NHS Payments to General Practice England, 2020/21

The majority of the payments are provided by NHS Digital’s GP Payments system – National Health Applications and Infrastructure (NHAIS).  These payments data were available for the first time in 2013/14; figures for earlier years are not available.

In 2015/16, figures relating to the payments made by NHS England and NHS Improvement’s Integrated Single Finance Environment (ISFE) for Local Enhanced Services (LES) – now called Local Incentive Schemes (LIS) - were included for the first time. Data capturing all ISFE ‘payables ledger’ payments has been included since 2016/17.

It is therefore important to consider the additional data included when making year-on-year comparisons, as payments made via ISFE are not available for earlier years.

For the 2020/21 reporting year, 99 practices received payments from ISFE only, and therefore did not have any practice, contract type, patient population or dispensing status information recorded in the 2020/21 NHAIS data extract. Of these, some contract types and patient counts were identified from other data sources. However, contract types could not be found for 80 providers. Practices are responsible for ensuring that information on their contract type is correctly maintained and updated as necessary by their PCSE office.

The total count of registered patients recorded in this release for the 2020/21 financial year – calculated by summing the quarterly average patients at each practice where patient numbers are known - is 60,671,585.  The published total at 1 March 2021[1] was 60,650,740   Though the figures are similar, there is still a possibility that the sum of the quarterly average patients presented in this report includes some double-counted individuals, but it is not possible to quantify the scale of this issue. This means that the average payment per registered patient at CCG, region and England level should be treated with caution as there is some uncertainty around the counts of patients used in the denominator.

Since 2018/19, the patient counts used to provide context in terms of practice size and in calculations of average payments per patient are the average of the quarterly counts of registered and weighted patients at each practice.

In reports prior to 2018/19, the patient counts were the most recently available figure and were taken at the end of quarters four, three, two or one as applicable. 

As a result of this methodological change, comparisons should not be made between the 2018/19, 2019/20 or 2020/21 figures and those for previous years. However, to provide context, the England-level average payments per registered and weighted patient for 2017/18 and 2016/17 are presented in the Comparison with previous years section.

[1] https://digital.nhs.uk/data-and-information/publications/statistical/patients-registered-at-a-gp-practice/march-2021

Although the NHS England and NHS Improvement regional structure has changed since the 2020/21 financial year, practices’ NHS England and NHS Improvement regions, CCGs and Primary Care Networks are presented as they were during the 2020/21 reporting year. This is to avoid any confusion which could be caused by reporting payments made during 2020/21 according to the current structure, where characteristics of practices differ between then and now. These could include differences in:

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

Since July 2019, most GP practices have joined with other practices and care providers in their local area to form one of around 1,250 Primary Care Networks (PCNs). Instigated as part of the NHS long-term plan, PCNs were created to provide accessible and integrated primary, mental health, and community care for patients. 

The PCN contract was introduced 1 July 2019 as a Directed Enhanced Service and initially aimed to fund 20,000 additional health and care professionals, to strengthen primary care, improve community-based care and reduce the need for hospital treatment. For more information on PCNs, see the Primary Care Network Workforce publication. 

Payments relating to PCNs were presented for the first time in the 2019/20 publication. Table 4 of Annex 1 (available to download under 'Resources' on the Overview page) presents payments at PCN and CCG level, which have been calculated by summing the payments made to constituent practices. PCN membership is optional and so not all practices are part of a PCN. Some practices changed PCN during the year. Payments have been assigned to the PCN the practice was a member of on 31 March 2021, or the most recent PCN the practice was a member of if it was no longer a PCN member on 31 March 2021. 

The payments relating to PCNs cover seven categories - PCN Participation, PCN Leadership, PCN Support, PCN Workforce, PCN Care Home Premium, PCN Extended Hours Access and PCN Investment and Impact Fund. PCN Leadership, Support, Workforce, Care Home Premium, Extended Hours Access and Investment and Impact Fund pertain only to PCN lead organisations and are therefore not included in the practice level Table 2 of Annex 1 (available to download under 'Resources' on the Overview page), the NHS England and NHS Improvement Region-level Table 3 of Annex 1, or the total payments and average payments per patient figures in these tables. However, total payments and average payments per patient figures have been calculated both including and excluding these three payment categories for comparison purposes and are presented in Tables 1a and 1b of Annex 1.

PCN Participation payments, which relate to all practices taking up membership of a PCN, are included in all tables, averages and totals.

The pandemic affected the way General Practice operated in 2020/21 and placed additional responsibilities on GP practices for which they received additional payments. Two additional columns have been added to the report for COVID-19 related payments, COVID-19 Support and Expansion and COVID-19 Immunisation.

COVID-19 support and expansion payments covered the additional costs incurred by General Practice due to COVID-19, for example; additional staff costs to cover sick leave, additional care home visits and personal protective equipment. This was a claims based process so practices submitted claims in line with published guidance and were reimbursed accordingly. COVID-19 immunisation payments covered the additional costs incurred to support the co-ordination and delivery of the COVID-19 vaccination programme. Practices needed to be signed up to the COVID-19 vaccination programme enhanced service and to be part of a participating Primary Care Network to be eligible for these payments.

COVID-19 payments are provided in Table 2 of Annex 1 (available to download under 'Resources' on the Overview page) as GP Practice level and total payments and average payments per patient figures have been calculated both including and excluding these payment categories for comparison purposes and are presented in Tables 1a and 1b of Annex 1. Due to the methods used to extract the data for this report some of the payments for COVID-19 related costs may be included in other categories within this report.