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Independents' Day

NHS England 'chaos' results in practices receiving late, incomplete and unidentifiable payments

Exclusive: GPs across England are having to delay paying essential bills as a result of persistent problems with NHS England’s bookkeeping that have seen practices struggling to submit invoices and being sent incomplete and unidentifiable payments, a Pulse investigation reveals.

LMC leaders in London, Birmingham and Essex have all complained that practices are failing to receive the full payments they are due, with reports of incorrectly addressed cheques, missing payments and unpaid enhanced services work.

In one common error, GPs told LMCs of enhanced services payments ‘just appearing’ on their bank statements without any reference to what they were for. Practices said this made it impossible to ensure they were being paid for the services they were providing, or indeed if they were being paid the right amounts.

NHS England said it was aware of the problems and has now written to all LMCs asking for details of the issues practices are experiencing.

GPs told Pulse the problems stemmed from the ‘chaotic’ handover from PCTs to NHS England, CCGs and local authorities who are now all responsible for paying for different enhanced services, while NHS England pays GPs for their core contracted services.

But the problems have come at the worst possible time, with most practices reliant on payments from enhanced services to make their businesses viable in light of the continued squeeze on core GP funding.

Pulse reported last month that payments to GPs in London had been hit by the chaos, with some practices being threatened by bailiffs as a result - but the problems now appear to be widespread across different parts of the country.

A dossier of payment problems collated by Essex LMC and submitted to NHS England at the end of last month, seen by Pulse, reveals that many practice managers are still unsure where to turn for advice, with NHS England in many cases not having supplied them with relevant contact details to follow up on payments.

One practice manager quoted in the dossier said: ‘We have just received a BACS confirmation for £400 with invoice number 0001 and no explanation. We always use invoice numbers which we can identify easily so not sure why they are not using ours.’

Another practice reported that its MPIG adjustment was not paid in April so staff were told it would be paid in May, but when the payment arrived it was still for just one month. They commented: ‘It is incredibly stressful at present and general practice will be destabilised if funds continue not to come in.’

Other problems listed in the dossier included:

- practices being forced to submit claims to tight deadlines, with one practice being given just three and a half hours notice to sign off QMAS problems and reports of late notice to submit MMR vaccination claims

- unpaid enhanced services work. One practice told the LMC: ‘We are carrying on providing services for LESs and DESs which to date we have not been paid for. In the last two months we have only been paid £480. I am sure I speak for all surgeries when I say that we cannot function with such little monies coming in.’

- incorrect payments being reclaimed with little explanation by NHS England

- practices having to submit multiple invoices, with one having to send the same invoice three times after they were lost

- incorrectly addressed cheques which had to be replaced

Londonwide LMCs chief executive Dr Michelle Drage said that many practices in the capital were facing similar issues.

She said: ‘It is about the non-core contract payments primarily, things like LESs which are locally paid. Sometimes it is local area teams, in some casse CCGs, sometimes CSUs, and sometimes local authorities. The LES payments seem to be variable, depending on what postcode you are in, which area team or CCG you belong to.’

‘This is not tolerable to practices who are providing services and not receiving their due entitlement. Also, when you find a wad of money in your bank account and you don’t know where it is from you can’t query it before it gets processed. So managers are tearing their hair out because they can’t work out what this money is for - if it is accurate. It is chaos.

She added: ‘Practices are so pared down to the bone now that they need every marginal payment that they are due to be paid on time so that they can get the cash flow to pay their staff and pay their bills. These local payments are what is enabling them to survive and when you don’t get them you either have to dig into your own reserves, or borrow from the bank or go under.’

Dr Dennis Abadi, a GP in St John’s Wood in north London, said that as a result of the issues his practice is now facing cash flow problems - despite the fact that he and his four partners cut their drawings by 15% this April in anticipation of a squeeze on funding.

He said: ‘We don’t quite know where we stand and it is going to cause problems because we are getting to a stage where we will have short-term cash flow problems. 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 don’t know whether we are being paid correctly. My practice manager is telling me that we are going to have to stall paying bills for a few weeks, hold on to them, until we are more sure of exactly what is going on.’

Birmingham LMC executive secretary Dr Robert Morley said that a ‘lack of capacity’ in the local area team and the ‘shambolic consquences’ of the NHS reforms had exacerbated the problems locally.

‘We have had many problems with all sorts of payments in Birmingham,’ he said. ‘There does not seem to be any particular pattern, it is totally chaotic.’

‘All this was totally predictable, in fact inevitable, which is why last year we advised all our practices that they should talk to their accountants and banks about putting financial contingency plans in place as part of their disaster recovery plans. The evidence is now there for all to see.’

Dr David Geddes, head of primary care commissioning at NHS England, said: ‘We are aware that GP practices have reported issues regarding payments. We are working with the GPC to identify and resolve these issues, and have written to all LMCs requesting detail of individual problems experienced.’

‘We are now in discussion with NHS Shared Business Services to establish ways in which we can ensure payments from CCGs and area teams are speeded up and improved.’

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Readers' comments (16)

  • Why don't GPs go on strike ? I read over and over in Pulse complaints by GPs about their workload, about QOF, about this and that problem with the government etc Patients are getting a raw deal but what are GPs actually doing about it other than moaning ? If you went on strike patients with urgent problems can go to A&E - apparently they already go to A&E as it can be difficult to get urgent appointments at many GP practices - it can take one to two weeks to get a non-urgent appointment so what do patients have to lose by GPs going on strike ? And we might all gain, GPs and patients, if the government took notice of GPs' complaints.

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  • What about locums such as myself on a limited income who have not received the £500 payment for an appraisal done in January this year, despite numerous promises that this would be paid, and always being given the excuse that "we are having problems with historic payments". What exactly is the legal situation here? A group action organised by the BMA would seem to be a good idea.

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  • As a locum, it took me 9 months, lots of emails, phone calls and a chat with medical director to get my appraisal fee.
    It just illustrates what a complete black hole it is beyond the front doors of the CCG. comments about accountability are justified. Where is our independent complaints procedure when it comes to these financial blunders?

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  • We have faced the same problem as well . Some LES payments not received ! above all no QIPP payment at all -! the reason given they did not receive any of our submitted forms for QP!- when every thing was sent in time ( we have all sent forms and papers in sent E-mail as proof have appealed against it resubmitting all papers. We as a small practice are really having cash flow problems. I am sure other practices are in the same situation

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  • What about locums? I am still waiting for my £500 payment for an appraisal done in January 2013

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  • I sympahise with the problems that practices are now experiencing and completely understand the frustration of not knowing who is responsible for what in the New NHS. The problems are numerous but can be summarised in two words - complexity & understaffing. When GP colleagues were calling for 'PCT bureaucrats in Ivory Towers' to be fired, wasn't this forseeable? And why wasn't the profession stronger in opposing the end of the NHS?

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