NHS Payments to General Practice - England, 2019/20

NHS England and NHS Improvement Region

NHS England and NHS Improvement Region

Clinical Commissioning Group (Code)

Clinical Commissioning Group (Name)

Practice Name

Practice Address

Practice Postcode

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

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 

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.

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

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.

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

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 (Amendment) Directions 2019. Appendix B of the SFE 2013 and para 21 of Amendment 2019  shows how Global Sum is calculated:

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.”

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, 5, 22, 23 and 24 of Amendment 2019.

Achievement Payments are payments based on the total points that the contractor achieves under the Quality and Outcomes Framework. See part 2 sections 4 and 6 of the GMS SFE 2013 and paras 4, 6, 22, 23 and 24 of Amendment 2019.

QOF achievement scores are published.

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 are available

also part 3 GMS SFE 2013 and para 7 to 14 of Amendment 2019   

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 16 of Amendment 2019

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: 

(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. 

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). 

Learn more about the General Practice Forward View. This includes expenditure in relation to the Improving Access to General Practice programme and the Estates and Technology Transformation Fund and other General Practice Forward View programmes.

PCN Participation

PCN Support

PCN Leadership

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 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.

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.