Coronavirus and GP practices: Running a healthy business
As the main point of contact for general healthcare the role of GPs is more important than ever during the coronavirus pandemic.
To protect patients, GPs and their colleagues must carry out this role under challenging circumstances, observing restrictions which have transformed the way they work. Here, we explain some of the advice, guidance and support which is available for GP practices, to help you continue caring for your patients while ensuring the survival of your business.
You can download our useful factsheet here.
In order to support GPs during the pandemic and help them put maximum effort into care related to COVID-19, changes have been made to GPs 2020/21 contracts.
Initially all non-urgent work was suspended. Practices were told to make increased NHS111 appointments available. (Government guidance was to make one NHS111 appointment available per day for every 500 registered patients to 30 June 2020). As the majority of these slots were not being used, practices are allowed to reduce this number providing they regularly monitor the number of referrals being received from the Covid-19 Clinical Assessment Service and increase availability as necessary.
Practices have now received a phase 2 letter advising that some services may be resumed providing it is in the best interest of the patient, cannot be delayed and can be carried out in a COVID safe way. To reduce surgery visits, increased NHS111 appointments should be made available and practices are expected to carry out postnatal checks alongside eight week checks and vaccinations.
When it comes to practice complaints, subject access requests or access to online patient records and other administrative tasks, practices are not being penalised for delays provided there are no patient safety or safeguarding issues and they remain open.
Quality and Outcomes Framework (QOF) income
The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England.
Calculations for 2019/20 will be made as usual, but income will be protected with practices due to receive the same QOF income as was received in 2018/19 or 2019/20 depending on which is higher.
This reward will be paid in May 2020.
Income for 2020/21 is also protected, with further details due to be published in future.
Enhanced service income
GPs have been asked to provide ‘enhanced support’ to patients who have been told that they are in high-risk groups. To enable this, the government has guaranteed that enhanced services income will be protected.
Enhanced service income for Q4 of 2019/20 and Q1 of 2020/21 are protected and these will be generally paid based on the average of the first three months of 2019/20, where services are disrupted or temporarily suspended.
Local authority payments
Local authority payments to June 2020 are to continue as normal. This will be the case even where service delivery has been disrupted or temporarily suspended.
Further information regarding payments beyond June 2020 is expected to be shared soon.
CCG support and claims
Clinical Commissioning Groups (CCGs) will cover any reasonable additional costs incurred during the months of March to June 2020 in responding to Covid-19. After this, the scheme will be reviewed. Practices are to complete a claim form to inform of any additional costs. Confirmation will be required from the practice to show why the cost is necessary, that it is in addition to costs that would normally be incurred and that, for example, the need cannot be managed within existing practice or PCN resources.
Practices are encouraged to complete a claim form in order to inform their CCG of any additional costs. These should be submitted in a timely manner each month while ensuring that all additional costs are included.
CCGs have been asked to support practices where cashflow is adversely affected by COVID-19. In order to access this support, practices need to demonstrate that these cashflow issues are purely due to COVID-19.
Practices will be reimbursed for PPE, but NHS England has suggested that practices will only be reimbursed for PPE that is recommended for use in primary care by Public Health England.
Bank holiday opening
To support the cost of supporting patients over the Easter bank holiday, some areas received a set fee. This was based on weighted patients with the balance being claimed via the CCG claim form. Others were to claim all costs on the CCG claim form.
The set amounts which could be claimed for each GP session worked were:
- GP partners: £289 per session.
- Salaried GP: The actual cost incurred to the practice including on costs
- Locum GP – £250 per session regardless of cost to practice
GP partners can also claim 14.38% employers superannuation where the GP is opted in to the pension scheme.
The amounts which can be claimed for the time worked by other staff is the actual cost to the surgery including on costs.
Other costs incurred from opening on the East bank holiday that were not already reimbursed under the premises cost directive should be claimed on your CCG claim form.
