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GP practices report payment 'chaos' after 1 April handover

Exclusive GP practices are reporting the 1 April transfer of responsibility has caused ‘chaos’ with payments that used to come from PCTs, resulting in severe cashflow problems.

Practice managers have complained of irregular payments and problems claiming for business rates and water bills, while elsewhere GPs have identified issues with PMS payments and DES reimbursement.

NHS England told Pulse that its local area teams were experiencing some ‘transitional’ problems with payments, but said it was working to sort out the issues ‘as soon as possible’.

GPs were warned to make contingency plans to protect their cashflow earlier this month, with LMC leaders warning that many of the local area teams handed responsibility for GP contracts were facing ‘huge problems’ and lacked the capacity to carry out their job effectively.

This warning looks to have been prescient in some areas of the country, with practices in London and Manchester among those to report problems.

Posting on Twitter, south London GP Dr Rosemary Leonard said: ‘Payments to GP practices in Lambeth chaotic post 1 April. Totally unacceptable - many GP and staff will get no pay at all.’

Dr Leonard was not available for comment, but one practice manager in Lambeth, who did not wish to be identified, said the problems locally related to PMS contract payments from the local area team.

She said: ‘It is in regards to the PMS payments and how we are being paid now. It’s now in drips and drabs, whereas we used to get one payment per month on a specific day of the month and everything was lumped into that payment. We knew it was all in there and you just divided it out.’

‘Now it’s so-and-so will pay this bit, and so-and-so will pay that bit, but no one knows when you’re going to get paid for that, who by, and it is still not very clear who is doing what.’

Another practice manager in Havering, who also wished to remain anonymous, complained of a lack of arrangements for paying business rates and water bills.

She said: ‘The bills are due by the end of the month and it is causing cashflow problems.’

A spokesperson for Havering CCG said: ‘The responsibility for primary care now rests with NHS England and the CCG has already met with their representatives to discuss issues such as this on behalf of our membership. We expect this issue to be resolved very soon.’

Dr John Hughes, honorary secretary of Manchester LMC and a GP in Crumpsall, Manchester, said a separate PMS problem locally had now been resolved, but added that he was also concerned about enhanced service payments.

‘There was a problem with PMS payments in the middle of April. Practices were due to be paid on the 15th but were paid on the 16th. The area team here in Manchester sent out a warning about that, so that was not a major issue.’

‘What does seem to be of a bit more concern is some of the LES and DES payments which were previously paid by the PCT. It doesn’t appear to be exactly clear who actually authorises those. So there is some concern that for the end of the month, and end of the quarter, that might cause cashflow problems.’

GPC negotiator Dr Chaand Nagpaul said: ”The main problem we are finding is that because of the changes from PCTs to local area teams some payments have not been made. My own practice was not paid for a DES from last year, for whatever reason.’

‘It may just be a delayed payment but this incurs time that practices have to spend to try to rectify the problems. Trying to find the right person is difficult. Local area teams are more remote to GPs than PCTs were. There are going to be administrative hiccups and there are going to be issues with identifying the right person to solve the problems.’

However NHS England moved to reassure practices that it was working to resolve issues.

A spokesperson said: ‘We are obviously committed to ensuring that the right systems are in place to make payments. Where there have been transitional difficulties, these will be resolved as quickly as possible.’

Readers' comments (14)

  • Yes well - as with any new system "stuff happens" - should be anticiapted abd preparations made well in advance.
    Re Dr Hughes point about no payment by the end of the quarter. Surely any prudent practice would keep reserves of at least 6 months running costs to cover this type of eventuality! It is not as if the change has happened suddenly, Practices have had the time to risk assess the transition and money should have been at the top of that list. Also why do practices appear not have quality Business Continuity Management Programmes in place? This s not just about "bird flu" and "flooding" A BCMP which meets the BS25999.ISO22301 standards will have systems in place which deal with a failure or denial of every aspect of the business. This will be required of every provider who tenders for contracts - sorry but this article simply provides examples of poor management.

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  • Janet Roberts - Can I ask what your background is, because you obviously have no concept of how practices work or are funded. To keep a six month reserve for my practice would require over £700,000 surplus cash, just sitting there ‘just in case’!

    We are continually being told to prepare for this or that, but when the biggest change in the management of the NHS comes along, NHS managers failed to prepare, simple as! Why were payments not scheduled to be a few days earlier than normal, so IF the system failed, they could make the changes needed and still pay practices on time?

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  • That is a perfectly reasonably business practice.

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  • It is rediculous to keep cash reserves of that amount. It's certainly not been considered a perfectly reasonable business practice in any of my accountancy studies! You want to keep cash working not have it sat in an account doing nothing.

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  • With the demise of another CSU in Surrey, it is clear that the problem lies with NHS management - not the GP practices.

    The CSUs and NHS management in general are not ready or capable in this interesting and exciting competitive world. The phrase - 'Not-fit-for-purpose' comes to mind and I'm saddened to see hard working GPs paying the price.

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  • @Janet Roberts
    Our paths seem to cross once again. Whilst I support your sentiment in terms of needing strong business continuity plans, you really seem to have little understanding of cash flow in small businesses? this sector's fixed costs are overwhelmingly in staff salaries and margins are slim. little room for error, I am afraid. But I guess you are promoting your business once again, just wished you would not do it on here.
    kind regards

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  • @Thomas Reihhelm
    Here here!!

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  • Not at all - pratices are businesses. They will be required to tender for some contracts. It is standard procurement practice to require tenderers to have six months reserves. If practices do not have that then they risk not securing contracts.
    In any case as I said Business Continuity demands that a sound business has sufficient financial reserves to carry reasonable levels of risk. The possiblity that there would be glitches in the payment systems during the first three months of a new system is a predictable high level risk. The same is true for any business.

    Mark - 40 years in public sector procurement, the past 20 in health and social care. Sorry to offend you Thomas but Mark asked. Yes I run a small business, Yes we carry six months reserves which were valuable when my husband had a stroke - unforseen risk! No I do not need to promote my business thank you Thomas - I am buried in providers desperate for help - I am simply making a point.

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  • Hey Jane what happened to just doing a good job within the caring profession we were trained to do and getting paid on time for doing it well!

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  • Janet,
    I'm not sure that the Government would be keen to see large amounts of cash sitting in GP practices piggy banks for a rainy day. This is public money to provide a public service. The Treasury has always released money to meet expenditure just before payment was made. They have never provided the transfer of equity to GP practices to establish these reserves and to suggest that the Practices should have established this reserve themselves is frankly ridiculous.

    The problem here is in the lack of planning of the transfer process from a poor conceptual glimmer in Lansley's eye to its ineffectual completion by Hunt.

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