GP Practices / NHS

Our experts offer a broad range of specialist accountancy and financial planning services specific to GP Practices.

These include:

• Recurrent annual services
• The preparation of annual accounts - well presented & including benchmarking data
• The calculation of profit allocations
• The preparation of the Partnership Self-Assessment Tax Return
• Advising Partners and Salaried GPs in advance of taxation payments
• The preparation of the Partners' annual Superannuation Certificates
• Attending a practice meeting with the annual accounts - we allocate as much time as you require to ensure the meeting is productive and covers all your questions
• Unlimited ongoing telephone support

For your peace of mind and to help you plan ahead we offer a fixed fee for our recurrent services. The package is dependent upon the size of the practice (number of Partners) and its existing financial procedures. Our services can encompass the Practice work and the partners' personal affairs if required.  Once we have met with you, we will provide you with a comprehensive fee quote so you know exactly what we will deliver for you.  Our billing procedure is also transparent.

Non-recurrent services

• Advising on property acquisitions
• Advising on practice mergers
• VAT planning
• Inheritance Tax planning
• Budget and cash flow planning
• Planning for Capital Gains Tax

As members of AISMA we benchmark your practice performance.  This involves an analytical review of your GP practice results in comparison with the national profile of GPs. Benchmarking your accounts against national statistics can help you gauge the financial performance of your practice.  Our experts identify and discuss possible areas where you can improve practice performance and plan for the future.

We also publish the AISMA technical publications, this includes the annual survey into GP’s accounts and local statistics by Strategic Health Authority.

Self employment offers many benefits. One such advantage is offsetting any business expenses against your trading profit, which will subsequently reduce your tax bill. However it is vital you understand the guidelines surrounding expense claims.

Allowable Expenses

In the simplest of terms an expense is allowable for tax purposes if it is incurred 'wholly and exclusively for the purposes of the trade'. If an expense is incurred for more than one purpose - for joint personal use for example - a deduction for any identifiable proportion of the expense which is incurred 'wholly and exclusively for the purposes of the trade' is allowable. 

Motor Expenses

Motor expenses can be claimed if a vehicle is used solely for the purposes of business. The expenses have to be apportioned so that only those incurred 'wholly and exclusively for the purposes of the trade' are allowed. Our team can assist you in agreeing what proportion of your travel is for business purposes, which can then be applied to your total expenses for the year.

Expenses that qualify to be claimed include:

• Petrol and oil
• Repairs and servicing
• Insurance
• Road tax
• AA/RAC subscription
• Parking
• Cleaning and valeting
• Finance interest

Other Expenses

There are countless other expenses which could be claimed so we provide all our GP clients with a simple yet detailed checklist and ongoing advice to ensure that all allowable expenses are claimed.

You'll be aware that you are part of the NHS Superannuation Scheme but do you really understand what the scheme will give you when you eventually retire?

Pension planning is often overlooked and left until retirement is fast approaching. We understand that's partly due to its complex nature as the terminology, methods of calculation and benefit options can be confusing when trying to plan for yourself.

Our NHS Pension specialists have provided pension forecasts for over 140 GP Practices, the team is led by Kevin Walker who is a leading authority regarding the NHS Pension Scheme.  Kevin regularly lectures to GPs and Practice Managers nationally and was responsible for highlighting the catalogue of errors made by the NHS Pension Agency. The quality of advice provided by the so called 'professionals' we have come across is alarming as very few seem to understand the complexities, have the ability to forecast accurately and advise medical professionals with regards to their Annual Allowance or Lifetime Allowance.

Working as a team, our specialist accountants and independent financial advisers have developed a bespoke financial model we use to provide our clients with accurate pension forecasts.

We can guide you through the process ensuring you understand your pension benefits and all it entails. If you require specific personal financial planning advice, Independent Financial Advisers at our sister company Blackett Walker Ltd can assist and help you to make informed decisions as they are authorised and regulated by the Financial Conduct Authority (FCA).

