N&E Devon HA faxed my practice and others at the end of May to inform
us that the payment system was unavailable and therefor payments could
not be made on time.

Resisting the temptation to tell my staff that their payment system
suffered from cascading unavailability, in case the staff developed the
same condition, I went on to reflect on the problem and produced a
solution which is in tune with the spirit of the age.

The reason that the HA fell over on payments is their antiquated IT
accounting system, to some extent, and they have a new officer doing by
all accounts sterling work upon it, so that should improve, at least
until th eyear after next.

Even more so, though, it is because of the antiquated way of working
which is forced upon them and AFAIK other HAs.  Each month they must
calculate the horribly complex fees due, and then make a series of
payments.  THis is difficult and there are not many staff in post to do
it.

Emergency Action Plan
One emergency solution which occurred to me, and which perhaps the LMC
will press for, is simply to whip out a pen, and a cheque book, and
write a cheque for the amount paid in the previous month or the
corresponding month if it is a quarter end, for each practice.  Writing
300 cheques should not take all day and should be near enough.

A balancing payment could be made in the following month and would be
likely to be small.

A General Solution, part 1
Generalising from this, it occurred to me that standing orders allow
regular payments to be made to one's regular creditors for the services
they provide.  I have several for instance for the energy, water, and
information services.

Occasionally a balance buids up, and I assume that the utilities
mentioned review about 1/10 of their accounts each month, allowing for
the absence of work done in August and December.  Balancing payments
are rarely so much as a fortnight's costs.

The HA could reduce its work, simplify it and spread it over the entire
month, by setting up a collection of standing orders for the various
suppliers of GMS it deals with.

I commend this as an idea to explore further.

A General Solution, part 2
Going a little further, as I customarily do, it occurred to me that in
many cases standing orders have been replaced by direct debits.  This
is to the benefit of banks, and to suppliers and receivers of services
and goods.

The HA could set up a direct debit arrangement for each practice to
draw down its monthly payments.  The practices could then be left to
ensure they collect the money each month, and all the HA need do is to
ensure it draws its money from the Treasury, and audit the accounts.

Helping the General Solution, Closing the Loop
Going one step futher, the calculation of the payments due depends to a
considerable degree on the item of service, and registration data which
is already held in the practice IT system.
The admin side of the clincial record system could present the correct
bills, and indeed could automatically set up the BACS or direct debit
instructions to the HA bank.

The practice audit trail would be held available to inspect, indeed it
might be interrogated at a distance via MIQUEST (provided this includes
suitable field types).


I think this should be implemented in time for ht enext quarterly
payments, and the savings in time and effort should show a profit by
the end of the year.

This is available for publication, paper serial rights, but ask first
and I assert my right to a suitable fee and to be known as the author. 
 Midgley  copyright 1998


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