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Publication

NHS Payments to General Practice - England, 2018/19

This is part of

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

Results presented and main headings included

Tables and Charts containing the data are presented separately in Excel format, available to download under Resources on the Overview page.

Annex 1

Tables 1a-1b Summary
Table 2 NHS Payments to General Practice in England for 2018/19 by individual practice
Table 3 NHS Payments to General Practices in England for 2018/19 by NHS England and NHS Improvement (Region) and NHS England and NHS Improvement (Region, local office)
Table 4 NHS Payments to General Practices in England for 2018/19 by NHS England and NHS Improvement Regions and CCG
Figure 1a Average NHS payment per registered patient by GP Practice 2018/19
Figure 1b Average NHS payment per weighted patient by GP Practice 2018/19
Figure 2 Average NHS Payment per patient type by GP practice 2018/19 (Registered and Weighted Patients comparison)
Table 5 Main headings included in the tables and their descriptions (also included on the following pages in this report)

 

Main headings included in the tables and their descriptions

Section Heading Description
Practice Information

NHS England and NHS Improvement (Region, local office) Code

NHS England and NHS Improvement (Region, local office) Name

NHS England and NHS Improvement Regional Local Offices have direct commissioning responsibilities for dental services, pharmacy and certain aspects of optical services. The Local Offices covering a minority of CCGs (17) in 2018/19, retained direct commissioning responsibilities for GP services, whilst 178 CCGs adopted full delegated responsibility for the commissioning of GP services at 1 April 2018.
The teams lead on specialised commissioning across England and carry out the direct commissioning of other services, such as military and prison health.
Practice Information

Clinical Commissioning Group (Code)

Clinical Commissioning Group (Name)

Clinical Commissioning Groups (CCGs) commission most services on behalf of patients, including emergency care, community care, planned hospital care, and mental health and learning disability services in their local areas.
Practice Information Practice Code A reference code unique to the Practice
Practice Information

Practice Name

Practice Address

Practice Postcode

Full name and address of the Practice to which the data relates
Practice Information Practice Open Date Date the practice opened
Practice Information Practice Close Date  Date the Practice closed if applicable
Practice Information Contract Type General Medical Services (GMS), Personal Medical Services (PMS) and Alternative Provider Medical Services (APMS) contracts
Practice Information Practice Type

The practice type as recorded in the Organisation Data Service (ODS) “prescribing setting field” for GP Practices

https://digital.nhs.uk/services/organisation-data-service 

Practice Information Dispensing Practice A practice that is authorised to dispense drugs. (Yes or No)
Practice Information Practice Rurality

Whether the practice is located in a Rural or Urban location based on the practice postcode. Sourced from NHS Digitals Organisation Data Service Postcode files 

https://digital.nhs.uk/services/organisation-data-service 

Practice Information Atypical Characteristics (List size changes, part-year payments and no known registered patients)

Indicates potential anomalies in the data, such as:
 - "Part year of data" - where the practice opened or closed during the year so was not open to receive a full year’s worth of payments which could, for example, result in average payments per registered and weighted patient looking too low.

- "Large fluctuation in patient numbers" - where the smallest quarterly registered patient count at a practice is at least 15% smaller than the largest quarterly count.

- "No known registered Patients" - where the practice has no known registered patients in any quarter of the reporting year or where the count of registered and weighted patients is unavailable.

Population Information Average Registered Patients The figure shown at practice level is the average of the counts of registered patients at the end of each quarter (30 June, 30 September, 31 December and 31 March). Figures in the totals rows for CCGs, regions and England are the sum of these averages. 
Population Information Average Weighted Patients The number of weighted patients is as calculated by the Global Sum process using a formula which takes into consideration 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
Population Information Average Payment per Registered Patient

The Total Payments (before deductions) figure divided by the Number of Registered Patients

NOTE: 
This is not representative of the amount of funding available to spend on direct patient care
Average payments per patient at CCG, region or national level should be treated with caution as some patients may be double-counted – for example due to practice closure – while conversely no information relating to patient list size is known for 130 practices. Please refer to the Patient List Size in the Accuracy and Reliability section of the Data Quality Statement for more detail.

Population Information Average Payment per Weighted Patient

The Total Payments (before deductions) figure divided by the Number of Weighted Patients

NOTE: 
This is not representative of the amount of funding available to spend on direct patient care
Average payments per patient at CCG, region or national level should be treated with caution as some patients may be double-counted – for example due to practice closure – while conversely no information relating to patient list size is known for 130 practices. Please refer to the Patient List Size in the Accuracy and Reliability section of the Data Quality Statement for more detail.

