PMgr is responsible for all aspects of administration in the surgery and here only certain areas are dealt with and reference to other sections are indicated.
IMT specialist should take care of all issues regarding communications and for the rest PMgr is responsible for the rest.
These sections are dealt with below:
8.1. Communications -Telephones
8.2. Computer, Printer, scanner and accessories.
8.3. Post, printing and Stationery.
8.5. Motor and Mileage.
8.8 Bank Charges
8.10 Petty cash.
8.1 Communications – Telephones Details dealt with in Section 2.6
Computer, Printer, Scanner, accessories:
Sections 2.2.5 to 2.2.9 deal with the basics for the systems used – computers, printers, fax, scanners and computer systems. PMgr would be the principle person for choosing the computer system provider along with GPs and IMT specialist. Once the system is in place, IMT specialist has to take over the running of the ‘show’ as detailed earlier in Section 3.0.
Modern surgeries have much better facilities:
- All staff has their own computers apart from all GPs, Nurses and HCA.
- Only in Reception they may share computers but at least two would be provided, sometimes three depending on the way the reception is set up. If they have 3 receptionists dealing with Appointments, Registration and Telephones then each must have one computer for access and quick response.
- There should be a separate computer for doing prescriptions and at least two other rooms for HCP visits.
- Each room will have its own printers, as the costs for these have spiralled down.
- The main heavy-duty printer, Copier along with a scanner may be in the main Administration room where usually medical secretary is seated.
- All consumables and accessories – which are the expensive items like cartridges – have to be ordered on time, stored in a secure place and continually made attempts to look for cheaper but good quality alternatives to reduce costs.
Computer system security units and disks need to be carefully kept away from anyone misusing it – only IMT specialist or PMgr should have access to it as the whole surgery operation depends on the main unit, which is usually monitored by the system provider, to fix any faults from their offices without the need for a visit.
Post, Printing and Stationery
Traditionally, the letters, duly addressed and stamped ready for the day are posted in the letterbox. Medical secretary usually does these as she leaves for home or sometimes by any of the receptionists. PMgr or senior receptionists usually deal with post office work relating to purchases of stamps, small items of stationery etc. For regular supplies of stationery items, like Copying paper, inks, cartridges etc., it is better to have accounts with three major suppliers like Staples, Office World and Vikings to get maximum discounts from time to time. Newsagents usually sell stamps, saving a lot of time waiting in a queue at the post office.
All staff working in the surgery has to make their own arrangements for travel – bus, underground, trains or cars and daily expenses for these would not be reimbursed. This applies even to GPs. Expenses for surgery related travel, which is mostly local, couldn’t be claimed as per HMRC rules.
Only when taxis had to be arranged in special cases for the patients to take them to hospitals, when it may not be a serious ambulance case, then the expenses have to be properly recorded, receipts filed and claimed as allowable expenses in the surgery accounts.
GP partners and other GPs, Nurses, HCA PMgr and other staff going for conferences and courses outside the area can claim reasonable travel and related expenses ensuring the proper receipts are kept and handed over to the accountant or the PMgr when claiming
8.5.1 Motor and Mileage
The above expenses could only be claimed by the GP partners and for mileage, as per HMRC formula applicable.
This is a complex issue, particularly for a GP surgery, and the accountant should be able to deal with it while doing final accounts.
Motor expenses allowed using the HMRC approved mileage rates (45p for up to 1000 miles and 25p for over 10000 miles). These rates are designed to cover the routine running, maintenance and depreciation of that vehicle.
HMRC guidance states that costs not covered by the mileage rate are those specific to that journey, such as tolls, parking and congestion charges are allowable.
The BMA is a voluntary membership organisation for doctors and, as such, under the Data Protection Act, their records are strictly confidential. They are, therefore, unable to provide members of the public with contact details for any of their members – or to pass on correspondence from third parties to their members.
See respective web sites given in References on details of memberships and benefits.
Benefits for individual and a GP group scheme:
MPS provides first-class specialist legal advice and representation in a range of circumstances, such as clinical negligence claims, disciplinary hearings and GMC fitness to practise proceedings.
MPS produces a range of serial publications to cover the main medico-legal issues GPs may face in their everyday practice.
Casebook – The flagship journal of MPS. Published three times a year, each issue is full of news, features and case reports.
