GP Earnings and Expenses Estimates 2017/18

2004/05 GMS contract (nGMS)

The General Medical Services contract introduced in 2004/05 was designed to improve the way that Primary Medical Care services (GMS, PMS, APMS and PCTMS) were funded and to allow practices greater flexibility to determine the range of services they wish to provide, including through opting out of additional services and out-of-hours care. The nGMS contract was fully in place in 2004/05.
 

Accounting year-end

The period to which earnings and expenses relate is an accounting year, which may end at any time in the fiscal year. The main results of this report consider only data for contractors and salaried GPs submitting Self Assessment tax returns with accounting years (i.e. full 12 months) ending in the final quarter (Q4) of the fiscal year, i.e. 1 January to 5 April. This allows analysis of information covering the period most compatible with that of health organisations’ financial information, and also ensures that earnings and expense data relate to financial activity largely under the GMS contract which has been in place since 2004/05.
 

Additional Voluntary Contributions (AVCs)

Additional Voluntary Contributions can be made by a member of an occupational pension scheme over and above his or her normal contributions. They can buy either added years (unless the individual has achieved the maximum 40 years’ membership) or pay in on a money purchase basis.
 

Alternative Provider Medical Services (APMS)

Primary medical services commissioned from non-GMS or non-PMS providers, for example from the voluntary sector, commercial sector or other NHS trusts.
 

Contractor GP

Previously referred to as a ‘Principal GP’, a Contractor GP is a practitioner who has entered into a contract with a Primary Care Organisation (PCO), either as a single-hander or in partnership, to provide primary care services. A contractor GP may employ salaried GPs.
 

Disallowable Expenses

Disallowable expenses are defined as expenses that are not allowed for tax purposes because they are for personal rather than for business use. Examples include repayments of the capital element of business loans and expenses incurred in providing business entertainment.
 

Dispensing GP

Most GPs are non-dispensers in that they issue a prescription which the patient takes to a pharmacy for the drugs to be dispensed. However, if a patient lives more than one mile from their nearest pharmacy, they can apply to receive dispensing services from their practice. If this request is authorised by the relevant Primary Care Organisation (PCO), the practice then dispenses drugs/medicines to the patient, as well as providing the normal medical services available to other patients. For the purposes of this report, if a practice has at least one dispensing patient on its list, all GPs in that practice are classified as dispensing GPs, as it is assumed that all GPs at a dispensing practice may dispense to those patients who are entitled to dispensing services.
 

Earnings

Gross earnings for contractor GPs are based on all medical income from self-employment sources. Income from employment sources is not included in averages for contractor GPs.

The majority of salaried GPs have a combination of self-employment and employment income. Therefore, the average total income before tax is based on medical income from self-employment sources and all employment income. The total expenses figure for salaried GPs will also be based on an average total of self-employment and employment data.
 

Employee’s [superannuation] contributions

These refer to contributions paid by the individual GP to the NHS Pension Scheme.
 

Employment Income

Formerly known as schedule E income, the tax schedule under which income of directors and employees of a company (and income from pensions) were assessed until the Taxes Act was rewritten. Income that was Schedule E has been reclassified and now forms a category called “Earnings and Pension income”.
 

Expenses

These refer to the GPs’ outgoings, and relate to business costs e.g. premises, employees, interest on business loans etc. These are also known as allowable expenses under the HMRC tax regime.

Expenses are split into the following categories:

• • Office and General Business;
  • Premises;
  • Employee;
  • Car and Travel;
  • Interest;
  • Other, which includes:
• ‘Advertising and business entertainment costs’ (which were classified as business expenses up to 2006/07);
• Interest for businesses where turnover is <£85,000 and interest is not reported separately;
• Expenses for businesses (where turnover is low) and detailed expense breakdown not available;
• Cost of drugs for dispensing GPs.
  • Net Capital Allowance.

Expenses figures exclude disallowable expenses.
 

Expenses to Earnings Ratio (EER)

The expenses to earnings ratio is a measure of the proportion of an individual’s gross earnings that is consumed by business expenses. For ease of understanding it is expressed as a percentage throughout this report.
 

Fixed Share Partner

Fixed share partners are included in the contractor group and are bound to the practice via the partnership agreement. However, unlike contractors, they choose to take a fixed level of income instead of a share of the practice profits. Consequently this income, although analogous to a salary, would actually be recorded as self-employment income; s/he may also be known as a ‘salaried partner’.
 

