Maximise your income for Personally Administered Items (PAIs)
A guest blog by Tracy Hole, The Surgery Network.
Many practices are losing thousands of pounds a year by not getting the full income they are due for Personally Administered Items. Guest blogger Tracy Hols demystifies this complex process and provides hints and tips to help surgeries maximise their income.
Complex processes involved in purchasing and managing Personally Administered Items (PAIs), and then claiming for them from Prescription Services (formally the PPA) means it is extremely difficult for GP practices to know if they are maximising their income.
Practices submit their FP34D returns each month based on the prescriptions raised, but it is very difficult to know what is claimable and whether all the eligible items used have been given a prescription.
Often claimable items are not included because it is thought that it is not worth raising the paperwork, or the items are not bought at all because of concerns over their high cost - for example cancer drugs.
And not filling in the forms correctly can cost the surgery money through reduced dispencing fees.
All of these issues can compound together to create a significant shortfall in income for many GPs.
So here are our simple tips that can help make a big difference:
1. Make sure you what is claimable! You can claim for:
- Vaccines, anaesthetics, injections
- IUCDs (including diaphrams)
- Diagnostic Reagents
- Sutures, but not all are claimable - check carefully
- You can find the list of claimable items atwww.dmd.medicines.org.uk
2. Conduct an end-to-end review
Once you know what to look for, go through your historic invoices to quantify all the PAIs you buy and compare this with the prescriptions raised and income received. This will tell you how much income you have under-claimed.
3. Ensure everyone knows what is claimable
- Choose someone to maintain an end-to-end view
- Communicatre the list of items to clinicians
- Identify claimable items when they are ordered and then track them through the surgery using visual cues and signs to remind everyone.
4. Raise prescriptions for every claimable item
Do this no matter how low the cost as the dispencing fees quickly add up.
5. Purchase cancer drugs, rather than issuing a prescription to the patient
Drugs such as Zoladex, Prostap and Decapapyl will earn the practice a profit of around £170 per patient per year. For example, a 6,000 patient surgery will have around 6 patients resulting in a profit of over £1,000.
6. Ensuring nothing is missed on the FP34D
When raising the FP34D, check the list of prescriptions against the list of items purchased and used. if there is a big difference each month, then this means that prescriptions have not been raised so further communications and training may be required.
7. Ensure you get the full dispencing fee for every item
The dispencing fee is reduced when more than 455 items are allocated to one GP in one month. Therefore during the flu season enter 'Influenza' seperately for each responsible GP and ensure no one GP has more than 455 items.
8. Check your Open Exeter payment
Keep a record of claims and the income you expect to receive. Check the payments for individual GPs. Log in to Open Exeter and go to 'Drug Payments'.
9. Work with your specialist medical accountant to understand your PAI profit
The Surgery Network has developed a 'PPA Health Check' for non-dispencing practices. Using the graph, look up your 'Traget PAI profit per patient' Then speak to your accountant to obtain the actual PAI profit from your accounts and compare the two. If there is a significant shortfall then you should investigate further.