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Publication, Part of

NHS Payments to General Practice - England, 2018/19

Official statistics
Publication Date:
Geographic Coverage:
England
Geographical Granularity:
Country, Clinical Commissioning Groups, Clinical Commissioning Regions, GP practices, Regions
Date Range:
01 Apr 2018 to 31 Mar 2019

Background Data Quality

Data for the NHS Payments to General Practice series of Official Statistics are taken from the National Health Applications and Infrastructure Services (NHAIS) system and NHS England and NHS Improvement’s Integrated Single Finance Environment (ISFE). In April 2013, ISFE was integrated with NHAIS and enabled more detailed information on payments to GP Practices to be collected and analysed. Data for years before this integration took place, i.e. prior to 2013/14, are not available.

The majority of the data is taken from NHAIS, a cash-based operational system in which data is signed off at the end of each quarter and financial year by the local Primary Care Support England (PCSE) office on behalf of NHS England and NHS Improvement Region Local Offices. GP practices and the other providers of general practice services included in this report should use their PCSE contact for any queries on the figures in the first instance. NHAIS produces an annual statement each April which is available to practices wishing to check their payments.

ISFE records the practice-level payments made by NHS England and NHS Improvement and CCGs. Payments data from ISFE was first included in the report in 2016 and covered payments made for Local Enhanced Services (LES) – now called Local Incentive Schemes (LIS) – only. Since 2016/17, all invoices raised through the ISFE payables ledger have been extracted and included in the report to provide a more complete account of NHS payments to general practices. Although the inclusion of these ISFE data improves the completeness and coverage of the data, there will nonetheless be other payments made to practices, for example by Local Authority Public Health bodies, that are outside these two systems so other potential sources of NHS payments data will continue to be investigated.

These detailed ISFE data are not available for financial years prior to 2016/17 and users are advised not to make comparisons with payments for previous years.

NHS Digital seeks to minimise inaccuracies and the effect of missing and invalid data but responsibility for data accuracy lies with the organisations providing the data i.e. PCSE offices and NHS England and NHS Improvement. Methods for data capture are continually being updated to improve data quality. However, payments made in error may occur and, if so, may be included within the data.

Along with payment data, practice and population information is extracted from NHAIS. However, some practices received no payments via NHAIS but have payments recorded in ISFE only so are not included in the NHAIS data extract. Where possible, contextual information relating to these practices and their populations has been taken from reference data but there remains a small number of practices with unknown values for some fields such as contract type, dispensing status and number of registered and weighted patients.

What the payments are for and how they are calculated

The basis and calculation of payments to providers of general practice services are set out in the General Medical Services (GMS) Statement of Financial Entitlements (SFE) and GMS Premises Costs Directions which can be found at: https://www.gov.uk/government/publications/nhs-primary-medical-services-directions-2013 and https://www.nhsemployers.org/pay-pensions-and-reward/primary-care-contacts/general-medical-services/gms-contract-changes/gms-contract-changes-201819

These payments relate to all categories of funding paid to general practice including, for example, payments for information technology, premises, waste disposal, dispensing and other activities. The payments do not signify the amount of money available to practices for the delivery of direct patient care.

The payments data is cash-based if taken from NHAIS or invoice-based if taken from ISFE, and thus excludes any accruals, prepayments and other accounting adjustments. The reported data constitutes the payments made to the practice or the invoices processed during the reporting period. The figures in the publication are calculated to the nearest pence and presented to the nearest pound. This facilitates consistency checks between different analyses of finance data and reduces the risk of introducing calculation errors when deriving other statistics such as percentage changes.

Figures are an accurate summary of the data supplied and validated as described. However, given the number of NHS general practice providers and their patient numbers, some figures, particularly counts of individuals, fluctuate within the reporting period. Also, due to the nature and timing of local data entry and checking processes, there will always remain some uncertainty about the true position of payments made at a granular level to individual NHS general practice providers.

