I think the underlying issue is that with the demise of primary care trusts, we don’t have one single source of payments. LESs, NESs, DESs and other payments are coming from different sources as opposed to being funnelled through one source. So we are not sure when payments appear in our statements exactly where they are coming from and what they are for. That is the first issue - it is very difficult to reconcile the receipt of those payments with where they come from or what they are for.
Number two is we don’t know if we are being paid for things that we are doing, or we are not being paid for things that we are doing. Because it is very difficult to try and trace back the source of the payment.
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The third issue is that the PCT used to pay us a quarter in advance and NHS England is now paying us a quarter in arrears.
So altogether we don’t quite know where we stand and it is going to cause problems. We are going to run into short-term cash flow problems. We are getting to a stage where, obviously we have a tax bill to pay at the end of July, we have our staff to pay on a monthly basis and we are not quite sure whether we are being paid correctly. My practice manager is telling me we are going to have to stall on paying bills for a few weeks and hold onto them until we are more sure of exactly what is going on. That is any bill apart from things we have to pay, like staff or rent - so suppliers, for instance. Stationery, vaccines, we will have to hold off paying them for a week or two. All of those small things.
And that has knock-on effects if the creditors of those cheques are small businesses as well. So I am concerned. I am sure it will reconcile itself in the end, but we are heading into cash flow issues now because of the reorganisation of different parts of the NHS.
We reduced our drawings anyway, albeit temporarily, because we are a very prudent practice. We underdraw and we save to pay for tax, but despite that we are still going to run into cash flow issues. In percentage terms, we reduced our drawings by about 15% at the beginning of April because we knew we would run into problems.
I don’t blame the people in the position of carrying out the payments because everything has been thrown up in the air and a lot of history has been lost. A lot of organisational memory has been lost as well. So it is now coming back and the poor people in charge at local authorities, NHS England area teams or CCGs have to pick up the pieces.
Dr Dennis Abadi is a GP partner at a large practice in St John’s Wood in northwest London
