NHS Resolution, formerly known as NHS Litigation Authority, is a not-for-profit organization established in 1995 as a Special Health Authority within the NHS. Their role is to assist the NHS in resolving concerns fairly, sharing learning for improvement, and preserving resources for patient care.
A recent example, on May 18, 2023, NHS Resolution made a decision regarding a dispute between NHS England and Gordon Street Surgery, a GMS contractor.
The dispute revolved around non-payment for vaccinations between April 2021 and March 2022. NHS England declined the request for payment because Gordon Street Surgery had not signed up for the Enhanced Service Specification – Seasonal and Childhood Influenza Vaccination Programme 2021-22 as required.
The decision-making body, NHS England & Staffordshire and Stoke on Trent Integrated Care Board, supported NHS England’s decision to decline payment. The Contractor, Gordon Street Surgery, appealed to NHS Resolution after being dissatisfied with NHS England’s response. They argued that they had administered the vaccinations and provided evidence of the work done.
However, NHS England stated that the practice did not complete the sign-up process for the flu service, and therefore, no contractual relationship was established for the vaccinations. They maintained that without supporting evidence of formal sign-up, they could not make the payment. The Contractor acknowledged that the previous Practice Manager had overlooked the sign-up process and the missed income.
NHS Resolution, acting as the dispute resolution authority, considered the application and the information provided by both parties. They reviewed the relevant documents, including the GMS Contract and the Service Specification for the Seasonal and Childhood Influenza Vaccination Programme 2021-22.
Based on their assessment, NHS Resolution concluded that NHS England was justified in declining payment. They noted that the Contractor had not fulfilled the sign-up requirement outlined in the service specification. The dispute was resolved in favour of NHS England, and the decision was communicated to the relevant Integrated Care Board.
This has cost the practice over £11,000. An oversight that could be made by any practice in the land.
Although in this case, the Practice had not signed up for the DES they will still be eligible to claim for the vaccines used. We will be reaching out to them this week to offer our flu vaccination reconciliation service.
We can review the last 6 years of claims and ensure that your practice has claimed all it is due. Where it has not we can provide you with an extensive report to submit a claim.
If you would like to know more you can book a call with Sally (former Practice Manager) here:
https://enhancedprimarycare.co.uk/book-a-call
The full report is available here:
https://resolution.nhs.uk/wp-content/uploads/2023/06/25860-Medical-Dispute.pdf
It is important to note that this summary is a third-party observation and not an official statement from NHS Resolution or any involved parties.