As the report is cash or invoice-based, it may include information on organisations which were not actively providing Primary Care Medical Services during the reporting year but nonetheless received payments, for example payments for services delivered during the previous financial year.

Relevance

Developments to the NHS Digital GP Payments NHAIS system in 2013/14 and the introduction of NHS England and NHS Improvement’s Integrated Single Finance Environment (ISFE) mean it is now possible to provide payments data in a clear and transparent format for publication.

The data in this report is at a more granular level than other GP finance-related reports. Data prior to 2013/14 are not available.

It is in the public interest to understand the amounts that providers of general practice services receive from the NHS.

Patient List Size

The National Patient Register, which is collected by NHAIS, is intended to be an accurate count of individuals registered with each General Practitioner. Amongst other benefits, accurate patient lists should ensure that the appropriate payments are made to practices for patient care. 

However, there is a known discrepancy between the estimated size of the England population and the number of people registered at GP practices which is known as list inflation, over-coverage or ghost patients.

List inflation occurs when the National Patient Register continues to record individuals that should have been de-registered. This can happen for a variety of reasons, including - but not limited to:

  • Patients move away and do not de-register when they leave
  • Young, healthy people have moved to a new address but did not prioritise de-registering with their former GP practice
  • Patients have left the country but did not de-register
  • Shared custody of children with split residence is not flagged in the medical record resulting in double-counting
  • Duplicate records, for example due to use of different names, particularly surnames
    • For example, children are recorded against their mother’s and their father’s surname, resulting in double-counting
  • Patients in nursing or residential care are registered for that address as well as their original place of residence
  • Death

In addition to list inflation, which incorrectly increases the count of patients, there are also issues associated with under-coverage. For example:

  • Individuals move to a new area, de-register from their former GP and do not register with a new practice in a timely fashion, if at all
  • Members of the armed forces and their families are included in population estimates but are not covered in the National Patient Register. However, from a statistical perspective, adjustments are made to mitigate the effect of this
  • Babies may not be included in the National Patient Register until formally registered
  • New (or returning) migrants may delay registration with a practice
  • Individuals may be inappropriately removed from a GP list under the “no-contact” criteria and may need to be restored

There are a large number of collection systems providing GP practice data to NHAIS, with variation in the quality of the data recorded, and in the verification and checking mechanisms in place. 

In terms of patient information, there are a range of data quality considerations – such as when hand-written records are added to electronic systems – which could contribute to over or under-coverage.

Weighted patient counts

The weighted patient count is a constructed value that is used in the practice funding formula (the Carr-Hill formula). It considers the following six indices which are then applied to the registered patient count:

  • Age and gender
  • Patient need (morbidity and mortality)
  • List turnover
  • Market forces
  • Rurality
  • Patients in nursing or residential homes

The weighted patient count is therefore a calculated count based upon the needs of the practice’s registered patient population.

Patient list counts in the NHS Payments to General Practice publication

For the purposes of this publication, the registered and weighted patient counts are the average of the counts at the end of each quarter (30 June, 30 September, 31 December and 31 March).

In releases prior to 2018/19, the most recent patient counts were used, so the count at the end of quarter four was used unless no count was available (for example because the practice had closed), whereupon the count from quarter three, two or one was used.

However, use of the most recent patient count can result in additional double-counting of individuals within the data beyond the issues outlined above in “list inflation”. For example, practice A may close at the end of quarter one. All patients registered at that practice will be counted against that practice along with the payments made while the practice was open. However, the patients may subsequently register with a new practice and will be counted against their new practice in later quarters thereby inflating the overall totals.

Conversely, some practices received payments from ISFE only and no information is available relating to patients that may be registered with these practices. As a result, no practice-level figures can be calculated for average payments per registered and weighted patient at these practices. However, the total money paid to these practices is included in the calculations of average payments at a CCG and national level, which again means that these measures should be treated with caution due to the uncertainty relating the patient counts used in the denominator.

