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My practice manager has missed a LES payment. What should I do?

Our practice manager has failed to ensure we received the full LES payments for the last quarter, which has left us seriously out of pocket. Is it too late to claim the money? How can we find out how the mistake arose, and should the manager be penalised if the error does result in financial loss for the practice?

Dr John Grenville

Dr John Grenville: Ask your CCG for late payment

The question of whether money can be recovered from an employee or partner who has made an error or acted incompetently depends on what is written in the employee’s contract and the practice’s disciplinary procedure, but I wouldn’t advise that you fine your practice manager. 

In the vast majority of cases, recovery of the money via fines is unlikely, and you must take legal advice first if you are considering this course.

If, at any stage, you feel the need to go down the disciplinary route with any member of staff, be certain to follow your disciplinary procedure to the letter and, preferably, seek advice from the BMA or an employment lawyer beforehand.

To reclaim the money from the local area team, go back to the most recent contract that you have signed at the time of the error and check what it says about claiming deadlines. Many contracts say money should be asked for within six months or by the end of the quarter after the one in which the services were delivered, but some are less strict. If you have missed the deadline, you may still be able to ask your CCG to make an ex gratia payment. Your LMC should be able to support you in doing this but obviously it can’t guarantee success. 

Dr John Grenville is the secretary of Derby and Derbyshire LMC 

 

Phil Harnby

Phil Harnby: Cross-check your payments from now on

It seems harsh to penalise your practice manager in this situation – anyone can make a mistake. The practice will get its money in the end and imposing punitive measures is likely to damage staff morale. 

However, if this is perhaps the latest in a series of problems with your manager, you should be examining your practice disciplinary procedures to see what options you can consider. But going beyond these procedures by trying to implement penalties or sanctions could land the practice in a difficult legal position – so seek professional advice from either your HR advisers or a suitably qualified solicitor before taking this route.

A mistake like this should encourage the practice to review the reasons the submission deadline was missed and to look for ways to give deadlines greater prominence in your management processes, perhaps by assigning responsibility to additional members of staff for cross-checking that claims have been sent off on time, or by discussing deadlines in partners’ meetings.

Making late submissions for payment claims is not uncommon. Complete the late-payment process for the unpaid LES income, and explain to the processing team what has happened and why you’re late in claiming, as it may be possible to fast-track your payment. Then assess how the delay in cash flow will affect the practice. If it is necessary to inform your bank or accountant, do so as early as you can.

Phil Harnby is the healthcare group manager at RMT Accountants and Business Advisers Limited 

 

Deborah Wood: The practice must bear the loss 

If the practice manager did not know that she should have claimed for LES payments the practice was entitled to, then you must find out whether there was a failure to set out clear expectations and job specifications, or whether it is a more fundamental performance capability issue.

The latter could mean that the practice will need to start its performance capability procedures, but it is advisable to consult an employment law specialist before embarking on this process. 

However, I would argue that the practice, not the manager alone, must bear any financial loss unless there is an option to make a claim through a relevant insurance policy. Docking wages or fining the practice manager should not be an option.

If you have identified the error early, then it should be possible to make a late application for the monies due, providing the correct paperwork is submitted to support the claims for payment. The important thing is to be able to prove the work necessary to be eligible for the payment has been done and to be able to show that a mistake had been made in the claims process. 

The practice manager now needs to set up a simple spreadsheet listing each of the available LESs, the dates when action needs to be taken and the amounts to be claimed, and then cross-check to payments received. In this way, it will be possible to see quickly whether any payments are outstanding at the end of each quarter.

Deborah Wood is healthcare services partner at Moore and Smalley LLP

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Readers' comments (11)

  • It is absolutely appalling to even suggest that a practice manager is individually at fault for missing/ submitting a claim for an enhanced service or any other contracted service. Inadequate or failing corporate and financial governance would be the underlying reason for this type of organisational failure. There should be robust monthly monitoring of all practice income and achievement of contracted activity. there should be strong clinical leadership for clinical functions, with the admin team providing sound foundations to ensure that all the money that is due to come into the practice is coming into the practice. A simple spread sheet would be wholly inadequate. Organisational wide implementation, monitoring, claiming and clinical care delivery need to be in place to ensure that patients are getting high quality clinical care that this is appropriately coded by clinicians and claimed through sound administration processes. Leadership from partners and the support of specialist medical accountants is essential in ensuring the practices maximises its contracted income and delivers excellent outcomes for patients as part of the process.

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  • Considering the complexity of the process for getting paid by three (often more) different sets of commissioners, with three (+) different processes for claiming payment, and the overwhelming volume of change and emails your practice manager has to deal with, I would interpret this as someone who is drowining/stressed. Or who just made an honest mistake.

    GPs need to remember a good practice manager is worth her/his weight in gold, often saves GPs' bacon, and you have only to look at First Practice Management's practice manager salary survey, to see that we are paid a LOT LESS than our counterparts at the CCG/NHS England. We are as stressed as you lot!!!!

