GP accounts are fairly straighforward to read once you get to know your way around them and they will help you understand how we make the money we pay ourselves. Talking to recently qualified GPs it is not something which is well taught so here is a simple guide of what things are and what to look out for as a GP partner. Next week I will explain where to look in the accounts for things to improve your profits.
The Main Sections of the Accounts
Income – what you earned
Expenditure – what you spent
Income and Expenditure Account – the profit
Balance Sheet – a snapshot at year end of assets and liabilities which gives the total assets and cash in the practice at that date
Fixed assets – the building, things you have bought, shares in the federation etc.
Partners’ Capital Accounts – share each partner owns in the assets
Partners’ Current Accounts – cash each partner has in the practice
Profit Allocations – how the profit is divided
Schedule of Drawings – money the partners have paid themselves during the year
Schedule of Superannuation – money paid for pension contributions during the year
Income
Global Sum – this is a large chunk of income paid per head of population – the only way to increase this is to register more patients.
Enhanced Services are fees for services – the more you do, the more you get. Some of these services are earned through the PCN and then paid to practices.
QOF – this is a well known system of target based payments for clinical indicators.
Notional Rent – payment for the premises you supply. If you own your building this is income for you. If you rent your building you pass it to your landlord.
Non-NHS medical income – insurance reports, medical students, research, police work, HGV medicals etc
Reimbursements – payments by the CCG for overheads and specific costs – these have been a huge support during the COVID-19 pandemic
Non-medical income – the commonest of these is dispensing income but there may be other non-medical things practices do.
Expenditure
Staff salaries – the biggest item of spending.
Locum costs – relatively expensive compared to permanent staff
Drugs and medical consumables – includes flu vaccines etc.
Professional membership – MDU/MPS, GMC, BMA etc
Insurance – Locum and property
Repairs and maintenance – cleaning – property repairs etc
Professional fees – Accountancy, legal etc
Equipment hire and depreciation – Telephones, printers, medical equipment
Office costs – cleaning, postage, printing, stationery etc.
Income and Expenditure Account
This is the bottom line: what you earned, what you spent, what the difference is, and how much did each partner get. It tells you what has happened overall but doesn’t tell you why.
Balance Sheet
Arguably the most important and least interesting section because it just tells you what assets and cash the practice had at midnight on the accounting day. It shows you were solvent on that day but nothing else.
Fixed Assets
Again very important showing the big ticket items (e.g. premises) but nothing much happens unless it is a year when you buy or sell.
Partners’ Capital Accounts
Hugely important showing ownership of the big ticket items but you only get these when you leave the partnership.
Partners’ Current Accounts
This is the most exciting page in the accounts for existing partners because it shows how much cash they personally have in the practice. The accountants tell you how much working capital you each need to leave in the practice and so, cash flow permitting, you can take the rest home as extra cash. Our accountants advise us relatively conservative regular income to pay ourselves during the year so we always build up a surplus. This surplus is actually our own earnings which we have left in the practice over the year so we don’t get a nasty shock and have to pay money back in.
Profit Allocations
This shows the calculations of who gets what based on what it says in the partnership agreement. Typically there will be some items which are not shared between the whole partnership and these are taken out of the profit first (called prior shares). Once these prior shares are taken off the rest of the profits are allocated in the profit sharing ratios in the partnership agreement.
Not all the partners may own a share in the premises and so the notional rent may be divided among only the property owning partners in proportion to their ownership. Property owning partners may have interest to pay on their property loans and the interest is allocated to the specific partner. Not all partners may do non-NHS medical work and the profits from these may go only to those partners who do the work. Some practices allow partners to do extra sessions for the partnership rather than employing locums and get paid an “internal locum fee”. Some practices also allow partners to “outsource” some of their sessions and directly employ another doctor in their place.
Although not particularly interesting to current partners (except to check the accountants have applied the rules in the partnership agreement correctly) the Profit Allocations page is very helpful to new and prospective partners because it shows which things are shared and which are individual.
Schedules of drawings and superannuation
These show what each partner has taken out of the practice over the year (or has had paid on their behalf in pension contributions). The totals show up in the current account page as they are taken off the profits for each partner to calculate how much they have left in the practice.
Our practice gives partners a regular fixed income and then pays any surplus at the end of the year but some practices vary the partner income each month depending on income and expenditure.
Taxation
Some practices keep back tax reserves for each partner and some pay the partners gross and expect them to pay their own tax. Having your tax savings in your home bank account can be helpful if you have an offset mortgage but it does mean you have to keep track of how much money to keep back for tax.