Contact us to arrange a free initial consultation 0191 653 1022

The UK NHS Pensions Agency offer limited information, which in our experience is rarely accurate and is focused on benefits only payable through the NHS. However, this does not provide a wider industry overview as many GP's make additional pension contributions through 'Added Years' Additional Voluntary Contributions (AVC's) or to external Free Standing arrangements. Some may also contribute to a Personal Pension plan or a Self Invested Personal Pension (SIPP).

The NHS Pension scheme is complex but it doesn't have to be with the correct support and expert guidance. We can work with you to establish what you want your pension to deliver and what your basic income requirements are now and in the future. 

If you have a partnership agreement it's crucial it is reviewed regularly. Our specialists can review this for you and advise you of any actions to be taken to ensure the Partners / GP practice is protected.

If you don't have an agreement perhaps it is time to assess the benefits of creating one otherwise any informal partnership is governed by The Partnership Act 1890 which could impact negatively upon your GP Practice.

We can work with you to implement an agreement, which will ensure all tax and legal implications are addressed such as:

• Protecting the financial interests of each partner
• Reducing the risk of acrimonious partnership disputes
• Agreeing rules for the appointment and retirement of partners
• Setting out the circumstances leading to the suspension of a partner
• Removing governance by the Partnership Act 1890 which denotes each partner jointly and severally liable

Our experts can offer advice on the inclusion of clauses regarding profit allocation, incoming and outgoing partners, property and taxation.

If you need to appoint a solicitor, we work with a select panel of solicitors who have specialist knowledge of the healthcare sector and who have a portfolio of medical clients.  This is to ensure you receive the best service, get value for money but most importantly that your Partnership Agreement is fit for purpose!

For the last decade there has been a requirement to complete certificates of pensionable profits (superannuation certificates) annually, which enable doctors to certify their income for superannuation purposes.

Calculating a GP's income for this purpose is extremely complicated and any errors could have a direct impact upon the GP's retirement income.

We remain abreast of all issues relating to this complex area of accountancy ensuring our clients' certificates are completed correctly and their retirement incomes are maximised.

Our superannuation services include:

• Completion of certificates of pensionable profits
• Liaison with the PCSE over correct superannuation payment
• Assistance with preparation of superannuable earnings forecasts

It's vital you understand which legal structure is the most appropriate for your business and the way you trade.

Typically there are four structures to choose from:

• Sole trader
• Partnership
• Limited liability partnership
• Limited company

By selecting the most appropriate legal structure you could achieve the following:

• Divide your income with a spouse or civil partner
• Reduce income tax to 40% or 20% rather than 50%
• Reduce national insurance contributions
• Protect income in a corporate structure where it will be liable for tax at 20% rather than 50%

However, not all NHS contracts allow you the freedom to choose your legal structure. Therefore this type of tax planning may not be suitable for you. Nonetheless our experience enables us to work within the constraints of your personal circumstances to develop the best possible solution.

Most GP principals will have two sources of income, a practice revenue and potentially salaried income from a hospital or a PCT.

Both sources are liable to national insurance contributions. However, there is a maximum amount of national insurance contributions, which any individual taxpayer must pay in any year. Often a GP will simply pay the maximum national insurance contributions due on their practice income alone and this can often be missed by an inexperienced or non-specialist accountant resulting in more national insurance being paid than is due.

What Can We Do To Help?

Firstly we would evaluate exactly what contributions are being paid. If contributions have been over paid in the past, we are then able to reclaim the overpayment.

We have experience in bidding for A.P.M.S. contracts and advising our clients how to bid successfully.

Our expertise includes:

• Effective business planning
• Cash flow and profit projections
• Advice on negotiations with the CCG/NHSE
• Assistance with the financial aspects of all legal agreements, partnership deeds and leases

The introduction of the Tax Health Plan has far reaching implications for GPs.

Protection against the increased frequency and cost of tax enquiries is now essential and as such we offer a service to safeguard GP's from the potential significant costs of any such investigation. While additional tax liabilities are an issue, equally important are the professional fees which could be incurred, should there be a dispute with the tax authorities. We therefore recommend all our GP clients take advantage of our Tax Protection Service, which covers professional fees incurred in handling a dispute with H M Revenue & Customs.

