Or they may be long-serving staff members who are trusted by the partners but have personal financial issues or cash flow pressures.

Whatever the case, opportunities to commit fraud within the practice, for example by creating fictitious payees, syphoning off over the counter cash or de-frauding the NHS by, for example manipulating claims, adding ghost patients to increase the list size or mis-managing prescription claims, need to be minimised.

Funds generated in this way could be diverted into the hands of the fraudster without the partners’ knowledge. This could also lead to a visit from the NHS Fraud Investigation team and action potentially being taken against the partners who had no knowledge of what was being perpetrated.

All medical practices should have a proper system of financial checks and balances to ensure they are not losing money through fraud.

Summer 2016 - Watch out – there’s a lot of fraud about!

Fraudsters are finding new methods to target GP practices. Ian Crompton warns about what you and your staff need to be on the lookout for GP practices, as with many other businesses, need to maintain a high level of vigilance in order to spot fraudsters who continue to develop new, increasingly sophisticated tactics to steal their funds.
AISMA Doctor Newsline - Summer 2016

This is particularly the case with cyber fraud attacks where criminals can easily hide their identity from unsuspecting victims. Ransomware and cyber extortion are both relatively recent types of fraud seen targeting medical practices.

Ransomware This is a type of malicious software, known as malware, which blocks or restricts access to the infected computer system. Fraudsters usually infect a victim’s PC by encrypting files on the system’s hard drive and then threatening that the user will not be able to access their data again unless a ransom is paid. The files will be almost impossible to decrypt without paying the ransom for the encryption key and this forces many victims into paying the ransom to the fraudster, usually in bitcoins which are difficult to trace.

Winter 2016 - 10 Tax Points For 2016

Now the New Year is here, it is a good time to have a fresh look at your finances and see if there is any way to keep the tax bills down. Faye Armstrong has 10 top tax tips to get you started.
AISMA Doctors Newsline Winter 2016

Have another look at limited companies From 6 April 2016 every tax payer can earn £5,000 of dividends completely tax-free. The dividends could be from a classic investment in shares, or from your own limited company. If you set up a company with your other partners to provide some of your services, the company would pay corporation tax on its profits at 20%, and the first £5,000 of dividends each shareholder took would be tax-free.

So, a five partner practice could have £31,250 of profits taxed at 20%, or £62,500 if shares were also given to the partners’ spouses, saving a significant amount of tax.

Spring 2015 - Tips For Keeping Tabs On Your Threatened Cashflow

Strong cashflow management will be even more vital for GP practices in the months ahead, warns Andrew Pow Follow his tips to help you stay on top.
AISMA Doctors Newsline Spring 2015

Then there are local councils - they will be into the third year of managing the public health budget and, in a sector already under financial strain, you can expect cuts in prices paid for public health services. And on top of all this there is another wave of organisational change from this month. Hopefully this time there will be no repeat of the chaotic payment systems of two years ago. So your management of cashflow will therefore become even more critical than in the past.

Most practice managers will be fully aware of the chaotic payment system resulting from the organisational change in April 2013. In some areas there is no respite to the organisational restructuring so we can expect more of the same as CCGs take on increased commissioning roles and Commissioning Support Units are restructured.

Winter 2015 - 10 Vital Practice
Resolutions

Dr Claire Macaulay, a medico-legal adviser with the MDU, runs through some important promises that every GP practice should make for...
AISMA Newsletter Winter 2015

... the 12 months aahead. Making New Year’s resolutions can feel like a triumph of hope over experience as we vow to purge ourselves of alcohol or visit the gym more often.

But while it may be difficult to resist that unfinished box of Christmas chocolates, research suggests the act of making a New Year’s resolution is more likely to make a difference than wanting to change but not making a commitment. And it is also possible to boost your chances of success by setting specific goals and seeking support from others. When it comes to resolutions, it seems there is strength in numbers.

