Exclusive NHS England has refused to pay a GP practice £20,000 of missed income from its flu vaccination campaign two years ago due to an ‘administrative error’.
GP partners at the Kingsfield Medical Centre in Birmingham noticed earlier this year that they had not been paid for participating in the flu campaign in 2021/22.
On raising this with NHS England, they were told that the practice had failed to send a signed declaration form, meaning that technically no contract was agreed to provide flu vaccines that year.
As such, NHS England has refused to make the retrospective payment, despite the practice’s consistent participation in the vaccination campaign every year.
The practice made an appeal to NHS Resolution, who supported NHS England’s decision.
One GP partner at the practice told Pulse that while the practice manager is sure the form was indeed sent to NHS England, the team is prepared to accept some fault as there is no email trail of this.
However, he said it ‘feels like a very hard judgement for an administrative error’, especially since the clinical work was ‘carried out appropriately and effectively’, and since practice has a ‘history of taking part in every flu campaign’ before and since.
The GP partner added: ‘We accept that we have made an error, but this has never happened before. We’ve always run a really good flu campaign, and we did run a good flu campaign that year – we can prove that we’ve vaccinated more than 2,000 patients in that particular campaign.
‘It’s pretty galling to have this response which feels clinical, cold, and punitive.’
He said the £20,000 is ‘very significant’ for the practice and could have been used on additional staff or resources, therefore positively impacting patient care.
The practice team feels that NHS England and NHS Resolution have focused on the technicality of the administrative error rather than the overall circumstances.
‘It’s a hit to the practice. It’s a hit to morale, and just doesn’t engender the most positive relationship between general practice and NHS England,’ the GP partner told Pulse.
The GP practice has also highlighted that if NHS England was aware of the omission in 2021/22, no efforts were made to encourage them to sign up for the flu campaign.
In NHS Resolution’s official decision, seen by Pulse, head of appeals Jonathan Haley wrote: ‘I am satisfied that the Commissioner can decline the request for payments for the period for the vaccinations given to its patient population for the 2021/22 financial year as the Contractor has not demonstrated that it submitted its DES agreement as required by the Enhanced Service Specification – Seasonal Influenza vaccination programme 2021/22 or the Enhanced Service – Childhood Seasonal Influenza Vaccination Programme 2021/22.’
Throughout the process, NHS England asserted it does not doubt that Kingsfield Medical Centre successfully administered flu vaccines to around 2,000 eligible patients during that period, but that the basis for the dispute is whether there is evidence the practice signed up in the first place.
NHS England also said the fact that the practice came forward with this information in March 2023, when their accountants noticed the missing payments, means any claim is beyond the policy window.
‘The Midlands Public Health Commissioning Team in NHS England has a clear and agreed policy that claims made outside of the 6-month contractual range will not be paid and therefore in order to be fair and transparent to all practices this policy is applied consistently,’ NHSE said.
NHS Resolution echoed NHS England’s belief that the practice ‘should have been aware sooner than the end of the next financial year that there was a problem with this DES’.
Birmingham LMC supported Kingsfield Medical Practice in this dispute, writing a letter which said NHSE’s initial decision was ‘completely unfair’.
The letter said: ‘We have based our supporting decision on information that has been supplied to us on behalf of the practice.
‘This included historical records clearly identifying the Practice as a high achiever in previous years in connection with the Influenza Vaccination Enhanced Service. In fact, the year 2021/2022 appeared to be their highest vaccination figure than any other year since the Enhanced Service inception.’
However, NHSE responded by saying that ‘historical performance has no bearing or relevance to this particular issue’.
The commissioner also highlighted that practices should have ‘robust systems’ in place to ensure more than just one individual is responsible for submitting financial documents.
NHS Resolution said ‘both parties were given opportunity to provide submissions’ to its Primary Care Appeals service ‘in line with our normal procedures’ and that the decision notice ‘sets out our reasoning’. It will further publish its its determination with full reasons on its website during week commencing 6 November.
NHS England declined to comment.
In August, the new enhanced service specification for this year’s 2023/24 flu vaccination campaign revealed that the time limit for submitting payment claims has been shortened from six months to three months.
