With difficult times ahead for the NHS, it is likely that GMS and PMS income will come under increasing pressure. The best we can hope for is that these income streams will not fall by a large amount. Consequently, it will be increasingly important to ensure that non-NHS earnings are maximised. This article looks at the sorts of income streams that are available to practices and provides tips on optimising your earnings.
1 Know the rules
The items for which you can charge are specified clearly within your GMS/PMS contract. It is important to know what is allowed and, equally importantly, what is not allowed. .Nevertheless, there are many items for which you can charge and it is important to know which ones they are. If in doubt, contact your LMC, which will be able to advise you.
2 Negotiate your fees
Many requests for information from insurance firms are accompanied by a letter stating that the company will pay you the ‘agreed BMA fee’ for a report. However, several years ago, the BMA was forbidden from producing such a scale of fees, as this was deemed to be anticompetitive. Indeed, it is arguably illegal for local practices to discuss how much they charge – this could be construed as creating a cartel. The only fees agreed are those charged by government bodies, such as those paid for disabled living allowance reports. All fees from private sector organisations, such as insurers, are open for local negotiation.
3 Don’t undersell yourself
It would be anticompetitive to set out fees – but as a rule of thumb, most practices charge £80-100 for insurance reports and will often attach an additional fee for reports needed urgently.
Be aware of an increasing trend among insurance companies to ask for a report covering only one issue. For example, you may be asked to provide information only about a patient’s diabetes. A ‘limited’ report can be almost as onerous to complete as a full report, yet the insurance company will attempt to pay you a smaller fee. I almost always ask for a full fee and to date there have been no refusals.
When it comes to other items, my practice has a simple scale. Items needing just a signature and a few words, such as a passport photo, have a small fee. There is a second fee for short statements. A one-page form, such as for holiday cancellation, has a higher fee, and detailed reports have the highest charge. This simple structure makes life much easier for staff and patients.
4 Review fees regularly
Your costs increase every year, so you should review your charges just as frequently.
5 Charges for sick notes
Sick notes are requested for all manner of things, from stating someone is fit enough to attend a gym, to certifying a child was unwell on the day of their exam.
All these notes fall outside your contract, so you are at liberty to charge what you wish for them.
Note that requests from patients for letters in support of housing applications also fall within this group. Many such requests are unlikely to make a difference to the patient’s housing application and a clear practice policy on charging for such reports can reduce demand.
6 Be consistent with charges
It is essential that you are consistent in what you charge. Ensure that all your practice’s staff know what you will charge for and how much. Patients talk to each other and if some patients are charged a different rate, word will get around. This can result in embarrassment and arguments, which can be avoided by agreeing within the practice what the charges are.
7 Maximise income from overseas patients
Some patients from other countries may not be eligible for NHS care. Patients from within the EU, and those from countries where reciprocal arrangements exist, are eligible for NHS care, so you may not charge them.
However, patients from North America, Asia and even the Channel Islands are not eligible. You are therefore at liberty to charge these patients. Most of them will have appropriate travel insurance and will pay whatever fee you set. Again, I cannot advise exactly how much you should charge, but you might wish to look at the different charges patients pay for private dental appointments as a rough guide.
8 Make good use of your premises
You should look at whether your premises can provide you additional income. If you are receiving notional rent, you may sublet your rooms, provided that the resultant earnings remain less than 10% of your total income. Many agencies – complementary therapists, counsellors and so on – may be interested in using a room. Negotiate a sensible rate and agree payment terms in advance.
9 Ensure you are paid promptly
With all non-NHS work, ensure that you know how much you will be paid and when, before you carry out the work. Some bodies can be very slow at settling their bills, so it is important to have something in writing confirming that they accept your terms.
Generally, settlement of all bills within 28 days should not pose difficulties for any organisation. In the past, some solicitors have attempted to delay payment until they receive their legal aid payment for the case. Remember that your contract is with the person for whom you are providing a report, not the person who is then paying them at a later date.