Winter 2015 - 10 Vital Practice
Resolutions

Dr Claire Macaulay, a medico-legal adviser with the MDU, runs through some important promises that every GP practice should make for...
AISMA Newsletter Summer 2015

... the 12 months aahead. Making New Year’s resolutions can feel like a triumph of hope over experience as we vow to purge ourselves of alcohol or visit the gym more often.

But while it may be difficult to resist that unfinished box of Christmas chocolates, research suggests the act of making a New Year’s resolution is more likely to make a difference than wanting to change but not making a commitment. And it is also possible to boost your chances of success by setting specific goals and seeking support from others. When it comes to resolutions, it seems there is strength in numbers.

Summer 2014 - Helpful Resource For The Practice Business

IT's all change for enhanced services! So make sure you stay on top of them. Kathie Applebee highlights the key areas to consider. AISMA Newsletter Summer 2014

Spring 2014 - GP's Facing Financial Meltdown

Insolvency and GPs have been two words that just never appeared in the same sentence – until now. Jeanette Brown looks at some alarming current issues arising in the wake of doctors' falling incomes. AISMA Newsletter Spring 2014

I have been seeing a worrying trend among doctors recently: they have not been able to pay their bills. Until now, as a healthcare accountant and insolvency practitioner, it was rare for my two worlds of work to collide.

But my recent experience suggests a number of common themes and I thought it would be useful to highlight a couple of examples. I have been speaking as an insolvency practitioner to a number of doctors in recent weeks where the combined effects of the January tax bills and superannuation balancing payments have caused huge financial pressure.

Summer 2013 - Time To Weed Out Those Choking Inefficiencies

Essential business components are missing in some general practices, warns Kathie Applebee. So can you now really afford not to tackle these profit-sapping killers?
AISMA Newsletter Spring 2014

If anyone was to look at it objectively then general practice must seem remarkably inefficient. Consider this: Highly trained professionals deal with some tasks which apparently could be done by less costly team members. Computer systems are frequently under-utilised due to lack of investment in training. Premises are generally only occupied for less than half the working week - and very little, if at all, at weekends.

Winter 2013 - Early
Retirement

Over the past few years we have been asked by an increasing number of our GP clients about their options for early retirement within or outside the NHS Pension Scheme. This appears to stem from three main causes:
AISMA Newsletter Winter 2013

The increase in workload in general practice, combined with pressures on funding, which are causing many GPs to consider retirement before the normal retirement age. The vast majority of GPs who are now in their 50s will be members of the 1995 section of the NHS Pension Scheme, where the normal retirement age is 60.

Increasing contributions, making the scheme more and more expensive for members. For many years until the new GP contract was introduced in 2004, GPs paid 6% employee contributions to the NHS Pension Scheme, in addition to any added years being bought. At that time, the new contract theoretically introduced funding for the 14% employer contributions, which GPs were then required to pay, so that contributions effectively rose to 20'.

Autumn 2012 - Hello Goodbye

Over the past few years we have been asked by an increasing number of our GP clients about their options for early retirement within or outside the NHS Pension Scheme.
AISMA Newsletter Autumn 2012

This appears to stem from three main causes. Every partnership will have to consider the retirement and replacement of a partner at some stage. For large partnerships this could be annually but smaller stable partnerships may only have to deal with this issue once every 10 years or more - and the uncertainties can give rise to anxious times for the practice manager and all the partners. Ideally the groundwork for successful succession planning will be in place even before a retirement is planned. A well run practice will be efficient and profitable, and therefore more attractive to new potential partners.

There will be an up-to-date partnership deed in place, setting out clearly the terms on which a retiring partner will be able to leave. It will cover such issues as notice periods, how properties and assets Cutting costs Tap in to free advice for your practice No more meetingzzzz. A GP's tips for effective meetings Legal Q&A GPs7#39; and managers' biggest legal questions answered Opinion Funding needed for general practice change u3 u4 u6 u7 are to be valued, and when capital and current account balances are to be paid. Of course, it is easier to negotiate these issues before any partner has a specific retirement date in mind.

