The Annual Investment Allowance (AIA) allows health practices to obtain 100% allowances on qualifying capital expenditure.  Currently companies can claim the AIA on expenditure of up to £100,000, but that is about to change.

From 1st April 2012, the amount on which the AIA can be claimed is being reduced to £25,000.

What does this mean for you?

As of the 1st April 2012, you will no longer be able to benefit from the 100% relief on the investment of qualifying items over £25,000. If you are planning expenditure on qualifying items over £25,000 then the rate of tax relief that can be claimed in the period of acquisition will be significantly reduced.

What happens if your trading year end straddles the 1st April 2012?

The short answer is that AIA relief is apportioned. Consequently if your year end does not end on 31st March 2012, and you are contemplating significant capital expenditure in this period, please contact taylorcocks medical to discuss your best options for managing the expenditure in the most tax efficient way.

Example

A practice with a calendar year period from 1st January 2012 to 31st December 2012 would calculate its maximum AIA entitlement based on:

a) the proportion of a year from 1st January to 31st March 2012, that is: 3/12 x £100,000 = £25,000; and

b) the proportion of a year from 1st April 2012 to 31st December 2012, that is: 9/12 x £25,000 = £18,750.(Note that strictly these calculations would be done on a daily basis).

Your basic maximum AIA for this period would therefore (a) + (b) = £43,750, although if all of the expenditure is incurred after 1st April 2012 then you will lose the higher amount and its maximum would be £25,000. These rules can be very confusing and complex, and professional advice should be sought as soon as possible.

Who is it relevant to?

Everyone can claim the enhanced relief under the AIA (although for groups of practices and connected practices the £100,000 and £25,000 limits are shared between them).

Some of the items included

     – Computerised/computer-aided machinery e.g. Heart rate monitors, BP monitors

     – Building fixtures e.g. new treatment rooms; desks, carpets, information signs

     – Building security systems, lighting & central heating systems

     – Phone systems

     – Sanitary fittings

What should you do next?

The considerable reduction to the AIA threshold from the 1st April 2012 means that any large scale capital investment plans may have their tax relief significantly reduced and consideration should be given to bringing this forward, however there are anti-avoidance rules to prevent expenditure being artificially brought forward.

Contact a member of the taylorcocks medical team to see if you could benefit from AIA

Forcing warring practices to create large CCGs “may not be the best thing for patients”.

It is claimed CCG mergers should not be imposed for fear of trust issues emerging.

Speaking at the NHS Alliance’s annual conference in Manchester yesterday (30 November), Dame Barbara Hakin, National Manager of Commissioning Development at the Department of Health, said small CCGs may be forming “due to poor relations with neighbouring practices”.

She warned “it may not be the best thing for their patients” if we force such practices to come together.

Birmingham’s Healthworks Commissioning Consortium has merged with a number of CCGs to bring its patient population up from 150,000 to 400,000.

The consortium’s Lead GP, Dr Nick Harding, attributes its success with the fact practices were given the freedom of choice.

“It is easier to trust that a bigger CCG will work if you have taken the decision to merge, rather than it being forced upon you,” he said.

“It really does make a difference.”

CCGs should be the same size as current PCT clusters and cover around one million patients to avoid being treated “like children”.

Dr Richard Vautrey, Deputy Chair of the BMA’s GP Committee, told MiP that government guidance on commissioning support means ‘bigger is better’ for CCGs.

In a statement last week, the BMA claimed the introduction of commercially-focused criteria to determine eligibility for providing commissioning support will make it “almost impossible for CCGs to have their own, in-house support staff”.

Dr Vautrey claimed small CCGs are in danger of “dancing to the tune of external commissioners” in the future.
“CCGs should be brave enough to challenge what the DH and PCT clusters say and create the structures that suit themselves,” he said.

Despite not wanting “a replication of the old PCT structure”, Dr Vautrey told MiP CCGs should be the same size as current PCT clusters in order for them to hold some “clout”.

Dr Shane Gordon, Chief Executive of NE Essex Clinical Commissioning Group, criticised the BMA for “playing up to the fear” of competition in its interpretation of the DH’s draft guidance of Commissioning Support Units (CSUs).
Dr Gordon told MiP the reverse of the BMA’s fears is actually true – CCG leads are not being given the freedom to look outside of their own PCT cluster for commissioning support.