Global Sum and MPIG

Global Sum

Global Sum Payments are a contribution towards the contractor’s costs in delivering essential and additional services, including staff costs. See part 1 section 2 of the General Medical Services Statement of Financial Entitlement (GMS SFE) 2013, para 3 of the General Medical Services Statement of Financial Entitlement Directions 2018 and para 2 of the General Medical Services Statement of Financial Entitlement (Amendment 2) Directions 2018. Appendix B of the SFE 2013 shows how Global Sum is calculated:

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 

Global Sum allocates money in accordance with perceived need. Figures are calculated quarterly, paid on a monthly basis and may change from one quarter to the next according to patient turnover and demographics.

Global Sum is the main payment to practices and is based upon each practice’s registered patient list which is adjusted according to the Carr-Hill Formula to take into consideration differences in the age and sex of the patients as well as any in nursing or residential care, additional patient need due to medical conditions, patient turnover and unavoidable costs based upon rurality and staff market forces for the area. This results in an adjusted count of patients known as the “weighted patient count.”

Global Sum and MPIG MPIG Correction Factor The Minimum Practice Income Guarantee (MPIG) is used to top up practices' core funding - their Global Sum payments - to match their basic income levels, before the new GMS contract was introduced. See part 1 section 3 of the GMS SFE 2013.
QOF Total QOF Payments

Total QOF Payments is comprised of Quality Aspiration Payments and Quality Achievement Payments.

Aspiration Payments are a part payment in advance in respect of achievement under the Quality and Outcomes Framework. See part 2 sections 4 and 5 of the GMS SFE 2013 and para 4 and 5 of Amendment 2018.

Aspiration Payments are a part payment in advance in respect of achievement under the Quality and Outcomes Framework. See part 2 sections 4 and 5 of the GMS SFE 2013 and para 4 and 5 of Amendment 2018.

QOF achievement scores are published at https://qof.digital.nhs.uk/

Directed Enhanced Services

Childhood Vaccination and Immunisation Scheme

Extended Hours Access

Influenza and Pneumococcal Immunisations 

Learning Disabilities

Meningitis

Minor Surgery

Out Of Area in Hours Urgent Care

Pertussis

Rotavirus and Shingles Immunisation

Services for Violent Patients

Details of Directed Enhanced Services can be found at https://www.england.nhs.uk/commissioning/gp-contract/ 

also part 3 GMS SFE 2013 and para 7 to 10 of Amendment 2017  

Local Incentive Schemes Local Incentive Schemes Total Local Incentive Schemes (LIS) is comprised of GP Extended Hours Access (a locally-developed service to provide extended hours access) and Other LIS (locally-developed services designed to meet local health needs) "Local Incentice Scemes " replaces the previous "Local Enhanced Services" and "National Enhanced Services" (NES). Publications prior to 2017 show these as two separate columns. NES were described in the original 2004 contract documentation but never commissioned as NES.
Premises Premises Payments GP Practices receive payments to cover certain premises costs, as detailed in the NHS (General Medical Services - Premises Costs) Directions  details can be found at https://www.gov.uk/government/publications/nhs-primary-medical-services-directions-2013  
PCO Administered

Seniority

Seniority payments are part of GP remuneration although the monies are paid to the practice. Payments are based upon a GP’s years of reckonable service and their qualifying income fraction which determines the amount to which they are entitled.

Since 2015, seniority payments have been reducing and will be phased out by 2020. The payments are instead made as Global Sum.

See part 4 section 19 of the GMS SFE 2013 and para 19 of Amendment 2018

PCO Administered Doctors Retainer Scheme Payments This is a scheme designed to keep doctors who are not currently working in general practice in touch with general practice. See part 4 section 20 of the GMS SFE 2013 and para 16 of Amendment 2017.
PCO Administered Total Locum Allowances A locum payment is made so the practice can employ a locum to maintain the level of services that it normally provides while a performer GP is absent. The Total Locum Allowance is comprised of Adoption, Paternity & Maternity; Sickness; Suspended Doctors; and Other Locum payments. See part 4, sections 15 to 17 of the GMS SFE and para 17 and 18 Amendment 2018. 
PCO Administered Appraisal Costs

Costs associated with the appraisal of GPs.
Payments to practices in relation to the appraisal of GPs to offset costs for GP partners / salaried GPs in preparing and undertaking appraisal.
Payments relate to the Retained Doctors Scheme, which were supplemented nationally under the General Practice Forward View. 
The Retained Doctors Scheme is now closed to new entrants and was replaced by the GP Retention Scheme in April 2017. Further information is available here: https://www.england.nhs.uk/gp/the-best-place-to-work/retaining-the-current-medical-workforce/retained-doctors/

(including guidance on the Retained Doctors Scheme which can be found at the bottom of the webpage).
This additional funding ended on 30 June 2019. 

