Non-clinical partner Ryan Smith advises practices on how to comb through contracts ensuring no payments are missed
This year, cost pressures are so acute many practices are, for the first time, facing the real threat of going under. Surgeries have to make sure every penny counts from their contracts and that they are paying attention to the minute detail – and the basics – in all the services they deliver.
This article covers some of the areas it’s important not to overlook. It may feel like I’m going over old ground but checking or reviewing that current processes are running correctly can sometimes highlight areas to improve or serve to remind you about other claims you haven’t made.
So, in no particular order, here are the basics you should be reviewing:
National Enhanced Services
Minor Surgery – Check the criteria closely, and ensure claims are double-checked in your clinical system so that you are maximising all areas. Think about whether some of your non-GP workforce can take on some of the activity i.e. injections. This will give you a better profit margin.
Learning Disability Reviews – Again, check the criteria and eligibility, and ensure your register is cleansed and up to date before your recall system kicks in. Review the staff member/role doing this type of work and work with your local community and acute trust if they have specific teams who can help with training and/or resources. Lastly, always double-check your read coding and do not accept the payment via CQRS unless you have checked the activity in your clinical system.
Weight Management – See my previous article on this for tips and advice.
Seasonal flu – For the past three years, I have found it much more cost-effective and manageable to plan for the flu campaign jointly with my PCN. We have increased uptake and profitability by holding joint clinics, purchasing vaccines as a group and ensuring our patient comms and recall are consistent. Taking this approach has also helped when it comes to making claims for the personally administered items portion of flu income.
Childhood seasonal flu – Same as above, but we have also found that communicating with schools and nurseries is effective in increasing uptake despite schools having a separate immunisations service. We have sent them information about the vaccine, what age ranges are eligible and where children can get the jab should they miss the school programme.
Local Enhanced Services
Every ICB area has its own local enhanced services that it offers. Below are a few that we are offered in my own ICB area. Check with your PCN, federation and ICB colleagues what is available for your practice, and check the activity payments and eligibility criteria before signing up – you may find it doesn’t make financial sense.
In our area, we can offer the following local enhanced services: leg ulcer, near patient testing, new anticoagulation ES, anticoagulation monitoring level 4, phlebotomy, treatment room, prostate cancer, shared care, spirometry, special allocations scheme, and asylum seekers in contingency hotels (only for practices currently delivering it)
Patient Registrations
This is the bread and butter for all GP practices – our main source of income is through the list size. Maximising this will be your best return on investment by far.
To fully understand your list size, log into PCSE and check your practice statements every month. They update quarterly with an adjusted Carr-Hill formula for your raw, weighted and adjusted list sizes.
Your PCSE statement will give you information on temporary patients, those in residential care and much more besides. In particular, it is worth checking your temporary patients, care home and student population against your PCSE statement, since each patient receives an uplift on the Carr-Hill formula and you could be missing out on thousands of pounds of income every month.
In both EMIS and SystmOne, there can be instances of patients not being registered correctly. To check this, you can run searches of your population then ensure that the figures match with PCSE and what you are being paid.
The two figures will never match exactly, but as long as they are within a 5% range, that’s fine. If there is a bigger difference, ask your system supplier, i.e. EMIS , SystmOne etc. and your ICB to help rectify it.
I would also recommend speaking to your partners about maximising your patient registrations. For example, how to register with your practice should be one of the first pieces of information people see on your practice website.
To encourage more registrations, use social media, post on local groups, and send flyers about your practice and the services it offers to new building complexes and/or universities in your area. The time and effort will be worth it.
QOF
This is another big-ticket item and something we all work hard on to achieve that elusive 100% score at the end of the QOF year in March.
Unsurprisingly, with the year-end happening on a weekend this year, I was glued to my laptop to make those final tweaks and adjustments, only to achieve 99.32%! Along with my GP partner and nurse manager, we were checking meticulously for any missed coding, observations and blood tests carried out elsewhere, i.e. hospital, just to get those .001% increases.
Even though it feels like we have just finished QOF activity for the year, there’s no time to rest on your laurels. Get a plan in place for recalling everyone who needs a review, a vaccination or test either by month of birth or diary entry.
There are tools and companies that can help you, if you are unsure or want to see what else is available speak to your PCN, federation or ICB colleagues for advice. I have had success with Primary Care IT Ardens and Insight Solutions just to name a few, although there are plenty more out there.
This year, since QOF has several indicators that are protected, it is worth going through the QOF guidance published in April with your nurse and GP lead to decide which ones you are happy to not do. You may decide it is in the best interest of patients to continue even though it is income-protected.
Lastly, I would still work on your prevalence, coding and registers. We don’t know what the contract will entail in 2025 and it is best to be prepared if, like this year, income is based on last year’s performance and/or prevalence.
Ryan Smith is a non-clinical partner and strategic manager at Kenilworth and Warwick PCN
