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Revealed: Almost half of English GPs still being affected by payment chaos

A Pulse survey has revealed that almost half of GPs in England are still facing unresolved issues with late or incomplete payments, indicating just how long-term and widespread the chaos has been since the transfer of responsibilities from PCTs to NHS England.

There have been numerous reports about practices missing out on payments or receiving incomplete paperwork since April but Pulse’s survey of 586 GPs provides a national picture, revealing that almost one in two English GPs is still being affected, with a further 44% being underpaid for services they had already delivered.

GP leaders have said the situation is ‘unacceptable’, with GPs having to take real-term pay cuts as result of an ‘over-bureacratic’ system.

Throughout this year Pulse has reported a string of issues with GPs receiving late or incomprehensible payments from CCGs, local area teams and other agencies as a result of the abolition of PCTs. Some practices have been threatened with court summons to take their properties away, with a cluster of practices in one region all facing legal action, while others have been forced to take out overdrafts to manage cashflow problems.

Pulse’s survey revealed that the majority of GPs have been affected in some way by the problems, with 366 out of 586 GPs who answered the question (62%) saying their practice had suffered. Out of the 586, 270 (46%) said that the problems had not yet been resolved.

A further 44% of the total number of respondees said they had been underpaid for services delivered since April, while close to one-third of GPs (30%) have received unidentifiable bills, a major problem to practice managers.

The survey also revealed that almost a third (30%) of GPs were experiencing problems with payments for enhanced services and one-in-five (19%) with QOF payments, while 8% reported receiving incorrectly addressed cheques.

In September, Dr Ian Hume, chair of the GPC’s Practice Finance subcommittee told Pulse that practices were having to take out overdrafts as a result of the chaos, and this survey backs up his findings, with 14% of GPs saying they had to take this course of action. A further 27% of GPs said their practices had been forced to delay paying out partner drawings as a results of problems.

A small number of GPs said they had also had to delay payments to staff (2%) or paying suppliers, with 13% delaying payments to non-essential suppliers and 5% delayed payments to essential suppliers.

Earlier this month, Pulse reported that a joint working group with representatives from NHS England, GPC, SBS and IT services had been set up to try to resolve the issues nationally, and NHS England said this group was still working to find a solution.

But Dr Peter Swinyard, chair of the Family Doctor Association and a GP in Swindon, Wiltshire, said the situation was ‘unacceptable’.

He said: ‘The whole system seems to be descending into chaos. We used to have a good paper system. With the PCTs we had an acceptable computer system. With the LATs/CCGs we have an unacceptable and over-bureaucratic computer system where even the providers of the system don’t seem able to identify payments so our managers can check them. GPs are having a major real-terms pay cut due to this. They are having to go cap-in-hand to increasingly unsympathetic bank managers – who see GPs as a much poorer risk than before – and GPs’ credit ratings are taking a bad knock.’

He added: ‘How very dare they? Would love to see the pay of senior civil servants and politicians dealt with in the same way – the mess would be sorted out very expeditiously but they do not think we have the clout to make life difficult for them so they continue to ignore the problems of late, unidentifiable payments with vast increases in the paperwork needed to make the claims.’

Dr David Geddes, head of primary care commissioning, at NHS England, said: ‘We are acutely aware that payment issues are creating cash flow problems and other difficulties for some GP practices and we are doing all we can to rectify this.

‘We have set up a GP payments working group and this is now focusing on priority action areas as identified by its members. The GPC has been very helpful in supporting this piece of work. In the meantime, if any practice is suffering with significant difficulties, please contact the area team who can discuss measures that can be taken to help.’

Survey results in full

Total number of GPs who responded: 586

Has your practice suffered from payment problems since the 1 April handover from PCTs to CCGs and NHS England local area teams? (Please tick all that apply)

Yes: 366 (62%)

No: 64 (11%)

Don’t know: 158 (27%)


Yes, my practice has been underpaid for work delivered: 258 (44% of all respondents)

Yes, my practice has been sent unidentifiable payments: 176 (30% of all respondents)

Yes, my practice has experienced enhanced service payment problems: 174 (30% of all respondents)

Yes, my practice has experienced QOF payment problems: 112 (19% of all respondents)

Yes, my practice has experienced incorrectly addressed cheques: 45 (8% of all respondents)


If you answered yes, are the problems still ongoing?

Yes – 270 (46% of all respondents)

No – 83 (14% of all respondents)

Didn’t answer/no problems in the first place – 233 (40% of all respondents)


How has your practice been affected by payment problems this financial year? (Please tick all that apply)

Had to take out or extend overdraft: 83 (14% of all respondents)

Delay paying drawings: 157 (27% of all respondents)

Delay paying staff: 12 (2% of all respondents)

Delay paying non-essential suppliers: 78 (13% of all respondents)

Delay paying essential suppliers: 31 (5% of all respondents)


About the survey

Pulse launched this survey of readers on 15 October, collating responses using the SurveyMonkey tool. The 26 questions asked covered a wide range of GP topics, to avoid selection bias on any one issue. The survey was advertised to readers via our website and email newsletters, with a prize draw for a Samsung Tab 2 tablet as an incentive to complete the survey.

As part of the survey, respondents were asked to specify their job title. A small number of non-GPs were screened out to analyse the results for this question. GPs were also asked on a voluntary basis to provide their GMC number and 549 of the 647 GP respondents did so, although these were not verified or used to screen out respondents.