PCO Administered Prolonged Study Leave GP performers may be entitled to take Prolonged Study Leave in which case the practice may receive an education allowance to forward to the GP performer and a contribution for the cost of locum cover. See part 4 section 18 of the GMS SFE 2013.
PCO Administered PCO Admin Other Payments made by Primary Care Organisations (PCO), which do not fall under the other categories. 
Information Management and Technology Information Management and Technology Payments made to GP practices to cover the cost of information management and technology services.
Non DES Item  Non DES Item Pneumococcal Vaccine, Childhood Immunisation Main Programme Payments for the administration of pneumococcal vaccine, see part 4 section 13 of the GMS SFE 2013. 
General Practice Forward View General Practice Forward View

Payments made directly to a GP practice for General Practice Forward View programmes. (Note payments made directly to GP practices via NHAIS or ISFE are a small part of the total GPFV programme expenditure as many goods and services are centrally procured). 

Details of the General Practice Forward View can be found at https://www.england.nhs.uk/gp/gpfv.This includes expenditure in relation to the Improving Access to General Practice programme and the Estates and Technology Transformation Fund (details of which can be found at https://www.england.nhs.uk/gp/review-of-access/infrastructure/estates-technology/) and other General Practice Forward View programmes.

Prescribing

Prescribing Fee Payments

 

Dispensing Fee Payments

 

Reimbursement of Drugs Payments

Prescribing Fees - practices that are not dispensing practices are still entitled to fees for items personally administered by the practice under section 23.4 of the GMS SFE 2013.

Dispensing Fees - fees for items dispensed by dispensing doctor practices under section 23 and Annex G and H of the GMS SFE 2013 and para 3 and 4 of Amendment No.2 2018.

Practices that dispense prescriptions are paid a fee for providing this service, as well as payments to reimburse them for the cost of the drugs. Please see part 4, sections 23 & 24 and Annex H of the GMS Statement of Financial Entitlements 2013 and para 3 and 4 of Amendment No.2 2018.

Non-dispensing practices do not receive additional dispensing payments because community pharmacies deliver the dispensing service instead. 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 needs to be taken into account when comparing them with practices that rely on community pharmacies to provide dispensing services to their patients.

Other Payments Other Payments

Other payments are mainly trainee payments, trainer grants and associated costs.

From 2017/18, “Other payments” may include some payments for clinical services that cannot be accurately allocated to other headings due to coding limitations.

Total Payments and Deductions to General Practice Total NHS Payments to General Practice Total NHS Payments to General Practice are the total of all the payments paid to the practice from the NHAIS system, and invoices allocated in the ISFE payables ledger, for the provision of GP services. 
Total Payments and Deductions to General Practice Deductions for Pensions, Levies and Prescription Charge Income

The NHAIS system makes deductions for pensions and professional levies from the Total Payments and pays these amounts to the pension providers and professional bodies on behalf of the practice.

In addition there are Out-of-Hours deductions, which relate to some practices that are paid to provide an out-of-hours service, but subcontract this to a third-party provider. The amount paid to the third-party provider is deducted from the NHAIS payment and paid to the third-party on behalf of the practice.

These are all costs the practice is responsible for paying, but it is more efficient to ‘collect’ the money centrally and to make the payment where a practice so chooses. Not all practices will choose to make these payments centrally.

Pensions contributions are the amounts paid by GPs into a Pension fund for retirement benefits and includes (but is not limited to) deductions for employers, employees, prior year adjustments, additional voluntary contributions (AVCs), Trainee, Registrar and Solo earnings.

Levies are fees paid by Practices to Local Medical Committees (LMCs) for their services; these services are similar to union fees as the LMC looks after Practice interests. The amounts deducted are paid to the relevant organisation on behalf of the practice.

Where prescriptions are dispensed by the General Practice any prescription income collected from the patient is deducted from the total gross payment made to the practice. The NHS therefore pays the practice a lower amount than they would have received if the prescription charge had not been paid.

Total Payments and Deductions to General Practice Total NHS Payments to General Practice Minus Deductions The total amount that is paid to the practices less the total deductions.
Last edited: 10 September 2019 11:03 am