Through an annual subscription, the scheme enable us to manage the process effectively on your behalf, dedicating the time from the necessary experts should you need it and removing the risk of any unexpected fees or costs.

With increasing financial pressure on general practice, there is a need to come together to explore new, innovative ways of delivering Primary Care at scale.

As with many business / financial issues there is no ‘right answer’ and the decision about the scale of joint working and whether to formally merge or simply work in a federated model will depend on local circumstances.

GP Practice mergers traditionally involved two or more neighbouring practices that were confronted with similar limitations: for example the desire for larger, better equipped premises or the opportunity to increase the patient list size and practice income. The benefit of sharing staff can also be a significant factor. These potential benefits continue to be relevant but GP practices are now also considering how a practice merger might put them in a stronger position to exploit opportunities or respond to the potential challenges arising from the requirement to work at scale within the NHS.

Our experts have the experience and track record to guide you through the pros and cons of a GP practice merger. We also have national contacts with specialist lawyers and banks with whom we collaborate with in order to execute a joined-up approach to meet your objectives and achieve the best results for our clients.

Before embarking on the process, it is crucial you seek specialist advice as there are numerous pitfalls to avoid which could result in significant tax implications. Talk to our Director of Medical Services, Keith Taylor.

Rising demand and greater financial limitations are two of the catalysts pushing General Practice to breaking point. Each practice needs to evaluate its operational, business and financial functions to ensure maximum performance and sustainability. Arrange a free practice health check and a free QOF benchmarking report via our Practice Management Consultant, Jonathan McCutcheon.

Jonathan has over 20 years' NHS experience and a track record of successful practice management. Through an initial 'General Practice Health Check' we quickly identify opportunities and make recommendations for improvement. We then offer support packages tailored to local priorities in order to assist you with implementation to achieve best results.  We also work collaboratively with CCGs and Primary Care Networks / Federations and have experience of large scale NHS project implementation. 

• Maximise profits
• Deliver quick wins
• Improve business performance
• Enhance the skill set of your practice team
• Address training issues
• Recruitment and selection
• Demand management
• Negotiation and Mediation
• CQC (Pre/post inspections)
• Marketing / stakeholder engagement
• IM&T support
• Interim Practice Management support as required

Our experts deliver educational sessions on a variety of financial and practice management issues. Sessions can be tailored to suit the audience - Practice Managers / GP Partners / Locums etc. 

We attend practice meetings, time-out sessions, LMC meetings and GP out of hours meetings in order to ensure you are up to date with important financial issues affecting general practice. We have also delivered sessions on behalf of the RCGP.

Our tax experts are the only non-clinicians to teach Doctors at a leading university.

We can supply references for our experts and examples of our workshop programmes. Please contact us on 0191 500 6930 or email enquiry@bw-medical.co.uk

(In addition to the standard AISMA newsletter issued by members, we produce our own magazine 'The Remedy' this is issued to our client base across England and includes informative financial and management articles specific to Primary Care.)

Unless you are a dispensing practice, the majority of medical practices will not need to consider VAT as most services provided by a GP are exempt from VAT.

However, as there are some exceptions to the rule, GPs should periodically review the level of these services to ensure you don’t fall over the threshold.

Services Exempt from VAT - Services principally aimed at the protection, maintenance or restoration of the health of a patient.  These are the principal services offered by a GP practice.

Services Subject to VAT - those where the principal purpose of the service is the provision of information to a third party to enable that party to take a decision.  Some of the services which are subject to VAT are the following:

• Certificates/reports. A certificate or report may be subject to VAT or exempt. The dividing line is often difficult to determine.  Reports enabling claims to compensation, benefits or registration as a blind person are all subject to VAT
• Dispensing of drugs for dispensing practices
• Fitness certificates as part of an individual taking up a particular professional or sporting activity
• Cosmetic services undertaken purely for cosmetic reasons
• A forensic statement or report
• DVLA medicals
• Medico-legal work
• Pre-employment medicals

If your GP medical practice is carrying out any of the above services or any other services that do not qualify as exempt from VAT and the total value of those services exceeds the current limit of £85,000 the practice will need to register for VAT.

We can help our GP clients by reviewing their income regularly and advising on any VAT liability.