Exclusive GP practices have been under-paid by thousands of pounds for the avoiding unplanned admissions DES, which NHS England have said is their own fault for ‘misinterpreting’ specifications.
Pulse has learnt that practices have lost up to £1 per patient on their practice list after being penalised for failing on the ’care plan review’ element of the DES due to apparent discrepancies between the guidance supplied to practices and the guidance provided to clinical IT systems.
As a result of the lack of clarity from the guidance, some practices had not carried out care plan reviews as often as they needed to in order to receive full funding.
It comes as Pulse has learnt that there has been a series of problems with payments for the DES.
The GPC said under-payment for the DES was a ‘significant issue’ and it is ‘urgently’ taking it up with NHS England.
But NHS England have laimed that the fault lies with the practices.
This is one of several problems identified, which include:
- Changes to coding for the DES this year have caught out some practices who are facing non-payment as a result;
- Practices are having to manually input records of patient deaths, which are not being picked up by the automatic extraction;
- The GPC had already declared a failure with October’s AUA DES collection, which meant HSCIC had to run a second collection.
However, the most damaging problem centres on the frequency of the care plan reviews, which involve practices looking at the care plans of the 2% most vulnerable patients on their list.
Many practices were under the impression that the reviews could take place at any point during the 2015/16 financial year for them to achieve maximum payments for the DES.
But the specifications used in the IT systems says that reviews have had to have taken place in the past 12 months – meaning any practices that were planning on undertaking reviews later this year would have failed this element.
An email from NHS Mid Essex CCG to affected practices seen by Pulse encourages them to dispute their achievement, pointing out that the communication was ‘not clear’.
GPC contracts lead Dr Robert Morley explained that practices were potentially losing £1 per registered patient as a result of the wording of the care plan reviews.
He told Pulse: ’The DES specification wording is ambiguous and, needless to say this has been compounded by the typically unreasonable and inflexible approach taken by some local commissioners where practices have done their best in good faith to fulfil the requirements of the DES.
’Practices’ losses could be £1 per registered patient because of this. The matter is being taken up urgently with NHS England by the GPC’s executive team.’
However, NHS England has told Pulse that practices were ‘misinterpreting’ the terms, and denied that it had supplied differing guidance to GPs and IT suppliers.
They told Pulse: ’Some GP practices may have misinterpreted the terms of the enhanced service specification and associated guidance. We can confirm that that there is no error in the HSCIC data collection and that it’s not the case that NHS England provided the wrong instructions.
’If a practice believes that their reported achievement is incorrect for any reason they should contact their local NHS England team who will work with them to resolve the problem.’
HSCIC said it was aware of the new issue related to the DES, ’which a small number of GPs have reported to their suppliers’.
A spokesperson said: ’This is around the interpretation of guidance and we are working with suppliers on a case by case basis to support them to resolve any issues as they arise.’
Dr Gavin Jamie, GP and expert on QOF and contractual issues, said: ’This is quite a hefty clawback for practices. The “rolling” nature of the DES is quite a contrast to the year end nature of the QOF. It is certainly becoming more and more complicated for practices to ensure they get the payments that keep them going.
’If there is no plan to extract the data from practices again – and I have not seen any such plan – then it will be up to practices to try to convince their local contract manager directly.’