• TEAM
    • Laurence Slavin
    • Katie Collin
    • Anil Sookharry
    • Our full team of professionals
  • WHO WE SERVE
    • GP Practices
    • GP Partners
    • Locums
    • Salaried GPs
    • Consultants
    • Federations
    • Primary Care Networks
    • Non-Medical Individuals
    • Private Ltd Companies
  • OUR SERVICES
    • Accounting
    • Taxation
    • Superannuation And Pension
    • Cloud Accounting And Bookkeeping
    • Primary Care Network Support And Advice
    • Advisory and Consultancy
    • Partnership Mergers and Restructuring
    • Corporate Financial Governance
    • Tax Investigation Service
  • CLOUD
    • What is Cloud Accounting?
    • Xero
  • CONTACT US
  • RESOURCES
    • See more social updates…
    • Read more from our blog…
  • CLIENT PORTAL
  • Menu
  • Skip to right header navigation
  • Skip to main content
  • Skip to footer

Before Header

A Leading UK Chartered Accountant Firm Specialising in Tax and Accounting for Medical Professionals
  Call Us  Email

RAMSAY BROWN

An integrated approach to navigating the NHS’s ever-changing financial landscape.

MENUMENU
  • TEAM
        • ABOUT RAMSAY BROWN
        • With over 30 years of experience in supporting the medical community, Ramsay Brown’s partners are dedicated to enabling practitioners to serve their patients’ best interests, whilst securing their individual and practice’s financial futures.
        • PARTNERS
        • Laurence SlavinPartner
        • Katie CollinPartner
        • Anil SookharryTax Partner
        • TEAM MEMBERS No matter your needs, Ramsay Brown will ensure that you receive a personal, trusted and innovative service.
        • Our full team of professionals
  • WHO WE SERVE
    • GP PracticesProtecting patient needs, whilst securing the practice’s financial future.
    • GP PartnersServing GP partners in all areas of financial management.
    • LocumsAssisting locum practitioners in adopting and implementing the best practices
    • Salaried GPsEnabling salaried GPs to simplify accounting while meeting the financial needs specific to their professional and personal goals.
    • ConsultantsEnabling medical consultants in optimum financial management and minimising tax liabilities.
    • FederationsEmpowering Federations to support the medical sector.
    • Primary Care NetworksEmpowering Networks to support the medical sector.
    • Non-Medical IndividualsDelivering on our clients and their families’ needs.
    • Private Ltd CompaniesTailored approach and reliable industry reputation.
  • OUR SERVICES
    • AccountingBreathing financial energy into organizations, keeping them fortified against losses and enabling optimum financial management.
    • TaxationNew perspectives to tax planning.
    • Superannuation And PensionNavigate through the complex landscape of NHS superannuation pension.
    • Cloud Accounting And BookkeepingVirtual bookkeeping using digital access technology.
    • Primary Care Network Support And AdviceDedicated support and advice.
    • Advisory and ConsultancyOvercome challenges and remain competitive.
    • Partnership Mergers and RestructuringRestructuring, merger and acquisitions.
    • Corporate Financial GovernanceAssisting corporates in financial governance, risk mitigation and compliance enhancement.
    • Tax Investigation ServiceSubscribe and protect yourself.
  • CLOUD
    • What is Cloud Accounting?Virtual bookkeeping platform.
    • XeroTop choice cloud accounting software for medical professionals and hospitals.
  • CONTACT US
        • OUR ADDRESS

          The Brentano Suite
          Solar House
          915 High Road
          North Finchley
          London N12 8QJ
          United Kingdom

          View Map
        • OFFICE HOURS

          Call us on 020 8004 0555 - we're open Monday to Friday, 8:30am until 5pm.

          View full contact details
        • ONLINE

          Email us at info@ramsaybrown.com anytime - or use our contact form and we'll get back to you.

        • SOCIAL
          • Facebook
          • Instagram
          • LinkedIn
          • Twitter
  • RESOURCES
        • RECENT TWEETS
          • Fraud in General Practice, PCN action now, Incorporating PCNs and other useful tips - https://t.co/7ctXjo9qTy https://t.co/33RO0CDvtx3 days ago
          • Introducing Hubdoc - the free App to Record your Personal Expenses - https://t.co/w70XHratwa https://t.co/cLOAZqNrGk13 days ago
          • In order to provide strategic support for networks, Ramsay Brown Chartered Accountants supply updates and advice on… https://t.co/BF4wq0MZnd27 days ago
        • See more social updates...
        • LATEST BLOG POSTS
        • Fraud in General Practice, PCN Action Now, Incorporating PCNs and Other Useful Tips

          Introducing Hubdoc – the App that Records and Allocates your Tax Deductible Expenses for you

          End of Year Financial Planning for PCNs

          10-Minute Guide to The March 2021 Budget

        • Read more from our blog...
        • SECURE FILE SHARING

          Ramsay Brown uses Virtual Cabinet to securely share files and sign documents - a streamlined process that is supremely easy to use for our valued clients.

