GP Practice Management

The Additional Roles Reimbursement Scheme is widely misread as free money for extra staff, when it is a reimbursement of defined employment costs up to a capped maximum, with real tax and VAT consequences for whoever does the employing. This guide takes the practical employer view: which roles are reimbursable, how the cap works, who can legally employ the staff and how each model changes the payroll, the NHS pension, the Employment Allowance and, most importantly, the VAT supply-of-staff question. It closes with how the reimbursement should sit in the accounts.

Dispensing turns a GP practice into a business that buys and sells stock, and the accounts have to show it. This guide sets out where drug reimbursement, dispensing fees, the margin adjustment, dispensary overheads and year-end drug stock each belong in the accounts, what the Drug Tariff actually pays for, how much of a large dispensing turnover reaches practice profit, how the income is taxed and pensioned, and the one VAT point a dispensing practice owns: dispensed NHS prescription drugs are zero-rated, not exempt.

Beyond the core Global Sum and QOF, a GP practice can earn a long tail of extra income from enhanced services: nationally directed schemes (DES) the practice can opt into, and locally commissioned services (LES) that vary by area and ICB. This guide explains what these streams are, who commissions them and how to weigh whether a service is worth signing up to, how the income is taxed as ordinary practice trading profit, and where the VAT line falls.

When partners leave a GP partnership faster than new ones join, liability for the surgery does not shrink to match. A leasehold practice can leave the remaining partners holding the whole lease, and an owner-occupier practice can leave departing partners unable to sell their premises share. This guide explains how the last man standing risk arises, the protections that exist, and how the partnership deed and ownership structure are used to manage it.

A GP practice is paid for its NHS work through a monthly PCSE statement, but the amounts are not always right: Global Sum can lag a list-size or weighting change, QOF and enhanced-services payments can be late or short, and premises figures can drift. This guide explains how to read the PCSE Online statement, how to reconcile each line against the Statement of Financial Entitlements and the practice's contract, and how to spot, query and recover an underpayment, with the discipline tied back to accurate trading profit and the partners' shares.

Alongside its NHS contract a GP practice earns a long tail of private and non-NHS income from medicals, reports, travel clinics, minor surgery and certification work. This guide maps those streams, explains how each is taxed as practice trading income on the partners' profit share, and draws the medical services VAT line stream by stream: genuine clinical care is exempt, while third-party-decision reports, certain medicals and purely cosmetic work are standard-rated, with the £90,000 threshold and the partial exemption position that follow.

When a GP partnership owns its surgery, the NHS reimburses the cost of providing those premises through notional rent, the legacy cost rent scheme, or improvement grants. This guide explains how each route works, who sets the figure, and the tax point practices most often get wrong: that the reimbursement is taxable income to whoever owns the building, set against the loan interest and running costs.

Owning a GP surgery and renting one are two different tax positions, not two prices for the same thing. This guide costs each limb of the ownership decision in turn: the SDLT on a purchase or a new lease, the capital allowances available on the fixtures and on the structure, the fixtures election that is so often lost, what a premises share does to a partner joining or leaving, and the capital gains tax and Business Asset Disposal Relief position on the way out.

Most GP partners draw a profit share but have never seen how the money actually arrives. This guide opens up the engine room of NHS GP income: the Global Sum as the core per-weighted-patient payment, the Carr-Hill formula that turns a raw list into weighted patients, the Statement of Financial Entitlements that governs it, and where GMS, PMS and APMS contracts diverge. It then connects that funding to what a partner takes home, because the Global Sum is practice trading income, not a pay packet.

A PCN clinical director can be paid in several quite different ways, and the route chosen decides everything that follows: the income tax and National Insurance, whether the pay is NHS pensionable, and even whether VAT bites. This guide sets out the funding, then walks the common payment routes (through a member practice, invoiced from the director's own partnership, via a personal service company, or self-employed direct), and for each one explains the tax treatment and the pension position. Pensionability is not automatic and depends on the route, so it should be settled before the arrangement is agreed.

PCN money is paid under the Network Contract DES to a nominated payee, usually a lead practice or a federation, and only then shared out under the network agreement, which is why the practice bank statement never tells the whole story. This guide maps the flow end to end: the 2026/27 funding streams (core PCN funding at £3.059 per patient, ARRS reimbursement, enhanced access at £8.903 per adjusted-population patient, the Investment and Impact Fund and the care home premium), the nominated payee, and how each line is recognised in the practice accounts and taxed through the partners' profit share.

QOF confuses partners because the cash arrives in two parts and across two financial years: monthly aspiration payments through the year, then an achievement reconciliation after year-end. This guide explains the points-based mechanics, then does the bit competitors skip: how QOF income should be recognised in the practice accounts on an accruals basis, and how it is taxed as ordinary practice trading profit. The aim is a partner who knows why the QOF cash and the QOF profit never match in any one year.

Becoming a GP partner brings significant financial changes beyond just income. Understanding the tax, pension, and capital implications is crucial before making the transition.

A complete GP accounting guide covering the SA800 partnership structure, drawings versus profit share, NHS income streams, NHS pension on the accounts, expenses, year-end tax and MTD for UK general practitioners.

A software-agnostic guide to GP accounting and bookkeeping tools for UK medical practices. Covers what MTD-compatible digital record-keeping actually requires, how to capture NHS income streams cleanly, and how partnership records should flow from your software to the tax return.

A practical guide to GP practice bookkeeping: recording NHS income streams (Global Sum, QOF, enhanced services and PCN funding), separating partner drawings from profit share, allocating practice expenses, and keeping digital records ready for Making Tax Digital.

GP financial planning means joining up the NHS pension, your practice or locum income, protection and retirement into one plan. This 2026/27 guide covers the priorities for partners, salaried GPs and locums, and links to the tax deep-dives for the detail.

How a GP partnership allocates profit decides each partner's tax bill and NHS pension growth, because partners are taxed on their profit share, not their drawings. This guide explains prior shares, the partnership deed, the premises return and the 2026/27 numbers that matter.

What GP practice payroll actually involves: PAYE and RTI for practice staff, workplace pension auto-enrolment alongside the NHS Pension Scheme, employer secondary NIC at 15% above the £5,000 threshold (2026/27), and where partners and locums sit outside payroll.

Private clinical care is exempt from VAT, so only the standard-rated streams count towards the £90,000 threshold. This guide sorts private medical work into exempt and taxable, sets out the rolling 12-month and 30-day registration tests, and covers voluntary registration, partial exemption and the flat rate scheme.