GP recruitment crisis

Practice under pressure, partners wanting to retire, is this is a familiar landscape for your practice?

The Public Accounts Committee and NHS England are expected to produce a report this month on what action they are taking to tackle key workforce issues, including nursing shortages and high levels of GP retirement and provide evidence to show whether current plans are adequate to tackle this serious problem.

Current solutions include:

GP retainer scheme

Could a partner leaving be persuaded to return as a salaried GP under the retainer scheme?

Those who are eligible are: GPs designated as ‘retained GPs’ (RGPs), any GPs who are not in practice but have practised in the past two years and any GPs who can provide their GP Deanery with ‘compelling evidence that they are intending to leave practice and would do so without this scheme’.

The practice can claim £76.92 per session that the RGP works. A retained GP session is 4 hours 10 minutes.

£1m is also being invested in the retention programme, this was announced as part of the GP Careers Plus pilots last November which will be looking at ways GPs aged over 55 can work more flexibly.

Golden Hello scheme

A scheme offering £20,000 golden hellos to GP trainees in areas that struggle to recruit will be widened as part of a package of measures to address the GP workforce crisis announced by the health secretary in November

The £20k salary supplement is attracting trainees to certain areas of the country where training is excellent, but the application rate has been historically low.

Health Education England alongside CCGs and NHS England operate this and other similar schemes

Be a training practice

Being a training practice can help recruit from the pool of trainees in practice whilst bringing in additional grant monies.

Work environment

It is important to bear in mind that there is a vast choice of vacancies available for GPs and the partner route is increasingly not the option of choice.

Take a hard look at how your practice is run, is it an attractive work environment with a solid work life balance?

Business coaching could offer the practice a chance to take a different perspective and improve the balance of where the practice is going and how it operates day to day formulating a strategy for the future.

MHA Moore and Smalley offer strategy days and previous delegates have given excellent feedback.

If you would like further information, please contact Susan Charnock or call 01253 404404.

Mental Health in the Workplace

Mental health issues tend to be hidden within organisations. This can often be a result of an organisation focusing on the process of the organisations rather than the people. Many people believe that there is a stigma attached to mental health and this can often be one of the reasons why it is hidden and not spoken about within organisations.

We discuss this further in our latest fact sheet here.

The Importance of Treating Staff Fairly

All employers should ensure that they are treating their staff fairly and that any reasonable adjustments are made to assist them within the workplace, especially where they have a disability. Employers should also ensure that their staff are also reminded of their obligations to treat their cowards fairly. Failure to ensure that all staff are treated equally and failure to make reasonable adjustments for a disabled worker, could give rise to a claim in the Employment Tribunal.

Last month Mr Caulcott bought a claim against the Department for Work and Pensions (DWP) alleging that they had failed to make reasonable adjustments and that the was treated unfairly because of his disabilities.

The Facts

Mr Caulcott suffered from chromic asthma, anxiety and eczema, as a result of this both his GP and DWP’s occupational health assessor advised that he should not work on the frontline. However, DWP had ignored this advice and moved him from an office role to the frontline, where he was often faced with claimants who were angry due to their benefits being sanctioned.

In March 2014 Mr Caulcott suffered a serious asthma attack, and was rushed to hospital, after taking part in a training seminar that was held in a small room, which caused him to feel anxious. Following his return to work, he was given a written warning due to taking two and a half additional sick days than he was allowed. In addition, it was alleged that the DWP pressured him to move to another office.

Further to this there was an email sent in which a DWP manager emailed another manager at Mr Caulcott’s branch stating “Let him whinge… and raise it at his ET. He doesn’t deserve us to be nice to him”.

Consequently, the Employment Tribunal found in favour of Mr Caulcott and ruled that DWP had treated him less favourably because of his disabilities.

What Should You Do?

As a first step you should ensure that if you employ anybody with a disability or you have a reasonable belief that they could have a disability, then appropriate adjustments are made to accommodate them within the workplace, if needed. In addition, it is advisable to ensure that staff are given equality and diversity training, especially those in more senior roles such as managers. Finally, you should ensure that you have a consistent approach when dealing with anybody who is accused of treating their co-workers less favourably.

This blog was originally written by Chris Boyle. However if you would like to discuss this blog in more detail, please contact Judith Dugdale from our Small Business team. Alternatively, please call 01772 821021.

Be prepared – it could be a big year for Annual Allowance charges!