And last month, the BMA’s GP Committee demanded an investigation into the Government and NHSE’s ‘mismanagement’ of this year’s vaccination programmes, claiming that communication were ‘muddled’ and that cuts to the Covid jab fee mean the campaigns will not be ‘financially viable’ for GP practices.
So although unlikely if they had made an error and overpaid us and it is more than 6 months then we can just keep the money? Seems that if they have a policy of 6 months then 6 months is 6 months. I know they are still rumbling on about overpayment of seniority to lower paid GP’s that is from years ago now.
I am sure we used to have clawbacks on the following year – so more than 6 months later.
But we also had to send lists of patients vaccinated, and also monthly or quarterly numbers of patients ‘dealt with’ under the LES/DES/vaccination scheme, which would count as a ‘claim’, if the Practice sent it, and should have triggered some sort of query from the NHSE at the time, not a complete ignoring of it.
It looks to me like a breach of contract by NHSE in not paying it.
it is certainly very bad faith – in a supposedly light touch/high trust environment.
Why did it not come to light earleir when the Practices LES/DES/Vaccination schemes paperworks were all checked at the annual visit?
Looks very much like NHSE are at fault here, not the Practice or PM !
I wonder if the NHS staff involved in taking this very hard-line decision to deny the £20k reimbursement have ever made a mistake themselves. This sort of hardline approach does nothing to foster goodwill – which is so important in the running of the NHS. Shame on those responsible!
We are living in a commercial world where the cards are very much stacked in favour of NHS England HMG
The ICBs will be less friendly than the CCGs but arguably the practice could approach the ICB to see if they may help in making up some of the short fall
Regret to say we are likely to see much more of this
HMRC makes mistakes on a regular basis and is very rarely forced to compensate-the approach of tax first and argue about it later with ordinary people rather than the super rich is very well established
You get what you vote for
Sadly we are now living in a world where establishment failure is bank rolled by the ordinary individual
So the commissioners have the right to refuse to pay So what!
Morals and ethics indicate that payment should be made
Where is the LMC in this case and can a judicial review be initiated?
The practice will have been struggling through Covid like everyone else
Have the commissioners read the Pied Piper of Hamelin? A kick in the teeth for stalwart work!
I don’t this is a harsh decision I think it is simply dishonourable and despicable -and ?might be challenged legally
Presumably that’s 2,000 patients who will have to go elsewhere for their flu vaccine now?
This is simple. Serve notice on all des and les. Decline to do any more vaccines. Hand back all shared agreements for all drugs. Stop doing phlebotomy in house. See the minimum number of patients and no extras or emergency due to being unfunded. Two can play this game
All of the above potentially harm yourself. I just think a tsunami of referrals because you know you can’t be too careful. Take on zero risk. Demotivating the front line really does mean the problem will land on the REMF.
Not on your Nelly has the right approach.
I’d perhaps plan to do it in a more staged way, picking the steps which avoid affecting my income first. But there are loads of steps you can take to make your point:
– Make clear that you do not intend to take part in any prescribing cost saving activity until this has been resolved to your satisfaction.
– Pick a commonly prescribed drug each month and start Px them as brands.
– 200 patienets with lipitor instead of atorvastatin will be >£4000/ month for example
– 100 patients with lustral instead of sertraline would be >£2000/ month
– 300 patients with plavix instead of clopidogrel would be >£6000/ month
we can get to 20k/ month very quickly. (as opposed to them retaining a one off 20k payment)
They are correct that they are under no contractual agreement to refund you the money.
But at the same time you are under no contractual agreement to prescribe generically.
You can achieve the same by not taking part in some optional very efficient enhanced services. Admitting every suspected DVT would be a good one and asking hospitals to take over all the shared care would cause chaos.
But I’d pick one of them for November 1st and then set out which ones you will start doing from December 1st Jan 1st and so on.
Bonglim Bong
exactly the right approach – but DO advise the staff on the phones that when the head honcho realises there is something going on, and rings you, then “you are very busy seeing patients and have said you can’t be disturbed for admin stuff………………..certainly, you will call him/her back later” – which will obviously be after 5pm because you are sooo busy !
“i did ring back sir – but i didn’t get an answer” !
plenty of ways to skin a cat !
remember – “one man who has a brain and can use it will always beat ten men who don’t and can’t” !!