Cashflow tips for GP practices

Having good internal processes is key to maintaining good cashflow within your GP practice. Here are a few suggestions:

• Starters/leavers – make sure the starter or leaver form is completed on the Primary Care Support England (PCSE) portal for any new GP partners or salaried GPs. This dictates when pension contributions are deducted on the monthly statements. For some practices, it can really dent cashflow when contributions continue to be taken after an individual leaves; or when a large backlog is taken a while after someone joins.
  
  
• Superannuation deductions – is someone within the practice checking the monthly pension deductions being taken on the General Medical Services (GMS) statements for GPs? These should agree to the Estimate of Pensionable Profits filed for the year. Are you checking all current GPs in the pension scheme are having deductions taken each month? Are there ad hoc adjustments with no detail? If you are ever unsure, please do get in touch.
  
  The income tax relief on pension contributions could be delayed if contributions are not collected until a later year so it’s well worth checking these are accurate as early as possible.
  
  
• Personal Medical Services (PMS) to GMS reversion monies/Investment and Impact Fund (IIF) funding – often a large pot of money is received just before the end of the tax year, but it’s often held for a specific purpose and spent over a period of time. Be aware that whilst these monies are in the bank, they need to be ringfenced for future spending.
  
  
• Primary Care Network (PCN) funds – most PCNs are making surpluses but these can take a long time to be paid out. Do you know who your lead PCN is and when the final accounts are expected? You will need to include your practice’s share of the surplus in your year end accounts so it pays to know when this information will be available. Also, the sooner you receive the cash the better!
  
  PCNs are generally slowing down the cashflow as the money goes into the PCN (or Federation) before it’s paid over to the practice, so the PCN does need to have proper financial management. The PCN could receive funds monthly but pay these over to practices quarterly to reduce their administrative burden, but this impacts individual practices’ cashflows. Currently, the guidance is that the Extended Access service will move to PCNs from 1 October 2022. It’s useful to be aware of what you’re due to receive from the PCN so you can chase up monies in a timely manner.
  
  If you would like any assistance with completing any reconciliations or accounts for your PCN, we would be happy to help!
  
  
• Salaried GPs – are they completing a year end Type 2 pension certificate? If they don’t normally, but then do complete one after they leave the practice and there’s a shortfall, this is usually taken from the practice. You would need to go back to the GP for reimbursement at this point. It’s much easier to check at the year end that this has been done so timely adjustments can be made. If your salaried GPs are unsure of what they need to do, please ask them to get in touch as we would be happy to assist.
  
  
• Additional Roles Reimbursement Scheme (ARRS) staff – within your PCN, if staff members are included on one practice’s payroll but another practice receives the reimbursement (or part of it), what arrangements do you have in place to minimise the gap in time between expenditure and reimbursement?
  
  
• Monitoring NHS income claims – do you have a finance manager who will keep tabs on any monies owed to the practice? They should keep chasing these up so if claims are late, they don’t impact negatively on cashflow. 

• Merged groups and super practices – for those with more than one surgery, are you making best use of resources across them? Are you benefiting from economies of scale in telephony, utilities, shredding, photocopying etc. or does each surgery have its own function? 

• Partner capital requirements – do you know how much cash you need to hold in the business at any one time to service existing working capital for a period of, say, three months? We would usually recommend agreeing an amount which should be held in a capital account within the practice accounts and not drawn out at the end of the year. This capital provides a buffer of funds within the business and should ensure a stable cashflow position, assuming no unforeseen one-off outflows. 

• Partner tax payments – for practices which do not hold back tax provisions for partners, make sure they are aware how much of their drawings they need to keep back to save for forthcoming income tax payments. This avoids partners reaching the tax payment deadlines of January or July each year and wanting to extract funds from the practice at short notice, which can unexpectedly hit cashflow.
  
  Many practices saw higher profits in the 2020/21 tax year, but we’re expecting these to have fallen for the 2021/22 year. For practices with non-March year ends there can be a big gap of time between profits being earnt and the tax falling due, and if profits (and therefore drawings) are falling now, but you still have high tax payments to make for earlier years, then this can cause cashflow issues for individuals.
  
  Do get in touch if you would like us to complete any tax estimates or projections at this stage.

• Cashflow forecasts – do you know how to run cashflow reports on your accounting software? If not, please get in touch as we would be happy to help.

Need help?

If you have any queries, please don’t hesitate to get in touch with your usual Larking Gowen contact within the Medical team, and one of our specialists will assist you. You can find contact details on the Our People section of our website. Alternatively, you can email us at enquiry@larking-gowen.co.uk, or telephone 0330 024 0888.

Emma Wood