We are expecting to see significant Annual Allowance charges for 2017/18 for several reasons:

  • The rate of growth of existing benefits is quite high in 2017/18 at 4.5%.
  • In contrast to the above, when judging the growth for Annual Allowance purposes the rate by which we are permitted to increase the starting position is only 1%. The difference between the actual growth and the permitted revaluation has the effect of increasing the exposure to a charge.
  • Many people have now moved across to the 2015 pension scheme. That scheme has a higher accrual rate compared to earlier versions.  Even without considering the growth in previous years’ benefits, if you have pensionable income above £135,000 in 2017/18 in the 2015 scheme, your growth in benefits will be above the standard Annual Allowance of £40,000.
  • Many pension scheme members will have had their 2016/17 exposure to the Annual Allowance reduced by the ability to bring forward unused allowances from earlier years. As the unused allowances were used in 2016/17, most of our clients will have to rely on the availability of 2017/18 allowances alone.
  • Some higher earning clients will be affected by the Tapered Annual Allowance perhaps due to PCSE’s failure to collect 2016/17 shortfall payments in March 2018. If those payments had been made, they are deducted from income when judging the level to determine if the tapering applies.  There will be cases where the failure to collect the shortfall means threshold income is now above £110,000 and therefore the taxpayer potentially becomes subject to an allowance of less than £40,000.

Whilst the above means we will almost certainly see higher charges for 2017/18, one prospect is being considered that may assist.

Presently, the NHS Pension Scheme can pay the Annual Allowance charges under a scheme pays election only to the extent that the pension growth exceeds the standard allowance of £40,000.

Where the taper applies, and your allowance reduces to below that figure, you will have further tax to pay through your tax return, which could mean a significant amount in January 2019.

The NHS Pensions Agency is currently considering whether they ought to accept requests for the scheme to pay amounts that fall above the reduced allowance rather than only the amount that arises above the standard allowance.

Any amount that is paid by the NHS Pensions Agency will have a knock-on effect to reduce the amount of final pension benefits, so advice needs to be taken before making a scheme pays election decision either under the current rules or if they are amended in future.

We don’t know when an answer is expected, but keep your fingers crossed!

If you would like to discuss this further with a member of the Healthcare Services team, please contact David Walker.

Pension Allocation – is it any use?

I would wager that most people have not even heard of Pension Allocation (PA), which is the ability when you decide to draw your benefits to give up a certain amount to provide a pension for someone else after your death.  That person may be a spouse, civil partner, nominated partner or somebody else who is dependent upon you.

It should be noted that the amount given up is in addition to the normal spouse or dependent survivor pension rights.  The maximum that can be given up is one third of your pension, but the beneficiary cannot have a larger pension than you.  Some numbers may assist.

Your pension benefit is £30,000.  After your death there would be a normal spouse pension of 50%, so £15,000.  You can give a maximum of one third away, which would be £10,000, leaving you with £20,000.  Your spouse’s pension would therefore be £25,000 (£15,000 plus £10,000).  This is more than the amount you have retained and therefore above the maximum.

The limit of allocation in the above case is therefore £7,500, meaning your spouse will end up with £22,500 and you will receive £22,500.

It is generally of limited use as the numbers don’t seem to stack up.  Let us take the preceding figures.  You have allocated £7,500 and receive £22,500 and survive 20 years.  Total received £450,000.  Had you not allocated, you would have received £150,000 more i.e. £600,000.

Your spouse now begins to receive the spouse and allocated pensions of £22,500 but dies five years later having received £112,500.  There is therefore an overall net ‘loss’ of pension of £37,500.

The donor must be in good health and be medically examined.

When can PA be effective?

Perhaps in these situations:

  • There is a significant difference in ages between spouses and you expect your spouse to survive you for a considerable period after you die.
  • You may perhaps have a disabled dependent child that requires long term care after you die.
  • You have Lifetime Allowance exposure. The reduction to your benefits is effective as a way of reducing its value.

When consulting your Independent Financial Adviser before taking your benefits, therefore, you need to make sure that this is considered.

If you would like to discuss this further with a member of the Healthcare Services team, please contact David Walker.

NHS seeking to reclaim VAT reimbursements re premises for dispensing practices

All dispensing practices have to be VAT registered because of the zero rated supplies they make. However, because of their exempt income they can usually only recover a proportion of the VAT that they incur on expenditure, i.e. they are partially exempt. Examples of the types of expenditure of which only a proportion of the VAT incurred can be recovered include, general overheads of the Practice including gas, electric, repairs, etc. In addition, if the property is rented and the landlord has elected, VAT will be chargeable on the rent and so in most cases practices will have made a claim for a proportion of the VAT charged on rent to be recovered under the partial exemption calculation.

