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GPs hit by £40,000 bills in ‘smash and grab’ raids by PCOs

Exclusive GPs are being hit by ‘smash and grab raids' from cash-strapped primary care organisations clawing back contract overpayments of up to £40,000 from as far back as seven years ago.

LMC leaders told Pulse practices were being ‘destabilised' as PCOs launched ‘fishing expeditions' to claw back five-figure overpayments dating right back to the start of the nGMS contract in 2004, and often demanded money back within just two months.

Directors at accountancy firms PKF – which represents 3,000 practices across England – and RS Medical Accountancy said the squeeze on NHS finances had prompted a growing number of PCOs to chase up overpayments as a quick source of finance.

Accountants warned GPs were being ‘hit hard' as PCOs scrambled to reclaim ‘everything possibly due back' from practices, with the move having ‘serious cashflow implications' for some. Claims commonly covered payments to GPs for enhanced services, notional rent and seniority pay, they said.

Valerie Martin-Long, national director of medical services at PKF, said: ‘PCTs are chasing everything possibly due back from practices. Issues of overpayments and duplicate payments that have laid low for some time are suddenly coming back. We're seeing PCTs claim overpayments from as far back as 2004/05 and for large sums – you can be talking of claims of £40,000. It hits practices hard.'

Rosemary Smith, owner of RS Medical Accountancy, said: ‘Clawbacks are coming in for anything between £10,000 and £25,000. It can be enormously unfair. You have no way of knowing when they are coming and, in some cases, little chance of fighting them. Sometimes money is clawed back within two months of the PCT notifying you – with serious cashflow implications.'

Dr Michelle Drage, chief executive of Londonwide LMCs, said: ‘PCTs are under a QIPP imperative to ensure they haven't paid out unreasonable sums to practices. But some of the cases we have seen of clawbacks are no more than smash and grab raids on practices that have provided excellent services within their contracts.

‘Some PCTs are sending out blanket messages to practices [about the possibility of clawbacks] and that, in itself, has a destabilising effect. When PCTs go on fishing expeditions, even for a small amount of money, it can be hugely destabilising. There is no question some PCTs, although not all, are adopting quite worrying approaches.'

Dr Philip Fielding, chair of Gloucestershire LMC and a GP in Cheltenham, said: ‘In the last 12 months, we've noted PCTs trying to claim back overpayments from some practices – it wasn't a problem before that. We've advised our practices they shouldn't feel intimidated by PCT demands and should contact the LMC for mediation.'

NHS Gloucestershire said it had identified ‘anomalies in practice payments' as part of a PMS review, and had reached an agreement with practices and the LMC on these.

In June, a meeting of Buckinghamshire LMC warned of PCT clawbacks of LES payments, advising practices the ‘PCT needs to prove unequivocally' an overpayment was due (see box, below left).

News of the clawbacks comes after Pulse revealed online that a group of GP practices lost up to £1m after PCT managers ‘reneged' on a deal to hand GPs a slice of cost savings to invest in frontline services.

Ten GP practices in Bury saved a combined £3.5m in 2009/10 as part of a PCT cost-cutting drive on the basis each would receive up to £100,000 of the savings. But the PCT board backtracked on the agreement last September, telling GPs the payments were being withdrawn ‘due to the trust's deficit'.


Case study – how claims are being made

In April, NHS Buckinghamshire informed the LMC of its intention to claw back £352,000 in LES overpayments dating back to 2006/07, with one practice facing a bill of £21,000.

The LMC claimed the PCT was arguing that practices received two months' extra payment after the LES payment schedule was shifted from monthly to quarterly in 2007.

Buckinghamshire LMC said it would seek ‘contractual and legal advice' from the GPC.

‘LMC policy is that the PCT needs to prove unequivocally to individual practices that there has been an overpayment,' LMC minutes stated.