Regarding the May bank holidays, arrangements are now being made at a local level for both funding and opening arrangements. Unless there is a radical change, GP practices will not be expected to open on the second May bank holiday.
GP Retention Scheme
The National GP Retention Scheme is a package of financial and education support to help doctors, who might otherwise leave the profession, remain in general practice.
Ordinarily, this scheme enables doctors to remain in clinical practice for a maximum of four clinical sessions (16 hours 40 minutes) per week or 208 sessions per year. Now, those restrictions have been lifted.
In addition, annual reviews which were due to take place before September 2020 have been deferred and where GPs were approaching the end of the scheme, CCGs will now consider an extension to September 2020.
NHS pension 25-hour retirement
In order to help retired NHS staff return to work to help the health service at this time, a rule preventing staff returning to work more than 16 hours per week shortly after retirement has been lifted.
Previously, staff would be unable to work more than 16 hours per week in the first four weeks after their retirement from the ‘95 scheme. This has been suspended to enable more staff to return.
Primary care networks
There have been several changes regarding primary care networks (PCNs) in England. Many of these changes have been made to ease the workload of GPs at this time, but there are a number of actions which should be taken to ensure that interruption is kept to a minimum.
- GP practices are urged to reconfirm their participation in their primary care network (PCN) to avoid interruption during the COVID-19 outbreak.
- The start of service specification delivery for Structured Medicine Reviews is to be delayed until at least 1st October 2020.
- Early cancer diagnosis specification was to be delayed until 1st October, but practices are being encouraged to start work on this earlier.
- Key elements of the PCN enhanced health in care homes specification was planned to begin from 1st October 2020. Key features have now been brought forward and are detailed in a letter sent to practices 1st May 2020. Practices will be receiving letters detailing plans and funding within the next few days. The funding proposal is not to attach money to these extra services but to reimburse practices by looking at net additional workload.
- PCN clinical directors should be delegating non-clinical functions and focusing on supporting practices to deal with Covid-19
- Where PCNs or practices have decided to recruit staff (under the Additional Roles Reimbursement Scheme) they are expected to do so as funding is protected.
- Half of the annual funding initially allocated under the Investment and Impact Fund (excluding for flu immunisations) has now been reallocated as a PCN support funding stream, based on 27 per patient of the PCN. This fund is to support PCNs and practices to deal with the current pandemic.
GP practices have a key role in supporting patients who are shielding during the COVID-19 pandemic. To aid GPs in this, payments are available for dispensing practices which are delivering to patients who are shielding.
However, the payment is only available if there are no friends, family or volunteers available to deliver the medication. Dispensing Services Quality Scheme (DSQS) rewards are protected.
While the Coronavirus Job Retention Scheme (CJRS) is being used to support around 7.5 million workers, the government has stated that they do not expect this scheme to be used by public sector organisations which continue to receive public funding for staffing.
As GP services are expected to continue – albeit following a very different structure – GP surgeries are not expected to need to furlough staff using the CRJ Scheme.
Practices which have larger non-NHS income streams and associated staffing costs may be able to make use of the CJRS. If these practices have experienced disruption in their non-NHS income streams or if those income streams have ceased, then they may be able to furlough staff using the scheme.
CJRS enables companies to furlough staff, effectively placing them on extended leave, with 80% of their normal monthly wages being paid for by the government. Recently, this scheme was extended to enable workers to be furloughed until October 2020 and, from August there the scheme will become more flexible, allowing workers to return to work part-time. Presently, workers who are furloughed cannot undertake work on behalf of their employer, although they can undertake training.
You can download a full and updated guide to the CJRS here
Additional staffing costs
NHS England has said that practices will be able to claim funding for any additional staff needed to deal with increased workload due to Covid-19, particularly as lockdown eases or to cover staff absence as a result of Covid-19. This is currently believed to be via CCGs. Please note that reimbursement for staff absence will only be available in full where practices are providing full sick pay for employees who are off with Covid-19 or full pay for those shielding. They do expect those shielding to work from home where possible.