Your Practice – Looks at real problems and concerns that practices have, giving practical tips for use in your own practice.
GP Registrar – A magazine specifically for GP specialty trainees covering the medico-legal subjects that are important once they start working in general practice
Sessional GP Features case studies and practical examples for locum and salaried GPs to help them avoid running into problems.
MPS also produces a wide range of factsheets and booklets, which provide practical advice on a variety of important medico-legal topics such as, consent, medical records, confidentiality, parental responsibility and complaints.
8.6.3 GMC (General Medical Council)
The GP Register was established on 31 March 2006. From 1 April 2006, all doctors working in general practice in the health service in the UK, other than doctors in training such as GP Registrars, have been required to be included on the GP Register. This requirement extends to locums.
Eligibility for inclusion on the GP Register
Doctors are entitled to have their names included on the GP Register if, in addition to being a registered medical practitioner, they:
- Hold a Certificate of Completion of Training (CCT) in general practice.
- Are a national of a relevant European State, or have EC rights and hold qualifications in general practice listed in Annex 5.1.4. Of Directive 2005/36/EC.
- Have an acquired right to practise as a general practitioner in the UK
- Fall within such other categories provided for in the General Medical Council (Applications for General Practice and Specialist Registration) Regulations 2010
One could view these Regulations in GMC Legislation section, and can find out more about CCTs in background information on specialist and GP certification.
Accessing the GP Register
One can access the GP Register via our online Register, the List of Registered Medical Practitioners.
Primary Care Organisations and performers lists
Primary Care Organisations (PCOs) are primary care trusts in England, Health and Social Services Boards in Northern Ireland, Local health boards in Wales, and primary care divisions within area health boards in Scotland.
PCOs are responsible for maintaining primary medical performers lists.
GP registration (i.e. being included on the GP Register) is one requirement for entry to a medical performers list for GPs, although this does not apply to doctors in training, such as GP Registrars. When a doctor applies to join a performers list, the PCO should check the List of Registered Medical Practitioners to see whether that doctor is on the GP Register, and make other pre-employment checks.
The criteria for entry to a medical performers list are set out in Department of Health guidance. See GMC guidance on employing a doctor for further information.
PCOs undertake a series of checks, in addition to registration checks, before admitting a doctor to their performers lists. See the NHS Employers’ guidance.
If one is a GP Registrar, one needs to be included in a medical performers list if one wishes to work in the UK health service. However, one does not need to be on the GP Register to complete your training.
Before one completes training one will need to apply for a Certificate of Completion of Training (CCT).
Read more about CCTs in the background information about specialist and GP certification section.
Practice teams, nurses and managers
If one is a practice manager, nurse or physician assistant, one can join RCGP through our General Practice Foundation (GPF). As well as access to the range of learning and development resources, membership allows all team members to get involved in shaping the future of general practice.
Through the General Practice Foundation (GPF), RCGP ensures that practice managers, nurses and physician assistants have a voice in the development of general practice. By joining, team members get access to the range of CPD and practice management resources.
To join the General Practice Foundation, you can either register online or download the form and see the web site in References to get more detail on fees and term and conditions.
RCN Member Support Services
Member Support Services consists of five constituent services:
- Careers Service
- Counselling Service
- Immigration Advice Service
- Welfare Rights and Guidance Service
- Peer Support @ MSS (formerly the Work Injured Nurses Group and Disabled Nurses Network)
Pay rates for each year for RCN’s, Agenda for Change pay bands etc. can be accessed using the web site.
RCN and other outside organisations do provide courses – the former for no fees but the rest may charge a fee for participation. The free PCT courses should be attended; as these would focus more on the work need to be done for GP surgeries.
With cash strapped surgeries, the opportunity to attend these courses would be severely limited and not all nurses might be able to attend. Lot of times these courses are not really practical – viewed from the surgery point of view.
For example, they may run a course on Job Specification and Job Description and it is not unusual to mention all the aspects of qualification, skills and experience, which would merit a very senior nurse on a pay of £ 30-40k, whereas the surgery may be seeking a nurse with a pay of £ 18-20k.
The courses, therefore, need not focus on what is needed as much as what they can impart – leaving the person to scale down expectations to meet surgery needs.
Courses pertaining to procedures are extremely relevant and useful and such courses are rare. It is often a better practice to follow self-help and use Internet to gain knowledge followed by discussions with peers. GPs are rarely of help as they are quite busy and their tolerance level is extremely low.