“It feels like we are being told we are too stupid to choose,” he said.

“The reforms peddle the message ‘no decision about me without me’ for our patients, so why isn’t that message the same for us as intelligent customers?”

Speaking at the NHS Alliance’s annual conference in Manchester yesterday (30 November), Dr Gordon told CCG leads to start “making noise” about CSU choice now if they don’t want to end up with the “same system as before”.

Sir David Nicholson, Chief Executive of the NHS, admitted CCGs should be able to choose between PCT clusters for commissioning support and said he is “very keen” to look into “how that can work”.

Practices that fail to work together could see patient numbers drop and their QIPP (Quality, Innovation, Productivity and Prevention) programme “fall apart”.

Speaking at the NHS Alliance’s annual conference in Manchester on Wednesday (30 November), Dr Hugh Reeve, Chair of the Cumbria Clinical Commissioning Group, said primary care providers will have to commence a radical transformation and start to work together under joint contracts.

“A co-ordinated approach to urgent care and managing long-term conditions (LTCs) is something that cannot be done by individual practices alone,” Dr Reeve told MiP.

“If practices don’t start to work together, they can “kiss goodbye” to QIPP success.”

Dr Reeve said there needs to be a “big enough population of patients and clinicians” to share best practice when developing crucial alternative primary care structures.

He told MiP that while he is not advocating practice mergers, small practices do not have the “right skill mix” to develop services alone.

Also speaking at the NHS Alliance conference, Professor Steve Field, Chairman of the NHS Future Forum, said the NHS had “lost the plot” over primary care provision. He told delegates GPs should no longer tolerate the variation in access to care.

Dr Reeve warned those practices that choose not to integrate with other practices in their area that they may start to see their patient lists fall.

“This transformation needs to happen at pace – if we do not make changes now, they will be imposed on us,” said Dr Reeve.

General practice “may not be the best place to go” for sexual health services if you don’t want your mum to find out, the Public Health Minister has said.

Speaking at a Westminster Health Forum event today (6 December), Anne Milton drew criticism for appearing to question the privacy of general practice in rural areas.

She said general practice is often the “last place” a person would go to receive sexual health advice or treatment for fear of being “found out”, agreeing it may not be the best avenue for people in rural communities seeking sexual health treatment.

One GP from London said Anne Milton’s comments were “not helpful”.

“It is this skewed public perception that is stopping people from visiting a GP and receiving the appropriate care,” he said.

“This has to change.”

Milton has since contacted MiP and said she was trying to “make the point that young people need to have the access to services they feel comfortable with”.

“GPs provide excellent sexual health care, including for young people. But in order to meet people’s needs, we need a range of services in a range of settings,” she said.

Dr Peter Marks, Director of Public Health at NHS Leicestershire County and Rutland, said stigma around sexual health is “undoubtedly more prevalent” in rural communities and Middle England, making it “difficult to access services and treatment anywhere other than a general practice setting”.

“We really need to get the message across that general practice is a confidential and private setting for conversations on sexual health,” he said.

Another GP from London described general practice as the “sleeping giant” of sexual health and said its “huge potential” is not being utilised.

“There is a perfect storm brewing and a danger general practice will lose all its sexual health services, making it very difficult to entice patients back.”

Health Secretary has told CCGs to ‘push back’ against ‘bullying’ tactics by PCT and SHA clusters used to dictate size and set-up.

Speaking at the NHS Alliance’s annual conference in Manchester yesterday (30th November), Andrew Lansley told CCG leaders ‘bigger isn’t necessarily better’.

He said even small CCGs are big organisations and advised them to look outside of the health sector to the education system to see how smaller organisations can be run.

He said it was “perfectly possible” for small CCGs to work.

“Being small doesn’t mean you are terrible. It means you can integrate with other practices, providing there are the right incentives,” said Dr Niti Pall, Chair and Clinical Lead, pathfinder Healthcare Developments CIC

“We still think talking about money is bad – it’s not – it provides incentives and as long as the outcomes are good at the end of it, it is the right way to go.”

Lansley also looked to reassure CCG leaders that the behaviour of PCT and SHA clusters will change once they become part of the National Commissioning Board.

