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Practices underpaid by thousands of pounds in DES chaos

Exclusive GP practices have been under-paid by thousands of pounds for the avoiding unplanned admissions DES, which NHS England have said is their own fault for ‘misinterpreting’ specifications.

Pulse has learnt that practices have lost up to £1 per patient on their practice list after being penalised for failing on the ’care plan review’ element of the DES due to apparent discrepancies between the guidance supplied to practices and the guidance provided to clinical IT systems.

As a result of the lack of clarity from the guidance, some practices had not carried out care plan reviews as often as they needed to in order to receive full funding.

It comes as Pulse has learnt that there has been a series of problems with payments for the DES.

The GPC said under-payment for the DES was a ‘significant issue’ and it is ‘urgently’ taking it up with NHS England.

But NHS England have laimed that the fault lies with the practices.

This is one of several problems identified, which include:

However, the most damaging problem centres on the frequency of the care plan reviews, which involve practices looking at the care plans of the 2% most vulnerable patients on their list. 

Many practices were under the impression that the reviews could take place at any point during the 2015/16 financial year for them to achieve maximum payments for the DES.

But the specifications used in the IT systems says that reviews have had to have taken place in the past 12 months - meaning any practices that were planning on undertaking reviews later this year would have failed this element. 

An email from NHS Mid Essex CCG to affected practices seen by Pulse encourages them to dispute their achievement, pointing out that the communication was ‘not clear’.

GPC contracts lead Dr Robert Morley explained that practices were potentially losing £1 per registered patient as a result of the wording of the care plan reviews. 

He told Pulse: ’The DES specification wording is ambiguous and, needless to say this has been compounded by the typically unreasonable and inflexible approach taken by some local commissioners where practices have done their best in good faith to fulfil the requirements of the DES.

’Practices’ losses could be £1 per registered patient because of this. The matter is being taken up urgently with NHS England by the GPC’s executive team.’

However, NHS England has told Pulse that practices were ‘misinterpreting’ the terms, and denied that it had supplied differing guidance to GPs and IT suppliers.

They told Pulse: ’Some GP practices may have misinterpreted the terms of the enhanced service specification and associated guidance. We can confirm that that there is no error in the HSCIC data collection and that it’s not the case that NHS England provided the wrong instructions.

’If a practice believes that their reported achievement is incorrect for any reason they should contact their local NHS England team who will work with them to resolve the problem.’

HSCIC said it was aware of the new issue related to the DES, ’which a small number of GPs have reported to their suppliers’.

A spokesperson said: ’This is around the interpretation of guidance and we are working with suppliers on a case by case basis to support them to resolve any issues as they arise.’

Dr Gavin Jamie, GP and expert on QOF and contractual issues, said: ’This is quite a hefty clawback for practices. The “rolling” nature of the DES is quite a contrast to the year end nature of the QOF. It is certainly becoming more and more complicated for practices to ensure they get the payments that keep them going.

’If there is no plan to extract the data from practices again - and I have not seen any such plan - then it will be up to practices to try to convince their local contract manager directly.’

Readers' comments (14)

  • So tell them to insert the DES, unlubricated. Not worth the paper it's printed on, of no proven clinical benefit, impossible to be paid for and ridiculously admin heavy. So shove it and tell them why!

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  • presumably we all achieved better than they expected last year and they had to look at a way to ensure we didn't this year. well played NHSE, well played you bunch of crooks

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  • Nothing has changed in the UK since I left a partnership just over 3 years ago.

    Back then we weren't paid our due for extended hours on the basis of a few patient satisfaction questionnaires, even though we had done the work and could prove we had done so. It's nothing more than plain theft the way some of organisations operate.

    Ask yourselves why you're all so bloody fed up with your careers, professional life and look no further than headlines such as these and real life experiences dealing with incompetent buffoons allegedly administering the system.

    There was a time when the British were considered the very best at running and administering an empire and building an administration and established institutions. No longer.......

    I can only sympathise with my colleagues who still remain.....

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  • Quote from Dr. Martin Geddes letter

    "achieve the 2% target should be based on a calculation utilising the full seven decimal places as specified in the CQRS programme"

    The GP Clinical Systems were not configured to show up to 7 decimal places and showed as 2% even when it wasnt and therby we acted in good faith,and hence GP`s should be able to mount a "class action" legal claim against their Clinical System provider- who will in turn have to claim it from NHSE if it was not included in the SLA.

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  • Your data from CQRS vanishes like our recent £1800 payment for flu vaccinations and you think it has been accepted but payments are not forthcoming.
    You have payment units on your Open Exeter statements but if you are not with the establishment, these are not paid up unlike other privileged Practices who get paid for the same details.
    We stopped buying all vaccinations including Hep A, typhoid, vit b12 and depo, zoladex etc as for 2 years it was not possible to identify payments and having spent money on these we had only a fraction of costs reimbursed.
    We missed a QIPP Meeting because CCG/NHSE wanted a meeting on this date and time and we were deprived of 30% of payment for missing the QIPP Meeting which was obligatory in this case.
    We fortunately declined to participate in any further eyewash exercises like this Unplanned admissions as it was a nonsensical exercise anyway and glad we did not allow NHSE to fool us again.
    As long as colleagues are ready to 'dive before a speeding truck for a penny'- as a colleague once put it, the establishment will fleece you. So, please think next time before getting involved in any NHSE games. This should not bother you if you are from Manchester.

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  • There are a myriad complicated ways to apply for payment for LES, DES whatever. Seriously time to tell the whole rotten edifice to shove it and get on with core stuff. The resultant shift of work to Secondary Care might give them a wake up call but somehow I doubt it. The NHS is holed below the waterline and NHSE is frantically paddling ultimately to no good effect.

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  • hands up who wants to be a partner and deal with this nonsense on a daily basis?

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  • class action and interest on late payments

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  • This is the worst written DES I have ever had the misfortune to work on!

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  • From the DES
    xiv "Patients who remain on the case management register from the previous year, will need to have at least one care review, including a review of their personalised care plan, during 2015/16."

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