Much of the funding available to practices will be subject to national reimbursement rates and it has been suggested that staff reimbursement will reflect the amounts previously agreed for bank holiday opening as seen above.
Where practices do have staffing issues due to COVID-19 and where practices incur additional costs, these should be recorded and claimed for on the CCG form. (see CCG support, above.)
Presently, all annual leave for NHS staff has been suspended. To compensate for this, it has been announced that up to four weeks of annual leave can be carried forward into the next two years.
It is possible to insist on taking annual leave which has already been booked, or which has already been taken and you can cancel leave (with appropriate notice).
You can read more about your responsibilities as an employer and the impact which CVID-19 might have on your employees in this guidance note.
If a member of your workforce has been advised to self quarantine by a medical professional or if official guidance is for them to be isolated, then they should be entitled to statutory sick pay from day one.
Precautionary isolation can be a little complicated in employment contracts as it’s unlikely to be explicitly covered and it may not fall under the general definition of sickness. Therefore, you should check to see if this is something they’re entitled to as contracts can vary.
Either way, you may decide to go above and beyond the terms of your contract and also grant them contractual sick pay at your discretion. Doing this will certainly help you to maintain a good relationship with your employee and with the rest of your workforce and it would undoubtedly support them, however, you will need to take care not to exercise such discretion in a way which could be discriminatory, so you may need to grant the same leniency if other members of your workforce are made to self-isolate.
Employees should let their employer know as soon as possible if they’re not able to go to work in line with your current policy and procedure.You should consider making allowances for Fit Notes as these may not be available during this period and particularly for isolation.
You can find out more about self-isolating here.
Support for practices that pay little or no business rates
Small practices which pay little or no business rates due to small business rate relief (SBBR) may be entitled to financial support through local authorities. The government is providing funding for a one-off grant of £10,000 to those currently eligible for SBRR or rural rate relief to help meet ongoing costs.
This grant will not be repayable to the NHS despite your rates being fully reimbursed.
If your practice is eligible for SBRR or rural rate relief, you will be contacted by your local authority and you do not need to apply for the grant. Practices which are not ratepayers in the business rates system are not included in this scheme.
Other than to ensure that the local authority has the information required to make payments to you, you do not need to do anything to secure the funding if you are entitled to it. Funding for the scheme has been made available to local authorities since early April.
Please note that some elements of business support are devolved and therefore support may differ in Scotland, Northern Ireland and Wales.
July tax bills
The payment of tax bills for July 2020 tax bills can be deferred until January 2021, interest free.
This may help cash flow initially but please remember that by January 2021 you will need to have saved the July 2020 tax money as well as the January 2021 tax.
VAT on PPE
A new temporary zero VAT rate now applied to supplies of PPE for COVID-19. The measure takes effect from 1st May 2020 to 31st July 2020 and applies to a wide range of items.
Other available support
As explained above, most additional costs incurred as a result of COVID-19 should be reimbursed by your CCG which should also address any cashflow issues which are demonstrated to be a consequence of the pandemic.
However, other schemes which may be beneficial to GP practices include:
- Coronavirus Business Interruption Loan Scheme
- Coronavirus Bounce Back Loan Scheme
- 3-month+ mortgage holiday for those borrowers in difficulty due to COVID-19 from mortgage lenders
You can find daily updates in our COVID-19 Knowledgebase
Now more than ever, it is imperative that practices are monitoring their cashflow. While GPs are working hard to ensure they meet the needs of their patients, it’s important to also ensure that your practice is financially viable. Cashflow forecasting is essential, as is requesting support where necessary and submitting full and timely claims.
Duncan & Toplis can assist with any financial issues surrounding Covid-19 and we can support with any claims.
We understand this is a very difficult time and we are here to support you in anyway that we can. If you have any other questions in relation to this guidance, please do not hesitate to contact the Duncan & Toplis team