Exclusive All GP practices who have met the minimum standards for the avoiding unplanned admissions DES will receive payments that had originally been withheld, following a nationwide review by NHS England, Pulse has learnt.
NHS England area teams had originally claimed that some practices were not eligible for the funding worth tens of thousands of pounds, despite following the guidance in the specification, and had withheld payments as a result.
In one instance, NHS managers in East Anglia had withheld payments to all practices, including those who had completed the requirements to NHS England’s satisfaction.
But a letter from NHS England has directed area teams to pay any practice that met the minimum standard of putting 1.8% of their patients on the DES risk register.
However, the area teams have been told to manually calculate practices’ achievement, which may lead to further delays in payments.
The problems centre on a dispute between NHS England and GPC around how often practices must complete a review of existing care plans to trigger payment.
GPC point to guidance given to practices, which said that they had to review care plans for their at-risk patients in the 2015/16 financial year, thereby giving practices extra time to undertake the reviews.
However, NHS England area teams claimed that practices actually had to review care plans in the past 12 months, and withheld payments for practices that had been planning to do reviews later on this financial year.
But in the letter, NHS England gives assurance that practices will receive the money even if they have not yet reviewed their care plans this financial year.
The letter states it was not NHS England’s ‘intention to withhold payment where the work has been completed’.
It recommends to local area teams that: ‘Any practice that has achieved the minimum 1.8% but has technically “failed” due to having insufficient updated care plans, or having failed to record allocating an accountable GP, should receive the mid-year payment.’
This change comes two months after Pulse first revealed the missing payments in November, with NHS England initially blaming GPs for ‘misinterpreting’ the DES specification, and causing GPC to step in nationally.
But GPC practice finance subcommittee chair and Norfolk and Waveney LMC medical director Dr Ian Hume warned that GPs would now face more delays in payments while the national accounting exercise took place.
He told Pulse: ‘If they had done a manual review, when we raised this at the beginning of December, then they would have the data available now and could pay. But the guidance from the central team was “don’t pay we’re looking at it nationally”.’
Pulse approached LMCs in Cambridgeshire, Norfolk, Suffolk and Essex to confirm that none of their practices had been paid, the region contains more than 500 GP surgeries though not every practice took on the DES.