GP practices across the UK have been losing ‘tens of thousands’ of pounds due to a discrepancy in data that has led to a ‘chronic underpayment’ for care home patients, practice managers have revealed.
The Institute of General Practice Management (IGPM) has said the problem is ‘widespread’, affecting surgeries in all nations and 70% of its members.
It has written to ministers, the chief executives of NHS England, NHS Wales, NHS Scotland and ICBs seeking urgent financial redress for practices.
The issue centres around a mismatch in data on the number of care home residents practices look after, which surgeries are remunerated at a higher level for.
Primary Care Support England (PCSE) statements, which detail GP payments, have been showing different numbers to those that practices actually have on their lists, leading to funding being incorrect.
The IGPM explained the discrepancy ‘goes back several years’, arising after a change to the clinical system coding for patients in residential institutes introduced by PCSE in 2021 but that practices have been unaware of.
The organisation was initially contacted by a single practice that only recently noticed information for care home residents on its PCSE statement didn’t match its own records.
When it became apparent this wasn’t an isolated issue the IGPM investigated further.
It said: ‘Almost 70% of IGPM members who responded [to a survey] identified a discrepancy between the number of residents they have in care homes compared with those on their statement. Furthermore, the highest discrepancy found so far is 400 patients for one practice.’
The issue has arisen in all clinical systems, it said.
The Institute went on to highlight that care home patients are given more funding – they attract a factor of 1.43 to the global sum payment, which is an uplift of 43%.
‘At even a variance of 100 patients for a practice, that is c.£4.5k lost in global sum income in 2023/24 alone,’ it calculated.
‘Furthermore, the weighted list is also the basis of calculations for a number of other payments practices receive, along with the payments for PCNs – such as the Additional Roles Reimbursement Scheme – meaning that impacted practices have lost out on thousands of pounds, or tens of thousands, in just the last couple of years.’
In their letter to ministers, the directors of the IGPM acknowledged that it is the responsibility of each practice to add the correct residential institute (RI) code to patient records.
However they said: ‘The level of disparity across so many practices does suggest that this change was extremely poorly communicated.’
Practices don’t recall being made aware of the change, they added.
They went on to explain that the issue has only become more visible to GMS practices with the more detailed PCSE statements than with the previous Open Exeter ones. ‘It has helped us in the identification of how widespread the issue is and helped some practices fix the issue.’
However, the IGPM warned, PMS practices who receive less frequent statements weren’t able to identify the problem until alerted to it.
The body also noted it was concerning that ICBs did not pick up the issue, failing to ‘identify that the number of care home patients for practices within their ICBs was significantly different to the number of care homes that they were paying for under the PCN DES.’
Its survey found that only three practices said their ICB had highlighted a discrepancy.
In a letter to health secretary Wes Streeting, Northern Ireland health minister Mike Nesbitt and NHS leaders, including Amanda Pritchard, the IGPM has asked that ‘funding owed’ should be paid to practices as soon as possible. It also set out that:
- ICB should work with practices to identify how long the RI code has been absent to determine the funding owed to each practice and for this to be paid as soon as possible.
- Each ICB should calculate the impact on all other payments affected by the variance in the weighted list size, both national, such as the PCN DES (e.g. network participation payment, ARRS etc), and for any local enhanced services.
- A communication programme be put in place detailing instructions for each practice and clinical system on how to add the RI codes (V0 and Y0). ICBs to follow up with subsequent communication and monitoring to ensure each practice implements the coding as soon as possible.
- ICBs to ensure that there are future systems in place to pick up discrepancies in practice income such as this, along with enhanced services claims, through mechanisms of trend and baseline analysis conducted at least annually. They should also ensure practices are not accidentally under claiming or miscoding, whether that’s due to national changes or due to work pressures, under staffing or similar.
‘We welcome an opportunity to discuss this in more detail and co-develop an action plan to ensure resolution,’ the IGPM said told NHS leaders and ministers.