Summer 2012 - NHS Pension Scheme

GP's are now asking AISMA member firms more questions about the NHS Pension Scheme than anything else. David Walker and Gareth Rose* answer the big concerns.
AISMA Newsletter Autumn 2012

This suggests there is a simple 'yes' or 'no' answer. But consider the bigger picture. Is it still worth it to the member and is it sustainable? Firstly, sustainability. The Scheme is often described as 'pay-as-you-go' - where contributions being made now are used to pay the pensions in payment now, with no fund of invested assets. But this does not really tell the full story. The funding objectives are that the pension contributions you pay now are sufficient to pay for future pensions. That may seem a small difference, but it has huge financial implications.

Will the 2015 scheme be worth it? Time will tell as full details emerge, but the BMA is working extremely hard to negotiate the best deal possible for those who will be in transition from either the 1995 or the 2008 schemes to the 2015 and for those who will be joining straight into the new one.

Spring 2012 - Stop Restrictive Covenants Backfiring On Your Business

GPs with restrictive covenants would do well to check the wording following a series of recent High Court hearings in London.
AISMA Newsletter Autumn 2012

The cases covered the protection of goodwill in practices and businesses - and the enforceability of restrictive covenants after employment is terminated. Although the issues related to bosses and workers in the financial markets the same law applies to any medical practice.

Although the issues related to bosses and workers in the financial markets the same law applies to any medical practice. What is now clear is that in many cases, especially where legal advice is not taken, restraint of trade clauses are overly optimistic about what the law will allow.

Winter 2011 - Take Time To
Beat New QOF

You just get used to QOF - and then they change it. Kathie Applebee advises on what's new for 2012-13 – and how to keep on top of this valuable income source.
AISMA Newsletter Winter 2011

Widespread QOF alterations from 1 April 2012 could catch out practices who, until now, have done well under previous versions. There are two new clinical areas - PAD (peripheral arterial disease) and osteoporosis – and 12 new indicators, as well as changes to existing ones in the form of retirements, replacements, wording alterations, and revisions to the numbers of points and/or thresholds needed to achieve top marks.

Where indicators have been changed (other than the value of points or thresholds), they are renumbered. This leaves gaps in the documentation where the redundant indicators used to be.

Where indicators have been changed (other than the value of points or thresholds), they are renumbered. This leaves gaps in the documentation where the redundant indicators used to be.

Autumn 2011 - Cash In Now On The CQC's Long Hold Up

Amid all the changes and reflective processes within the NHS, the much talked about Care Quality Commission (CQC) registration plans for NHS GPs are also undergoing some changes.
AISMA Newsletter Autumn 2011

Originally due for April 2012, NHS GP registration has been pushed back to April 2013 following protests from GP leaders that resulted in the CQC acknowledging that it is looking at ways to 'ensure registration is more closely aligned with accreditation schemes.'

Winter 2010 - Make Your Resolutions A Team Effort

Happy new year! But be sure to hit it running and you will stand a better chance of surmounting the hurdles ahead, says Kathie Applebee. Back in April 2006 I presented a seminar entitled '2006 – a year of challenges'.
AISMA Newsletter Winter 2010

The first slide provided the following list:

This was a formidable list but general practice weathered that year and the years since. However, 2011 has a 'last chance at the OK Corral' feel about it that should banish any complacency. English practices have to contend with preparation for GP-led commissioning and compulsory registration with the Care Quality Commission (CQC), while practices throughout the UK are facing financial pressures in addition to workload demands which seem to increase in inverse proportion to the availability of free time and surplus income.

Autumn 2010 - Brush Up Now For White Paper Success

Sweeping changes in the offing for general practice will demand greater financial capabilities from GPs. The specialist medical accountant's input will pay dividends, says Deborah Wood.
AISMA Newsletter Autumn 2010

Practices are already facing cuts to their current core PMS/APMS baseline, if not immediately, certainly with effect from April 2011. GMS practices are losing the benefit of MPIG through gradual erosion. And all practices face reduced income from enhanced services while many have less QOF funding.