However this will lead to an over recovery of VAT because under the NHS Premises Costs Directions the practice would have been in receipt of a gross rent reimbursement for the whole rental cost including all of the VAT.

The new 2013 NHS Premises Costs Directions specifically clarify this issue and the rules are now being actively enforced in this respect which in many cases were not enforced under the old 2004 Directions.

The NHS England national team now consider that the duplicate reimbursement of costs is not appropriate and as such they are advising Area Teams that they should seek to recover any duplication reimbursements for however long they have arisen.

If you are approached by your Area Team you will be asked to undertake an exercise to calculate the amount of duplicated reimbursed VAT. Moore and Smalley can assist in undertaking this work and liaising with the Area Team on your behalf.

If you would like further information about this area please contact Debbie Wood on 01253 404404 or 0115 972 1050.

NHS Pension Scheme and Payroll

Processing a payroll for a specialist sector as Healthcare comes with certain rules, legislation and particular processes to follow.  An area that needs particular specialist care is the NHS Pension Scheme and how it is applied to the payroll.

When applying the NHS Pension to an employees’ record, in order to deduct the appropriate pension amounts, it is necessary to take into account a few considerations:

Establish the ‘whole time’ annual figure for the member of staff for their particular role

This is quite likely to vary from one Practice to another with no standard contract set in stone, it could range from 35,37,37.5,40 to name some common ones.  Then for each member of staff the annual figure is achieved by taking their ‘whole time’ hours for the role and multiplying this by the hourly rate particular to that role.  The ‘whole time/full time’ hours for the Practice are used to establish the tier even if the member of staff works part time.  Below are 2 worked examples explaining this further:

Example 1 : Full Time Employee working 37 hours per week

Practice ‘whole time’ hours are 37 x 52 (or 52.143 should the Practice use this ruling) = 1924 hrs x hourly rate of £9.00 = £17316 total annual pensionable pay (see table below) this would fall into 5.6% tier.

Example 2 : Part Time Employee working 20 hours per week

You would still take the ‘whole time’ hours for the Practice which in this case is 37 and follow the same calculation as above, the same 5.6% tier would be applied.

In relation to the NHS Pension Scheme, the correct percentage is applied to the employees’ pensionable pay up to and including the ‘whole time/full time’ hours worked.  The maximum number of hours that can be pensionable are the normal (standard) whole time hours for their particular role.  For example, if the standard working week is 37 hours, a part timer normally working 20 hours a week may pay pension contributions on up to an additional 17 hours per week (up to whole/full time), any additional hours over and above the ‘whole/full’ time hours would be non-pensionable.

Contribution rates before tax relief (gross)

TierFull-time pensionable pay used to
determine contribution rate
Contribution rate
(before tax relief) (gross)
1   Up to £15,431.99   5%
2   £15432.00 to £21477.99   5.6%
3   £21478.00 to £26823.99   7.1%
4   £26824.00 to £47845.99   9.3%
5   £47846.00 to £70630.99  12.5%
6   £70631.00 to £111376.99   13.5%
7   £111377.00 and over   14.5%

The employer pension contribution for this current tax year 2017/18 would be 14.38% on pensionable pay.

If you would like to discuss the NHS pension scheme and payroll in more detail, or you would like to speak with a member of our team, please contact Jane Irving or call 01524 388719 to be put in contact with a member of our Payroll team.

Self Employed – Are you properly registered?

If you are a self-employed individual, either as a sole trader or partner within a partnership, you should be formally registered as self-employed with HM Revenue & Customs. If you are not registered then you may discover that you have not been paying National Insurance contributions (‘NIC’).

 

The self-employed pay Class 2 NIC at a current rate of £2.85 per week which qualifies you for state benefits, one being the state pension. By paying a full year’s worth of Class 2 NIC you will obtain a full qualifying year for the purposes of your state pension. Under current legislation you require 35 years of qualifying years in order to obtain a full state pension. Class 2 NIC is now collected via the self-assessment tax return, it was previously dealt with as a separate monthly direct payment.

 

In addition to Class 2 NIC, self-employed individuals pay Class 4 NIC as a percentage of their profits. Class 4 NIC currently awards you no qualifying years towards state benefits. However, from 6 April 2018 Class 2 NIC will be abolished, and qualifying years towards state benefits will be dependent on the level of the individual’s profits which are subject to Class 4 NIC. This system will mirror the current NIC regime for employed individuals who pay Class 1 NIC to obtain qualifying years.