Finally, as a result of the uncertainty described, CCG and England-level figures for average payments per weighted patient are likewise subject to comparable levels of uncertainty.

Some practices show no registered or weighted patients but nonetheless provide healthcare services and receive payments accordingly; these practices are identified by a “No registered patients” flag in the Atypical Characteristics column and by “N/A” in the average payments per registered patient and weighted patient columns.

Regional figures

The NHS England and NHS Improvement regional structure is subject to change, generally at the beginning of the financial year.

Figures are provided for practices, CCGs, Local Offices and regions according to the structure during the reporting year in question. This is to avoid any confusion which could be caused by reporting payments made during the reporting period in terms of a new structure, where characteristics of practices could differ between then and now. These could include differences in:

  • practice details (such as name)
  • the practice’s CCG, Local Office or NHS England and NHS Improvement region

However, it may be the case that as a result of a restructure, some CCGs or regions may no longer exist.

Negative amounts

The data tables in the report include some negative amounts. The data is extracted the data from NHAIS and ISFE based on the payment code used at source. Adjustments can be required to these codes for a number of valid reasons, including rectifying the use of an incorrect code. As adjustments can be either positive or negative this can result in what appears to be a ‘negative payment’.

  • As some payments are made on account, negative payments may also occur where there has been an overpayment in a previous period and the money has subsequently been recovered.
  • Similarly, some ‘deductions’, for example for pensions, levies and prescription charge income, could be positive amounts, once adjustments have been made.

Where a zero is shown, there is no payment for that category for the practice; it does not signify missing or unavailable data.

Additionally, some payment categories may be removed, added or altered year-on-year to reflect any changes made to services and how they are paid for.

Payment types

The data provided is analysed according to the coding allocated at the time of payment via NHAIS or accounts payable in ISFE. These payments codes may be subsequently changed as part of normal accounting processes. However, as data is extracted from source data rather than the general ledger it is not possible to replicate such modifications to the data.

Global sum makes up the bulk of payments to practices. It is calculated based upon each practice’s patients – according to the Carr-Hill formula, which includes patients’ age, gender and health conditions. Two practices with the same count of registered patients may have very different populations with very different needs; this is partially reflected in the weighted patient numbers. These practices, while apparently similar in terms of list size, may thus receive very different levels of funding.

Practice types

The data includes all GP practices, Walk-in Centres and (combined) Walk-in Centres and Out-of-Hours practices that received a payment through the NHAIS or ISFE systems between 1 April and 31 March. Any practices which have received total payments between £-1.00 and £1.00 have been removed from the data.

Walk-in Centres may have low numbers of registered patients but apparently receive large amounts as they deliver a variety of services.

Some practices may provide a broader range of healthcare services than others, for example undertaking diabetic retinal screening for patients across the wider community rather than solely their own patient base; such practices are likely, therefore, to receive additional funding.

Prescribing and dispensing

Dispensing practices have two distinct roles for which they receive appropriate payments on both the clinical and dispensing elements of their services to patients. This should be considered when comparing dispensing and non-dispensing practices that rely on community pharmacies to provide dispensing services for their patients.

Regardless of their dispensing status, all practices receive fees for any personally-administered items such as vaccines and inoculations.

Prescribing costs have been categorised as Prescribing Fee Payments, Dispensing Fee Payments and Reimbursement of Drugs Payments.

PMS practices, however, may capture additional payments over and above their core services which are recorded in "Balance of PMS expenditure". These “Balance” payments could include figures relating to prescribing costs but cannot be further broken down.

Since the first publication of 2013/14 data in February 2015, a report covering the previous financial year has been published annually.

The publication consists of provider-level payments data for England only.

Data prior to 2013/14 is not available at a level sufficient for extraction. Therefore figures cannot be provided for any earlier years.

