17 March 2024
We (referred to as the ‘LMC’) are the representative body of general practitioners across Nottingham & Nottinghamshire. The LMC was alerted by the Nottingham & Nottinghamshire Integrated Care Board (ICB) in October 2023 that 16 GP practices across the city and county had been overpaid over a period of months/years the longest being 3 ½ years.
The ICB is in contract with GP practices to provide services to the public, most practices being small businesses and these practices had all moved over from a local version of the national contract (PMS), to the national contract (GMS) but in the move an administrative error had been made. This error meant that practices opting not to provide their own cover in evenings and weekends went from being deducted 4.75% of their contract sum to this no longer being taken.
The ICB wants this money back from the practices.
Q. By how much were practices overpaid?
A. The figures range from relatively small amounts to over £100,000 up to around £300,000.
Q. How did this happen?
A. We do not have a satisfactory answer as to who made the error or why it wasn’t noticed by either PCSE (who administer payments on behalf of the NHS) and the ICB.
Q. Does the ICB have the right to take back the money from the practices?
A. Contractually yes we believe that they do. The ICB is clear that it intends to recover all amounts owed but it is willing to negotiate over the repayment periods.
Q. Should the practices simply pay back the owed amounts, it is money that shouldn’t have been paid?
A. We are concerned about the bigger picture. We have asked the ICB to consider a partial or full write-off of funds owed given that monies paid to the affected practices have been invested into practice teams and clinical care for patients. Remedying the longer term impact of these mistakes could cost more than the monies owed over time and from a moral standpoint, the practices are being punished for an error not of their making.
Q. What will happen if the ICB continues to insist on full repayment?
A. We may see a number of practice experience greater instability as businesses and the fear is that this could lead to more deciding that they are no longer financially viable and close completely. Surgeries are finding it hard to cope financially with years of government underfunding and growing health needs with less people to do the work.
Q. How come practices didn’t immediately notice this mistake themselves?
A. The vast majority of the 16 practices affected did not realise that there had been an error made, the financial information given to them around their payments can be difficult to understand - vague and unhelpful. This requires reform.
Q. I’m worried that I could lose my local surgery, should I be concerned?
A. If your practice is affected by this error then they are likely to find their sustainability under greater threat depending on the impact. They are being asked to pay back money but also face a reduction of 4.75% on future contract payments against budgets made including that money. If a practice closes the risk is a domino effect as others feel the strain. Nationally, many practices face possible extinction as the government continues to fail to invest directly into GP practices at sufficient levels. Some GPs are finding it hard to get work because surgeries cannot afford them, we worry that new GPs need jobs too.
Q. What can I do if I am concerned?
A. Firstly, please do not call your practice and ask if they were affected but you may opt to get involved with their patient group to have your say and learn more about the future plans of your surgery.
Equally, you may wish to air your concerns with your local MP as we know that health will again be an important factor for people when deciding who to vote for. Strong general practice supports the rest of the NHS and those working in surgeries are desperate for government to recognise the growing gap between their requirements to run a high quality service and the funding awarded directly to them.
Michael Wright
Chief Executive
Nottinghamshire Local Medical Committee Limited
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