GPs receive less than £2 per patient in Covid cost reimbursements

Exclusive CCGs on average reimbursed GPs £1.69 per patient for additional Covid-19 costs in the first four months of the pandemic – far below the £3 per head set aside by the Treasury.

In some 25 regions of England GPs have been reimbursed less than £1 per patient by commissioners, according to data supplied to Pulse by 90 CCGs under a Freedom of Information request in August.

Details of NHS England’s General Practice Covid Support Fund – covering reimbursement for costs related to bank holiday opening and staff cover, but not PPE – were delayed until August.

In the months before, some CCGs used their own reserves to pay back GPs but others waited.

The BMA said the ‘significant initial delay’ to the national Covid-19 fund being finalised had placed many practices under ‘financial strain’. It also warned that some CCGs were refusing to approve appropriate claims.

Pulse’s data show the lowest overall reimbursement level was in NHS South Sefton CCG, with 12p per patient returned to GPs by the end of August, and the CCG having paid out around £19,000 overall – though the CCG said it had authorised all claims.

Meanwhile NHS East Lancashire CCG has provided the highest sums of reimbursement for GPs – an average of £4.82 per patient up until the end of July, or a total £1.87m across the region.

On average, GPs have been able to claw back the most money for staffing costs, followed by PPE (see chart, below).

But in NHS Manchester CCG, commissioners had not paid GPs for any of their PPE costs by the end of August due to awaiting further funding details from NHS England – though it said it had ensured PPE supplies were available.

It said in its FOI response: ‘No direct reimbursement has been made yet for PPE. This is subject to further national guidance.’

A spokesperson from Manchester Health and Care Commissioning, a partnership between NHS Manchester CCG and Manchester City Council, later told Pulse: ‘In terms of reimbursement MHCC is following the “Covid-19 support fund for general practice” guidance which was published on 4th August.

‘Returns from Manchester practices are currently being reviewed and these payments will be made in line with the payment timescales outlined within the guidance.’

The spokesperson stressed the CCG had begun to recompense practices for opening during 2020 bank holidays, ahead of NHS England’s guidance.

GPs had up until earlier this month, on 15 September, to submit their reimbursement claims to commissioners under NHS England’s General Practice Covid Support Fund.

The Treasury has budgeted an average of £3 per patient for GP costs for the fund, to cover the first three months of the pandemic, with NHS England set to top up that figure.

Pulse asked CCGs last month how much money they had paid to GPs so far and for what items.

A total of 90 CCGs covering 43.1m patients provided FOI responses in relation to reimbursement largely up until the end of July, and around half of those provided data for August too – revealing £72.8m had been reimbursed so far.

GPs received an average of 41p per patient for staffing costs to cover absence – such as when shielding or self-isolating – according to data provided by 54 CCGs.

On average, GPs received 19p per patient for PPE reimbursements, based on the 59 CCGs supplying data.

GPs have said low levels of reimbursement are likely down to the months of delays before the Covid fund was released.

But they also say CCGs are not processing all legitimate claims, in some cases because they fear looking ‘greedy’.

NHS Doncaster CCG had reimbursed £52,000 – an average of 16p per patient – to GPs by August.

GP Dr Dean Eggitt, chief executive of Doncaster LMC, said: ‘I’m unsurprised that Doncaster CCG has had such little Covid reimbursement.

‘We actually had a challenge convincing our CCG to place claims at all.’

He added: ‘I suspect our low Covid reimbursement is a sign of not wishing to be seen as “greedy”.  This will have wider system consequences. No money results in less care for patients.’

A spokesperson for NHS Doncaster CCG said: ‘NHS Doncaster CCG has followed and continues to follow guidance given by NHS England and NHS Improvement relating to the supply and reimbursement of PPE for local practices in Doncaster, as well as other costs, to ensure practices could operate safely and efficiently.

‘Throughout the coronavirus pandemic, we have continued to ensure local practices have enough PPE and the resources they need to provide health and care services safely.’

They added that further GP costs had been reimbursed since Pulse asked for data last month.

Meanwhile, a spokesperson for NHS South Sefton CCG, which reimbursed 12p per patient up until August, said: ‘At the time of the FOI request, not all practices had submitted claims so the value only represents a small number of South Sefton practices.’

They added: ‘All claims submitted to South Sefton CCG were authorised. the process was done in agreement with the local medical committee.’

BMA GP Committee chair for England Dr Richard Vautrey said: ‘The significant initial delay in funding to help practices manage the demands placed upon them by the pandemic has already placed many practices under financial strain.

‘The BMA has also heard reports that some CCGs are not approving claims for some legitimate additional costs. This is not acceptable, especially if this funding is simply sitting in CCG baselines instead.’

He said national funding must be passed on by CCGs ‘quickly’ to practices and that it should be extended to claims covering costs beyond the end of July.

A spokesperson for NHS England said: ‘The NHS issued clear national guidance on 4 August setting out how practices can claim reimbursement for additional Covid-19-related costs as they continue to care for our patients.

‘Practices have been asked to submit claims by mid-September and local commissioners are expected to approve these in line with the guidance.’

To compare reimbursement levels at different CCGs go to Pulse Intelligence, our new platform providing financial tools and advice for practices in England. Sign up for a free trial to access articles and features including income comparison tools.

Additional reporting by Karl Tomusk