Yet there is an expectation to continue providing essential and additional services to the patient population efficiently whilst maintaining a high quality service. In addition practices are being encouraged to innovate through PBC. Soon to follow will be revalidation and CQC registration and then into the mix comes the coalition Government's White Paper consultation.

Summer 2010 - Avoid A Federation Disaster

It was reported recently that the RCGP and NHS leaders are warning GPs that they must start to develop federated models immediately or face new structures being imposed on them.
AISMA Newsletter Summer 2010

Despite pressure to move ahead with federating, there is little guidance for GPs on going about it. A toolkit promised by the RCGP is not expected to be ready until the autumn and, in any event, it is doubtful that a generic document can provide the tailored advice required in these situations.

Many GP practices have already formed federations or are in the process of doing so, some with greater success than others. Some PCTs are pro-active, perhaps providing funding to practices for set-up costs and allowing the practices access to the PCT's own legal advisors.

Winter 2009 - Now Promise To Make These New Year Resolutions

Many GPs and their practice managers would greatly benefit financially in 2010 by making some new year's resolutions to their accountants. AISMA member firms set out what they would like to see.
AISMA Newsletter Winter 2009

AISMA accountants find the annual 'big chase' one of their biggest problems and it is the area they complained about most when they were asked for their resolution ideas. Most GPs need to know their tax and superannuation bills well in advance of the due payment dates and although estimated calculations can often be prepared, these may have to be revisited on numerous occasions as information from individual partners becomes available. This means more time spent by the accountant - and a bigger bill for the GP.

Autumn 2009 - How To Cope With Swine Flu

Wintertime is bad enough in general practice without the threat of a swine flu pandemic - and the urging to plan for it may seem pointless when many practices feel stretched under normal circumstances.
AISMA Newsletter Autumn 2009

However, we cannot prevent seasonal outbreaks and their sinister pandemic relations from troubling us, so a degree of planning is prudent. A good starting point is to accept that you will have limited resources and that these must be used wisely.

Now that pay agreements have been reached for vaccinations, practices will need to plan for the storage of additional vaccines and where to hold clinics. Because of the volume, production-line systems will be needed. This means reception staff marshalling patients into queues and helping with clothing removal and other administrative staff updating patients' medical records while nurses and HCAs administer vaccines. For clinics held off site where practices lack remote computer facilities, paper lists are needed for checking patients in. These ideally would be bulk entered on return to the practice, either by creating a patient group and thence updating their records or by using macros (such as Keyboard Express) to automate data entry for individual patients.

Summer 2009 - Going For Gold Starts With Digging At Home

Income may be static but many practices' profits could be maintained by better controls. Bob Senior unlocks a treasure trove of in-house areas to review.
AISMA Newsletter Summer 2009

As GPs face financially challenging times they often think along the lines of: 'I must maintain my profits, despite all the changes the Government is introducing and its drive to reduce costs – but I don't actually want to change anything I am doing'.

That objective is understandable, but in reality quite difficult to achieve. The starting point for any plan needs to be to consider how the practice is doing. That is best done by considering some fundamental questions.

April 2009 - 10 Top Money Issues For GPs

The credit crunch is hitting everyone but there is much that GPs and their practices can do to make the most of their finances.
AISMA Newsletter Spring 2009

This month marks the start of a new fine collection regime for any misdemeanour you make on almost any type of tax related document filed with HM Revenue and Customs (including VAT and PAYE).

Taxpayers and their accountants now have to try to forget the previous separate systems for settling disputes with the former Inland Revenue, and Customs & Excise, and get used to dealing with a new aligned system. In future, if you make a ‘careless’ undisclosed error you could be fined 15-30 per cent of the amount of error. If you tell the taxman first then this may be waived.