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  • The phrase "Our practice manager has failed to ensure we received the full LES payments for the last quarter" tells me that we are only hearing one part of the story. Singling out the PM for a simple oversight seems very harsh, and most probably counter productive.

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  • I wholly agree with what your first commenter has said. There are too many different places to claim things from and every year they get messed around with. Even if you are lucky to have supporting staff you still have to oversee that it happens. No matter how good a system you have in place it all takes time to monitor. Sadly, I like many practice managers feel that I am drowning in this job, where everything but the kitchen sink is thrown at you and the expectation is that you will embrace it, understand it, organise it, claim it etc. GP's are very good at passing everything that crosses their desk without a discussion or offering their drowning practice manager a life line because they are too busy trying to meet their own daily demands, tasks and hoops they have to jump through. Every day you may have a " to do" list that never gets done because the S*** hits the fan and guess who gets called to sort it!! You continually have to find the extra time to fit everything in. What happens when the nurse/doctor phones in sick, quick drop everything help the receptionist at 8:00 a.m. ring round cancelling appointments. The receptionist has phoned in sick, the others have commitments and cannot work tonight, guess who does it. The cleaner has phoned in sick, quick get the brush and mop out. Ring, Ring, I have so and so on the phone and they want to make a complaint can you speak to them (shall I stop doing the payroll and take the call). Knock, Knock, my colleague "won't pull her weight", Knock, Knock "I don't like the way my supervisor has just spoken to me". Knock, Knock "this patient has upset me, Ring, ring could you come and look at this for me", Ring, Ring, “my computer is not working”, Ring, Ring “my printer has stopped printing”. Today my “to do” list says it is time to update the policies in case we get a call from CQC, do they get done? Hours in the day not enough, responsibility too much and still it keeps coming. We all know what we need to do and when it should be done by but hey, it would help if the very people who employed you pulled their weight particularly when you have to keep nagging them because they are losing their own income by “not read coding” QOF/PCQF, “not using template” or escaping half way through cause it takes too long and don’t encouraging complaints by saying “no” to that nice demand patient. This job is not what it is cracked up to be, give the manager some help and look at why it has happened. In my experience most CCG’s/NHS England make allowances for late claims as they themselves make mistakes i.e. make an overpayment and claw it back several months later, quite often it is the manager who has told them about the error.

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  • Flip this round and ask the GP's to make up any shortfall between the QOF maximum and what was actually achieved, or for not maximising income from all the DES/LES on offer and see the GP's do a swift U-Tun!

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  • @12.27
    I have absolutely every sympathy for you. It is clear that the responsibilities and volume of work that a practice manager has to do have mushroomed and I know several managers who are stressed beyond belief. Practice nurses are stressed, reception staff are stressed, and so are GPs.
    The entire system is about to collapse. You clearly are at the end of your tehther and need to get some help/ set some boundaries/ refuse to answer the phone when in the middle of something else/ do not disturb button etc. speak to your partners.
    @ 4.51
    I would be worried if you were my practice manager. It is already a fact that any loss of income, for what ever reason, is Bourne directly by the partners. This is the whole point of the article. If practice income drops, the personal income of all the staff is protected but the partners take home less.
    The fact that you do not seem to understand this worries me......

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  • @4.51pm understands perfectly, I'm sure.

    Whilst I appreciate this article was probably not meant to insult all 'non-GP but still absolutely essential' staff, it will feel like it to those of us who know what challenges we face, particularly in regard to claiming what is due (often made far harder by coding failures). How easy it is to point the finger at your practice manager, without considering that CQC's 'Well-Led' line of enquiry very much includes the partners and it isn't sufficient to simply say 'but that's what I pay the Practice Manager for!'. The vast majority of us do our very best, care as much if not more than our partners do about the practice and often take the lions' share of the worry, despite being 'only' employees.

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  • Sounds like you won't have a practice manager for very long anyway so you may have other issues to worry about. Or you could try looking into possible issues such as ever expanding workload, lack of support, multiple changes in NHS Business processes caused by Lansley reforms and so on. And then try providing some appropriate professional support.
    / mentoring etc.

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  • No offence but I don't know of any other business who do not hold their senior most manager to account for loss made due to lack of diligence on their part.

    Unless the PM's job spec does not list ensuring all payments are claimed by the practice (i am aware some PMs do not have this in their job spec), I find it difficult to understand reasons given by above posters as justification. If you have signed the contract dock lists this as spec, then it is your duty to fulfill the contract. If the job is too complicated and work load unmanageable, this should be flagged up before the problem arises. After all, PM are employed as manager, not receptionists.

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  • If I, as a GP, make a mistake - however understandable, or however pressurised I am - then I must bear full responsibility for that, even to the extent of losing my licence to practice.
    What do you think it feels like to a GP to be told 'You the GP can be struck off, but if a member of your staff fouls up then the practice (i.,e. the GP partners again) must bear the responsibility and the penalty'?
    So let's get real - and institute equality. Either we are all to be held responsible for our individual actions, or none of us should be held responsible. We can't have it both ways.

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