Asking too many questions or clarifying doubts would eventually result in GPs thinking that the nurse needs a lot of support and might go against the nurse when pay rise and staff evaluation is made.
Section 18.0 deals with all aspects of surgery accounts.
The practice, depending on its size, may have an accountant working, one day a week or even part-time. He will still be deemed as a staff member from HMRC perspective and not as an independent contractor, unless the person comes for a few months on an ad hoc basis but not on fixed days to escape HMRC ruling.
In some practices, PMgr, with a good knowledge of the accounts, might deal with all day-to-day issues and act as a ‘side kick’ to the accountant. PMgr is expected to have tighter controls on all expenses and manage the petty cash expenses and income from all insurance work, HA etc. More importantly PMgr should have a good handle on all claims and ensure due amounts were collected on time from PCT appropriately.
All staff salary to be paid by standing orders to their respective banks and the mandate should be set up within 2 weeks of the employee joining the surgery. GP partners may take cash advances each month for their expenses and PMgr has to withdraw cash from the bank on the payment date. PMgr should ensure that there is enough money in the current account and, if short, then a transfer to be made from savings account.
Only GP partners would be signatory to the accounts. It is recommended that two partners sign each cheque issued for effective control. For withdrawing large sums of money from the bank, PMgr should go with another person to the bank, even if it is close by. Crime in inner cities had increased and surgery should not take chances with any attack on PMgr, thereby losing cash and injuries to the PMgr.
8.8 Bank Charges
These would generally relate to charges levied by the Banks for the accounts operated by the surgery – current and savings. Surgery should have a separate account for capital expenses like building extensions and modifications etc. and income claimed from PCT or other sources. The accountant usually deals with these. All fittings and furniture expenses should be charged to this account.
All bank accounts should be checked regularly for correctness and ensure unexplained payments or debit do not occur. If they do appear, then investigate thoroughly and obtain the correct transactions.
PMgr should have a good rapport with the Banks and able to deal with them successfully in getting better loans and mortgages for the surgery premises and for any extensions to the premises envisaged. PMgr should also ensure high bank charges are not incurred and bank accounts are in credit to meet all expenses.
Sundries are for unbudgeted expenses and, as a rule, should not exceed 3% of the total surgery expenses. Also, any one item of expenditure should be less than £100 and, preferably, most of the others less than £ 50.
It is important that PMgr budgets expenses with all thoroughness and keeps the sundries to a minimum. Food and hotel expenses for the GP partners, which are not allowed by HMRC, should not be claimed under Sundries.
However, certain expenses on special occasions, like Christmas e.g. cards and presents to a select deserving few in the practice population, might be included. Christmas lunch for staff in a modest standard restaurant might also be included as a ‘one-off’.
Common sense approach should prevail when claiming expenses under Sundries.
8.10 Petty Cash.
Practice Manager (PMgr) should record all the income and expenses on a daily basis in computer and at the end of the month should prepare a statement as below for income and expenses for the year.
See 8.10.1 Petty Cash Typical Layout
PMgr should be taking some money each month as cash for expenses for the following month.
Usually the surgery would also be getting cash payments for some services e.g. travel Vaccinations etc. from the nurses. In addition PMgr may make cash withdrawals for postage of various documents; and some income would accrue from some patients for insurance related work.
The major income would also be from cheques issued for insurance, mortgage work, passports etc.
On the expenses front, wages would be paid in cash for cleaners. Also, small contractors would do maintenance or other work on payment of cash only. Other expenses would include -Salary for temporary staff and any salary advances, tea/coffee/biscuits/milk etc. for all surgery staff, postage and sundries.
GP Partners always perceive petty cash as a high expense area and think that the PMgr might not generally manage it properly. This paranoia is endemic in all GP surgeries and PMgr should not be sensitive to these feelings or some brash comments dished out by the GP Partners.
If there were two partners, then one would be very sympathetic and seen to put up an argument for the PMgr. A wise PMgr would soon realise that it would be a ‘Laurel Hardy’ act and both GPs feel the same but one lets the other to say the harsh comments.
Petty cash usually is such a small amount in comparison to the surgery income and expenses but GP Partners give undue heavy weighting! The good work of the PMgr would only be appreciated when he is able to make IOS claims on time and the GP partners’ income increases.