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Practices face £1 million clawback of payments in latest round of chaos

Exclusive GPs in one area of England are having an average of £14,000 per practice clawed back by their local area team, despite the LMC highlighting problems with the payment system 16 months ago.

The NHS England local area team had been paying practices in the former Cambridgeshire PCT area double payments in 2013/14 for enhanced services, in the latest of a long line of problems with payments that have occured since NHS England took responsibility in April 2013.

Practices in Peterborough, who aren’t facing enhanced service clawbacks, will have a ‘further deduction’ due to a ‘miscalculation’ by the area team with regards to out-of-hours deductions, the LMC says.

The LMC says that it had given the area team a deadline of December 2013 to reconcile practice payments having originally raised concerns 16 months ago, though the area team says practices were given the opportunity to flag errors.

Adding to the chaos, the area team will also have to make reimbursements after PMS practices submitted evidence that they were being underpaid because the PCT had not applied list adjustments in 2012/13.

In its October newsletter, Cambridgeshire LMC has said the reimbursement is likely to negate half of the enhanced service claw back, but that the scale of the upheaval will be ‘substantial’.

A spokesperson for NHS England (East Anglia) area team admitted that the errors amounted to more than £1 million.

They said: ‘The total value of double payment is £1,053,000 and the average overpayment payment is £14,000. This issue only applies to Cambridgeshire.

‘The area team and LMC discussed this issue in 2013, and there was a shared understanding of the difficulties in completing the reconciliation due to historical payment arrangements.  

‘All practices were encouraged, and given the opportunity to highlight any areas where they felt payments did not reconcile.’

Cambridgeshire LMC has said it’s ‘distressed’ by delays in addressing payment problems, and says the reimbursement wouldn’t have been picked up if practice managers hadn’t submitted their evidence, though the area team contests this.

The newsletter states: ‘The LMC is most distressed at the damage caused to practices by NHS England’s failure to run their side of our contract properly, and the delay and confusion in their payment systems that appear to only be resolved so much later by our accountants and their auditors.

‘The area team has accepted, on the evidence provided by the LMC with the considerable support and work of local practice managers, that… PMS practices list size adjustments were not compounded properly – from 2011 onwards – and that a corrective payment, and ongoing baseline adjustments will need to be paid.

‘These changes, for PMS practices, mitigate about half of the loss due to the enhanced services payment error.’

It adds: ‘The LMC has no way of knowing whether these new calculations are correct or not, though we do not believe that they have no basis, as we raised concerns about this potential error 16 months ago. ‘

Katie Norton, director of commissioning for the area team said: ‘The Area Team has sought to work constructively with the local practices and the LMC to effectively manage GP contracts.

‘We are disappointed that the constructive discussions we have had with the Cambridgeshire and Peterborough LMC over the last 18 months, and the significant progress that has been made, are not reflected in the minutes of the LMC meeting.’   

These are just the latest reports in the payment chaos saga that has afflicted practices since the introduction of the Health and Social Care Act, despite NHS England pledges that they would be resolved by April.

NHS England claimed in February that just two practices had been affected since Christmas, but the very next month more than 1,000 GP payments went missing, ahead of stasff payment deadlines.

The ongoing problems have since led one LMC to contemplate issuing NHS England with a breach of contract notice for failing to meet their obligations, and the GPC have advised practices to file claims for missed payments.