General Medical Services (GMS)

A GMS practice is one that has a standard, nationally negotiated contract. Within this, there is some local flexibility for GPs to 'opt out' of certain services or 'opt in' to the provision of other services.
 

GPMS

GPMS results are combined results for GPs working in either a General Medical Services (GMS) or a Personal Medical Services (PMS) practice.
 

Gross Earnings (previously Gross Turnover)

Self-employment and/or employment income from NHS and private work before the deduction of total expenses.
 

GP census

The annual GP censuses in Wales, Scotland and Northern Ireland are the primary data sources of GP details for this report. Data are collected at 30 September which is the mid-point of the financial year.
 

Income before tax (previously net income)

Income before tax is the difference between gross earnings and total expenses. It can be considered as the ‘profit’ element of gross earnings for contractor GPs and (for the purposes of this report) relates to pay before tax deductions and employee pension contributions.
 

Investment in General Practice

Allocations of monies towards primary medical care to deliver NHS services to patients. However, not all the financial flows will reach the GP or practice, for example IT or cost of drugs.
 

NHS England and NHS Improvement (Region, local office)

The NHS England and NHS Improvement (Region, local offices) changed on 1 April 2015, with a subsequent restructure of the NHS England and NHS Improvement South region on 1 April 2018 and NHS England and NHS Improvement North and Midlands and East regions on 1 April 2019.  Shortened versions of their names are used in this report for presentational purposes. The table below shows the shortened versions as well as the full names.

Net Capital Allowances

A GP can claim tax allowances, called ‘capital allowances’, for the costs of (and improvements to) vehicles and equipment which are not allowable as an expense in working out their taxable profits. The capital allowance figures in the report are actually new capital allowances, which are capital allowances plus a balancing adjustment arising when an item on which a GP has claimed capital allowances is sold, given away or ceased to be used in the business. Net capital allowances can be claimed for the cost of:

• Plant and machinery, which will cover items such as GP equipment, computers and business furniture.
• Patents, certain specialist type of ‘know-how’ and research and development.
   

Pensions cap amount

In 2007/08, the maximum allowable superannuable net income for GPs that joined the NHS Pension Scheme after June 1989 was £112,800. The cap applied to NHS earnings only. Any earnings over this amount for such GPs were not eligible for superannuation contributions. However, it should be noted that GPs who joined in or before June 1989 and who have had no breaks in service of one year or more were not subject to the pensions cap.

From 2008/09, there has been no pensions cap (although a ‘virtual’ cap will apply to those GPs previously eligible for the cap and who have purchased added years before 1st April 2008, or elected (prior to 1st April 2008) to purchase added years).
 

Personal Medical Services (PMS)

The PMS contract was introduced in 1998 in England and Scotland (as in the Chapter 17c agreement) as a local alternative to the national GMS contract. PMS contracts are voluntary, locally negotiated contracts between Primary Care Organisations (PCOs) and the PMS Provider, enabling, for example, flexible provision of services in accordance with specific local circumstances.
 

Primary Care

Primary care includes medical, dental, ophthalmic and pharmaceutical services, as well as NHS walk-in centres. In the UK, all these services are managed at a local level by Primary Care Organisations (for example, Clinical Commissioning Groups in England) which are responsible for ensuring that the primary care services available meet the needs of the patients.
 

Quality and Outcomes Framework (QOF)

The Quality and Outcomes Framework (QOF) is part of the General Medical Services contract for General Practitioners and was introduced in April 2004. It enables payments to be made to general practices according to achievement in caring for patients with certain chronic conditions, and also for achievement in terms of practice organisation and management. Participation by practices in the QOF is voluntary, but most practices (including PMS practices) choose to participate.
 

Single-hander GP

A single-hander GP has no partners, but may have other staff, for example, a GP registrar (trainee GP), receptionist or practice nurse.
 

Workforce Minimum Data Set

The workforce Minimum Data Set (wMDS) is now the primary data source for General and Personal Medical statistics in England and replaced the general practice census in September 2015.  Collected quarterly, it is used to monitor the GP workforce. It records numbers and details of GPs in England along with information on their practices, staff, patients and the services they provide.