          EXISTING CLIENTS Secure Login
  • CLIENT PORTAL

Primary Care Networks, Federations and the Brave New World – Learning Lessons from Past Failures

You are here: Home / Primary Care / Primary Care Networks, Federations and the Brave New World – Learning Lessons from Past Failures

April 27, 2019 //  by admin

The imminent creation of Primary Care Networks which in turn will be expected to expand into larger organisations in the future, will place some GPs into the nature of organisations with which they may be unfamiliar. My own experience so far is that a number of PCNs will be looking to work with their local federations, and that may well involve some reorganisation to meet the various legal, accounting and tax requirements.

There is a lot written about PCNs, the mandatory agreement, the various five structures mentioned in the BMA PCN Handbook, but this article is written from a different perspective, to look at two well-known failures from the past and to see what can be learned from them.

Hinchingbrooke Health Care NHS Trust

In March 2015, the House of Commons Committee of Public Accounts published an update on the failure of Circle’s management of Hinchingbrooke Health Care Trust.

The report explains that in February 2012 Circle took operational control of Hinchingbrooke Health Care NHS Trust. In 2013, the Committee reported their concerns that Circle’s bid had not been properly risk-assessed and was based on overly optimistic and unachievable savings. In the event, Circle was unable to make the Trust sustainable and in January 2015 Circle announced its intention to withdraw from the contract just three years into a ten year franchise.

What were the lessons learned?

According to the Public Accounts Committee, these are the key lessons:

  • The savings expected in Circle’s bid were unprecedented and the high risk involved played down.
  • Oversight by various parties who had a role in the organisation was poor and inadequate and no one was held accountable for the consequences.
  • The Committee commented that public bodies will not achieve value for money from their contracts until they become commercially skilled.

UnitingCare Partnership Contract

The second case to look at is the collapse of the UnitingCare Partnership contract in Cambridgeshire and Peterborough. In July 2016 the National Audit Office produced their investigation into the collapse.

According to the investigation, Cambridgeshire and Peterborough CCG commissioned an innovative integrated contract from UnitingCare Partnership, a Limited Liability Partnership (LLP) formed from two local NHS Foundation Trusts. The five year contract was terminated after just eight months because it ran into financial difficulties.

These were the key findings of the investigation:

  • On a positive note the general consensus was that the contract design for patients was innovative and ambitious, popular with patients, staff and providers. However:
  • The VAT implications of using an LLP had not been properly considered and the VAT that was expected to be reclaimed could not be, adding significant costs to the contract
  • There was confusion over who would fund the transformation funding, the CCG expected the provider to invest their own funds while UnitingCare disagreed with this expectation.
  • The 10% cost reduction over the term of the contract was optimistic.
  • There were important gaps in the specialist advice given.
  • There were limitations in the data available which meant that it was difficult to price the bid accurately.
  • The timings were too tight, the contract started on 1 April 2015 even though the CCG knew that the contract price would change.
  • Within a month of starting the contract, UnitingCare Partnership requested £34m of extra funding and by December 2015 UnitingCare was forced to terminate the contract when the CCG informed it that no further advanced funding was available.

There are a number of lessons here from these two cases:

  • Getting good advice early, especially about the structure would have clarified the VAT issue.
  • Being rushed into unrealistic deadlines can prove to be expensive and potentially catastrophic if it means that the full extent of risk has not been assessed.
  • While it is reassuring to make plans with an over-optimistic mindset, it does not help if it proves to be unrealistic.
  • Clarity over responsibilities, not just between the commissioner and the provider, but between members in the provider team is essential, effective delegation does require properly allocated responsibility.
  • There is much to be excited about with the changes in primary care and learning the lessons from the past can help avoid mistakes in the future.

This article was written by Laurence Slavin, a partner at Ramsay Brown who specialises in the finances of Primary Care and GPs. He can be contacted at laurence@ramsaybrown.com or 020 8370 7710

 

Category: Primary CareTag: Federations, NHS Trusts, Primary Care Networks

Previous Post: « Don’t Worry About Hard or Soft Brexit – Think About Hard or Soft GP Mergers
Next Post: An Overview of Pension and Annual Allowance »

Footer

MENU

  • Home
  • Our Team
  • Our Services
  • Client Portal
  • Contact Us
  • Updates
  • Privacy Policy
ADDRESS

Ramsay Brown
The Brentano Suite, Solar House
915 High Road
North Finchley
London N12 8QJ
United Kingdom

  020 8004 0555
  info@ramsaybrown.com
VISIT US

FOLLOW US
  • Facebook
  • Instagram
  • LinkedIn
  • Twitter

Copyright © 2021 · Ramsay Brown Chartered Accountants