“[PCT and SHA clusters] are still legally accountable until April 2013 and as such have a legitimate right to ask small CCGs how they will manage and big CCGs how they will maintain engagement,” he said

“This is a transition period and responsibilities and accountabilities are become gradually devolved.

“In many places we are already seeing a substantial devolution of accountability. PCT and SHA clusters have been asked to take the maximum devolution next year to fully prepare for CCGs coming out of shadow form in 2013.”

The advice comes as an NHS Alliance survey reveals six in ten CCGs feel they are being “bullied” by PCT and SHA clusters into altering their size and set-up.

Also speaking at the conference, Sir David Nicholson, Chief Executive of the NHS and soon-to-be Chair of the NCB, said “there is no right size for clinical commissioning nor is there a right place to set organisational boundaries.”

He said CCGs now have all the information they need to “get on with the job” but admitted it will be “very difficult” to drive on until we get the size right.

Plans to share patient records with private companies “rings alarm bells”, the Shadow Health Secretary Andy Burnham has said.

Prime Minister David Cameron is expected to announce the government’s desire to open up the NHS to private healthcare firms today.

“The end-game is for the NHS to be working hand-in-glove with industry as the fastest adopter of new ideas in the world,” he will say.

A £180m funding pot is also due to be unveiled to help commercialise medical breakthroughs and consult on an “early access scheme”- aimed at putting new drugs in NHS on a quicker basis.

The plans include the sharing of anonymous patient data in the hope it will speed up the development of new treatments.

Government officials claim patients are not in any danger of being identified or tracked through their records, but campaigners have publicly slated the proposals, fearing commercial interests are being put before patient privacy.
Speaking to Sky News, Burnham said he was concerned one of the patients’ groups that was on the working group looking at this issue of creating closer ties between the NHS and the private sector has “walked away”.

“That gives real cause for concern and rings alarm bells,” he said.

“The Government simply can’t say: ‘This is all red tape and it all must be brushed away’.

“Proper regulation, essential safeguards need to be in place when it comes to the use of patient data.”

Dr Vivienne Nathanson, Head of Science and Ethics at the British Medical Association, said while the proposals to share anonymised health data would benefit patients, they could also “undermine patient confidentiality”.

“We are especially worried by recommendations that would grant researchers, possibly from large commercial companies rather than the patient’s healthcare team, access to patient records,” said Dr Nathanson.

“This could mean that details of an individual’s health status and treatment will be revealed if researchers are able to search through records and identify patients in order to contact them.

“The BMA will be examining these proposals carefully. We believe that patient records must be kept confidential and be anonymised if they are to be used for research purposes unless explicit patient consent has been obtained.”

An MP fears GPs will begin to freeze out independent providers for the provision of sexual health services under the new public health commissioning arrangements.

Speaking at a Westminster Health Forum event today (6 December), Diane Abbott, Shadow Minister for Public Health, slammed the variation of primary care access in England and questioned its place in sexual health.

“For many Londoners, the average time a person has to wait on the phone to book an appointment with their GP is half an hour,” said Abbott

“This level of poor access is not good enough.”

She said “there is a real danger” GPs will commission sexual health services solely from other GP surgeries, rather than look to other independent providers post-2013.

“Community pharmacists have done a great job to make it easy for people to access sexual health services they otherwise wouldn’t have been able to access if they were left with general practice as their only option,” Abbott told MiP.
“I would hate to see a pharmacist’s role diminish because the system gives way to a GP’s inclination to commission their own services.”

Tory Minister for Public Health Anne Milton told MiP the new commissioning arrangements will lead to a more “imaginative and flexible” style of healthcare.

“Lot of different providers are looking to get involved in sexual health provision and I do not believe GPs will get in the way of that,” she said.

“Local authorities know their population better than anyone and will commission the right services to meet people’s needs.”

Abbott said the future of sexual health provision will be “tricky” and believes the “breadth and quality of commissioning of sexual health services will be constrained” by local authorities dipping into their ring-fenced public health budget for services like the gritting of roads to prevent people falling over.

Also speaking at the event, Judith Hind, Contraceptive Manager in the Sexual Health Team at the Department of Health, countered Abbott’s claim and said the conditions placed on public health funds devolved to local authorities will ensure “money is spent appropriately and not on filling in potholes”.