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A faulty production line

GPs hit with massive bills after 'inconsistencies' found in out-of-hours deductions

Exclusive Hundreds of practices have been warned that their deductions for opting out of out-of-hours provision will be reviewed, with one practice facing a £19k bill to be paid in the next 12 months, Pulse can reveal.

NHS managers have admitted that due to ‘inconsistences’ in the way PCTs applied the rules on opting out of out-of-hours provision - agreed in the 2004 GP contract - they may face under- or over-payments.

NHS England’s London area team has sent out letters to 388 practices to inform them that they were reviewing all GP contributions for providing out of hours services after ‘differing approaches’ by PCTs led to practices being paid inconsistently.

One letter, seen by Pulse, and sent this week, told a practice it had to make a make a payment of £18,700 over the following 12 months.

But LMC leaders have questioned the methodology used to identify the inconsistencies and have rejected claims that the move had been agreed with the LMC.

The local area team said that it was only clawing back overpayments over the past financial year after inheriting the payment systems from PCTs, and some practices will receive money back for underpayments too.

The letter to one practice, seen by Pulse, said: ‘NHS England is in the process of reviewing all primary care contractors’ contributions for providing out of hours services.’

‘This review will ensure that there is an equitable methodology in deduction across all practices across London going forward, and that GP practices aren’t being over, or under charged.’

‘Previously, each borough was using a different methodology to calculate the deductions and this will standardise the approach across London.’

It added: ‘In your case the difference is £-18,700.97. If this figure is negative you owe money to NHS England and if it is positive NHS England owes you money.’

A spokesperson for NHS London local area team said: ‘In line with the issued guidance and a single operating model approach, NHS England London region has written to its contractors advising them of the correct level of deduction for their decision to opt out of OOH provision. While these inconsistencies have existed for a number of years, the revised levels of deduction will be only be implemented from the 1 April 2013.’

However, the LMC leaders questioned the methodology. Dr Tony Grewal, medical secretary of Londonwide LMCs, said: ‘We have not seen the calculations that NHS England have made to compare with the calculations that PCTs have made, so we are looking for clarification on that.’

The NHS England letter claimed that the methodology ‘was discussed and approved by the LMC in October 2013’. But the LMC rejected these claims. In an email to members, it said: ‘The methodology was not discussed and agreed with the LMC in October 2013, as is stated in the NHS England letter.’

Readers' comments (11)

  • I hope NHS England can be persuaded to suspend this until agreement has been reached with the LMC about a reasonable methodology and timescale. The letter has come out of the blue at a time when general practice is already suffering cashflow issues due to problems with remuneration from NHS England the the CCGs. It also comes at a time when we 'd like to be building positive relationships with NHS England.

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  • I find this strange as back in 2010 I asked out then PCT what the methodology was to calculate the amount deducted as we have seen out list size drop and always believed it was based on that. Perhaps we will get some cash back??!!!

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  • Simple - if you've been overpaid, you have to pay it back. Without whingeing. Maybe they'll think twice about leaving this important service to third parties who generally provide a below-par service to the patient.

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  • Can GPs build a positive relationship with NHSE,when their soon to be retiring head is negative towards pimary care in its current form,nd all the noises coming out of this arm of government seem of the same tone.

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  • There will soon be many other paybacks . Qof inconsistencies , enhanced service inconsistency , in fact any excuse to pay less and claw back more. Wasn't DDRB supposed to report soon ? You can bet it will only be 3 % to cover inflation.

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  • Lies , Damn lies and statistics .

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  • "Maybe they'll think twice about leaving this important service to third parties who generally provide a below-par service to the patient."

    Do you have any idea as to how poorly OOH is funded? Perhaps the patients should stop whingeing about the service that they are paying very little for.

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  • out of hour service was unpaid work in past (before 2004) average gp earning in 1980's was 12000 pounds per year. we were paid £13 TO £18 for calls between 11pm and 7 am. rest of time including weekends and bank holidays were free cover and we had pay ooh from pocket.. if they could pay us back for underpayment for ooh till 2004 we will l be a rich ..

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  • What was the formula used by the PCTs?
    I thought it had been fixed under the new GMS contract and not changed since..
    It does seem that NHS England and/or its LATs are rewriting all elements of contracts with GP practices, without consultation, and applying massive decreases in practice income (has anyone heard of a practice being told they had a massive refund due?) retrospectively.
    Mind you, after thea debacle, it is clear that the quality of their consultation and communications is sadly lacking...
    Sorry to remain Anon:

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  • It is time to leave this mess behind. We get only £ 60.00 per patient per year profit and about £ 35.00 take home for 6 consultations and 20 pieces of paperwork [ bloods, prescriptions etc]. This game is not worth the candle anymore.

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