Exclusive GP practices lost out on Quality and Outcomes Framework (QOF) and Local Enhanced Services (LES) funding in 2020/21, despite assurances from NHS England that funding for enhanced services and QOF work would be protected through the pandemic, according to exclusive figures.
A survey by Management in Practice’s digital platform Pulse Intelligence, found that over a quarter of respondents (26%) said their QOF income had decreased, 27% said CCG LES income had dropped, while 33% said local authority LES income had fallen.
In the data, which surveyed 190 GP partners and practice managers with access to their financial accounts for 2020/21, around 40% of partners and practice managers reported that their overall income decreased in 2020/21.
It comes after NHS England had made assurances that funding for enhanced services and QOF work would be protected throughout the pandemic.
In a letter to NHS managers in March 2020, practices were told that funding for QOF, DES and LES would be protected during the outbreak, despite these activities mainly being on hold for the year. Practices were told they would be paid based predominantly on previous levels.
Some QOF activity was resumed for the 2020/21 financial year with the aim of catching up on flu vaccinations and cervical screening targets, but the bulk of indicators continued to be subject to income protection.
However, the survey found that around 20% of practices said the QOF income protection arrangement led to a loss of income, as their higher 2019/20 achievement had been discounted, and payments instead had been based on 2018/19 achievement.
One practice manager said: ‘We achieved all of QOF but were paid at the pre-agreed protected rate.’
The majority also reported their income from work on flu and cervical targets stayed static or even fell, despite the points allocated to these doubling.
A GP partner commented that ‘impossible targets to achieve for QOF will decimate profits.’
‘We can’t achieve this with current levels of staff and increased acute workload/backlog.’
Loss of profits
Nearly half (45%) of practices surveyed by Pulse Intelligence expected their overall profits to have fallen in 2020/21 due to a combination of lost income and pandemic-related costs.
Alongside the drop in QOF and LES, practices also reported other lost income across the year, including 48% reporting a drop in minor surgery income, 36% said there was a drop in other routine immunisation funds and 21% said childhood immunisation income fell.
Private practice income also dropped among a significant number of respondents, with 75% saying medical records income decreased.
Practices also incurred a significant cost from extra PPE, locum fees and other Covid-related costs. Despite additional funds being made available for these extra costs, there was early confusion about what was reimbursable at the start of the pandemic.
Around two fifths (39.5%) of respondents said some of their PPE costs were not reimbursed, while 30% said they had to pay for some locum fees themselves. Over a third (31%) also said some IT costs were not covered.
A practice manager from northwest England said their practice had to make cuts in order to ‘offset the increased costs’.
‘There has been some additional costs of working that we have had to pick up ourselves, but generally minimal,’ said the manager.
‘The hard side of this, is the effort we have had to put into to identify the costs, create a claim, submit the claim and then chase up when it remained outstanding, none of that cost was covered.’
He added that the next financial year is potentially going to be an even greater challenge.
‘The real hardship has come in 21/22 where essentially we have been expected to begin working as normal with no safety net and expected to offer up staff to assist with the Covid vaccination clinics,’ he said.
‘Staff cannot be in two places at once. QOF is well behind and targets have been built up over a number of years, we are now 2 years behind and I would expect it to take 2 years to catch back up again.’
The survey also found that GP practices have been delivering Covid vaccinations ‘for free or at a loss’.
A spokesperson for the Institute of General Practice Management (IGPM) said: ‘The IGPM are concerned that practices are reporting they have lost income during the busiest time in the history of the NHS.
‘This is despite the assurance from NHSEI that we would not be financially penalised during the pandemic. We will be talking to leaders from across the system and will be discussing this very issue.’
NHS England declined to comment on the survey findings.
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