 

Before these changes are implemented it is strongly recommended that you check that you are indeed registered as self-employed with the NIC Office. If you are not then you will now need to register and carry out a thorough review of your NIC record to consider whether you should make voluntary contributions for earlier years. Before making any voluntary NI contribution it is strongly advised that you seek professional advice for the best course of action.

 

You can either request an NIC record from the NIC Office or alternatively log into your online personal tax account which will give details of your NIC record. From this record you will be able to review your NIC history and most importantly whether you have qualifying years.

 

If you would like to discuss self employment in the Healthcare Sector in more detail or you would like to speak with a member of our  team, please contact 0115 972 1050 to be put in contact with a member of our healthcare services team.

Reminder of the policy for the 31 October review of UDA’s for NHS contractors

Here we look at the guidance policy provided by NHS England to ensure that all parties to GDS and PDS contracts understand the process and procedures that must be followed when mid-year reconciliation and financial recovery are applied to dental contracts.

The policy removes any deviation from the regulations and provides a fair and equitable process for all contract holders. Is also provides an element of proportionality when dealing with contractors.

The policy will be used to implement the contractual and regulatory processes required to:

–       Review activity at mid-year.

–       Make the required financial recovery.

–       Issue a breach notice, in line with requirements as set out in part 5, paragraph 19 of the National Health Service (General Dental Services Contracts) Regulations 2005, and part 5, paragraph 15 of the NHS (Personal Dental Services Agreements) Regulations 2005.

 

Mid-year review:

The mid-year review looks at delivery against the contract and taking action where necessary. It must be undertaken by 31 October of the financial year to which it relates.

The regulations stat that mid-year processes can apply where a contractor has provided less than 30 percent of the activity that it is required to deliver in that financial year scheduled by 30 September.

The figure has to be used in this calculation is the figure given to the area team by NHS Dental Services (NHS DS), which is based on the FP17s transmitted by the contractor for completed/incomplete courses of treatment. If a contractor disputes this figure it is up to them to liaise directly with NHS DS for resolution of this dispute.

 

NHS England

Mid-year reconciliation and financial recovery policy:

The GDS regulations, in schedule 3, part 5 (38) and PDS regulations in schedule 3, part (59) states that transmission must be within two months of a completed course of treatment. If this time passes then NHS England does not have to pay for this activity nor take into account its delivery and therefore does not have to have it included within the activity report.

The area team will identify contractual activity using reports available from NHS DS. Following identification of delivery the process below will be followed.

 

Contractors who have delivered at least 30 percent of their activity (GDS, PDS and PDS Plus):

Send the contractor the standard letter in annex 2. It is also important to identify if over-delivery is apparent and include this in the letter.

 

Contractors who have delivered less than 30 percent of their activity (GDS, PDS and PDS Plus):

If a contract has achieved less than 30 percent of its contracted units of activity at 30 September, the area team need to carry out a mid-year review meeting with the contract holder. This meeting does not necessarily need to be face to face and be conducted on the telephone if appropriate. The review may be followed by an action plan to identify how contracted activity will be delivered by year end and/or a withholding of monies as described in schedule 3, part 8 (59) (3) of the GDS and PDS regulations.

If there are reasonable explanations and remedies given at the review meeting, then the area team is able to take no further action at mid-year. However, the area team should be satisfied that the contract is on target to deliver at year-end.

 

Process for area teams to follow:

– Send a letter asking the contractor to arrange a review meeting.

– During the review, discuss any written evidence put forward to demonstrate. Greater achievement and consider any reasons stated for delivery at current level.

– A final copy of the notes of the meeting, if the area team is still concerned about contract delivery it may request an action plan to be followed.

– Following the review meeting, if the area team is still concerned about contract delivery it may request an action plan to be followed.

– Following the review meeting the area team may withhold any monies as appropriate and make any adjustments to the payment.

 

NHS England

Mid-year and year-end reconciliation and financial recovery policy:

– System in accordance with schedule 3, part 8 (59) (3) of the GDS and PDS regulations.

– Area team to send a written copy of the review and any feedback from the action plan to the contractor.

 

Reductions to payments following a mid-year review

Any withholding of monies needs to be calculated in line with schedule 3, part 8 (59) (3) of the GDS and PDS regulations as below:

The maximum amount that may be withheld pursuant to sub-paragraph (2) (b) of the GDS and PDS regulations is:

– The amount that is payable under the contract is respect of the number of units of dental activity or units of orthodontic activity required to be provided in a financial year.

– The amount that would be payable under the contract as a relevant proportion of that amount if the contractor provided in the whole of the financial year only twice  the number of units of dental activity or orthodontic activity that he provided between 1 April and 30 September.