A similar publication is published annually for practices in Scotland and is available from:
http://www.isdscotland.org/Health-Topics/General-Practice/Publications/

This is an annual series of NHS Payments to General Practice statistics, using data directly from NHAIS and ISFE, which have not undergone any amendments or adjustments such as for accruals.

These figures are not directly comparable with other GP finance statistics but do provide a basis for the figures which feed the England data for the Investment in General Practice report. Specific differences and exclusions from this report are:

  • accounting adjustments - the data are cash payments or based upon invoices raised, whereas the data provided in the Investment in General Practice report is on an accruals basis
  • not all payments in the Investment in General Practice report are paid directly to providers of general practice services and are therefore not paid through NHAIS or analysed at GP practice level in ISFE. These include, for example, some Information Management and Technology (IM&T) costs and some premises costs although, overall, these are a relatively small proportion of overall investment in general practice
  • some payments which are made by NHS England and NHS Improvement on behalf of GPs and other providers cannot be broken down to practice level. For example, payments for clinical waste and IT services are centrally procured and cannot be accurately allocated to each individual provider;
  • income from Local Authority Public Health Grants for the provision of public health services will not be included in this report but is included at an aggregate level in the Investment in General Practice report.

All major categories of payments within the Investment in General Practice report are included, along with some deductions that are not relevant to that report, i.e. pensions and levies deducted before payments are made to the practice.

Trade-offs between Output Quality Components / Known Issues

Some figures may seem anomalous for a variety of reasons. These practices are identified as having “Atypical Characteristics” in the practice-level tables as follows:

Atypical Characteristics – Part year of data

Results include some practices which have opened or closed during the reporting year.

Payment figures for these practices, which are identified by a “Part year of data” flag in the Atypical Characteristics column are therefore part-year payments which should be borne in mind when making comparisons between practices, particularly the average amounts paid per registered and weighted patient.

Atypical Characteristics – Large fluctuation in patient numbers

Practices may experience large changes in the numbers of patients during the course of the financial year; for example, new housing may introduce more residents to a local area. This would have an impact upon the payment figures per registered and per weighted patient.

Use of average registered and weighted patient counts will mitigate this effect to an extent but nonetheless, large changes in patient counts should be taken into consideration.

Where there is a 15% difference between the highest and the lowest counts of registered patients, a flag is included indicating a “Large increase in patient numbers” or “Large decrease in patient numbers” as applicable.

Practice business arrangements

Practices may change business arrangements during the financial year. For example, several practices may merge or otherwise centralise funding and payments activities at one practice while retaining separate practice codes and identities. Such practices cannot be identified within the available data which should be borne in mind when considering apparently anomalous figures.

Assessment of User Needs and Perceptions

Comments and feedback are welcomed by email to enquiries@nhsdigital.nhs.uk or PrimaryCareWorkforce@nhs.net, or by telephone 0300 303 5678.

User needs and feedback are taken into consideration during the production process.

The data is extracted from NHAIS and ISFE as part of the operational processes of the systems and are a secondary use of the data. There is, therefore, no additional burden on NHS organisations, GP practices or other providers to complete and return the data from which the report is developed.

Published GP payments information is derived from NHAIS and ISFE. Users of these systems (appropriate persons from practices, Clinical Commissioning Groups (CCGs) and NHS England and NHS Improvement Region (Local Offices)) can monitor their own NHAIS information on a continuous basis throughout the year and also have access to an annual statement from NHAIS. NHS England and NHS Improvement and CCG purchase invoices recorded in ISFE are visible to the bodies making the payments.

The standard NHS Digital data security and confidentiality policies have been applied in the production of these statistics. The data contained in this publication is Official Statistics. The Code of Practice for Statistics is adhered to throughout the publication cycle along with NHS Digital’s Statistical Governance Policy.

All publications are subject to a standard NHS Digital disclosure risk assessment prior to issue. Disclosure control is implemented where judged necessary.

Last edited: 11 September 2019 10:33 am