If you want to manage GP accounts, you’ll need bags of flexibility and an excellent deskside manner.
Hazel Murphy has spent 20 years getting to know GPs. Having learned her specialism while working for a firm in Luton, before moving to Scotland in 2000, she has helped William Duncan & Co, a member of the Association of Independent Specialist Medical Accountants (AISMA), grow its portfolio of healthcare clients into one of the biggest in the Glasgow and Ayrshire and Arran area.
Murphy is audit compliance partner at the firm, jointly running the healthcare team with Stephen Bargh, and, as a recognised expert in healthcare accounting, delivers regular talks at NHS events.
Amid the political uncertainty post-election, the priorities for Murphy’s clients are practical ones. For example, NHS Scotland has proposed changes to GP contracts, and the firm is speaking to the experts who are managing the process in order to provide clients with the most up-to-date information.
“We don’t get involved in the politics, but there’s always talk when an election is coming up,” Murphy says. “The NHS is a huge focus for all parties, and you’re never sure what’s going to change next.” The healthcare system varies depending on where in the UK you are. Keeping up to date is a constant concern.
Meet the patient
GP practices are different to commercial clients in how they get paid, the terminology and the end-of-year accounts. “We have to deal with superannuation certificates on an annual basis, in addition to doing their tax returns,” Murphy notes.
William Duncan & Co tends to deal with GP partnerships, which are more common than single practitioners, as they can share a patient list. Although GP practices are paid a regular monthly income by the NHS, they run like a business – a fact Murphy and her team sometimes have to remind them of: “We tell them: it’s up to you to make sure you structure your business so that you’re maximising the return for yourself. That’s sometimes easier said than done with the complexities of dealing with thousands of patients.”
MTD: the prognosis
Making Tax Digital (MTD) is a concern. There is still no clear guidance on exactly what GPs will need to submit under MTD. “As far as we understand, it will be high-level – basically sales, cost of sales, and overheads,” says Murphy. “What we’re not sure of at the moment is whether we need to allocate partnership profits on a quarterly basis, which has never been done before.”
As part of the preparations for MTD, William Duncan & Co is looking at software to help GPs. Practice managers and GPs are very time-poor, so anything that limits the number of keystrokes involved in compliance is welcome.
The firm is a Xero partner, and Murphy has been running weekly Xero demos for its GP clients. She has created GP-specific report templates; GPs are particularly sold on the fact that they have a much more holistic, real-time view of their practice.
“We know Xero is working with HMRC to ensure clients are ready for the launch of Making Tax Digital, which will help ensure that the process is well managed,” notes Murphy. “The concern is for clients that aren’t on any product – how do we get them to a place where they’re comfortable that they can meet the requirements?”
The firm is in the process of moving those clients to Xero to ensure a smooth transition once MTD is introduced. “You need to think about how you can automate and streamline your practice’s workflow across all clients for better efficiency, and work through your client list to identify which businesses you’ll need to migrate to digital accounting, and when,” says Murphy.
People skills prescribed
For those thinking about specialising in the healthcare sector, Murphy says that it’s soft skills that are most important when working with GPs. As the practice structure is so unique, GPs want to know that their accountants understand how they work; their day-to-day and longterm concerns; and where they need support. You can only really learn these things on the job, Murphy argues.
“It’s about being open and building up that trust between yourself and the client,” she says. “That works with any client, but it’s particularly true for GPs. Their accounts can be quite complicated, because they work in a partnership, and we need to make sure we understand the relationship between each partner and the profit-sharing agreement between them. They place trust in us to get that right at the end of the year.”
There is a shortage of GPs, so William Duncan & Co also provides recruitment support. Clients must decide whether to take on a doctor as a partner or a salaried GP, as the cost implications differ.
“You need to avoid accounting jargon and speak to them in a way they understand,” says Murphy. “Xero has certainly helped with that. In terms of accounting skills, there isn’t much in particular that is different to any other specialist sector; what matters is the ability and commitment to invest time, and getting to understand the accounting as it affects them.”
Mark Rowland is a journalist and former editor of Accounting Technician and 20 magazine.