A Question of Fairness: Lessons from the Practice’s Breach Notice Appeal
The recent decision by NHS Resolution to uphold a breach notice against the Practice highlights the complexities of navigating compliance and procedural obligations within the NHS. Despite a robust challenge from the Practice, this case ultimately reinforces the importance of adhering to contractual requirements and procedural processes for all parties.
The Breach Notice
The dispute arose when NHS Greater Manchester issued a breach notice against the Practice for failing to submit Friends and Family Test (FFT) data for three consecutive months—October, November, and December 2023. Under the General Medical Services (GMS) contract, practices are required to report FFT data monthly via the CQRS system, a task deemed essential for gathering patient feedback.
The Practice acknowledged missing the submissions but argued that mitigating factors, including procedural irregularities and technical issues, warranted the withdrawal of the breach notice.
The Practice’s Arguments
In their appeal, the Practice raised several concerns:
1.Failure to Provide a Remedial Period: The Practice argued that NHS Greater Manchester did not follow the required steps to issue a remedial notice, which should have given them time to address the breach. They contended that the breach notice was procedurally flawed.
2.Technical Challenges: The Practice highlighted historical issues with the CQRS system, including changes to login procedures and delays in system functionality. They claimed these technical difficulties prevented timely submission of FFT data.
3.Delayed and Inadequate Communication: The Practice noted that the initial notification of non-compliance came via email in January 2024, long after the reporting windows had closed. Furthermore, the remedial notice was sent in February 2024 without specific instructions on how to remedy the breach.
4.Efforts to Comply: The Practice demonstrated their commitment to compliance by promptly submitting FFT data for January 2024 and subsequent months. They also offered FFT data for the disputed months via alternative methods.
The Decision
NHS Resolution determined that the breach notice was valid and upheld NHS Greater Manchester’s decision. Key findings included:
•The Breach Was Not Capable of Remedy: NHS Resolution agreed with the commissioner that the missed FFT submissions could not be rectified once the reporting windows had closed. As a result, issuing a breach notice was appropriate under the circumstances.
•Adequate Communication: The commissioner was deemed to have met their obligation to notify the Practice of the breach, even if the Practice disputed the delivery method and timeliness of the notices.
•Responsibility to Notify: While the Practice argued technical challenges, NHS Resolution highlighted that they did not inform the commissioner of these issues at the time, nor did they seek assistance to address them.
Implications for the Practice
The upheld breach notice carries significant consequences for the Practice. Beyond the immediate reputational impact, it may influence future contract evaluations, patient trust, and staff morale. The decision also underscores the importance of robust administrative processes within general practice.
Lessons Learned
This decision offers important lessons for practices and commissioners alike:
1.Proactive Communication Is Key: Practices must notify commissioners immediately when technical or operational challenges arise, ensuring there is a clear record of attempts to comply.
2.Timeliness Matters: Commissioners must issue notices promptly and follow contractual procedures to ensure fairness. Practices should be vigilant in tracking compliance deadlines and addressing issues early.
3.Collaboration Could Prevent Escalation: While the decision was made within the framework of regulations, a more collaborative approach might have resolved the issue before it escalated to a breach notice.
4.Invest in Resilient Systems: Both practices and commissioners need to ensure that reporting systems are fit for purpose and accompanied by adequate support when issues arise.
Moving Forward
While the appeal did not succeed, the Practice has taken steps to prevent similar issues in the future. They have implemented enhanced compliance monitoring and pledged to report any challenges proactively to commissioners.
This case serves as a cautionary tale for all practices. Compliance with contractual requirements is non-negotiable, but fairness and collaboration must underpin the relationship between commissioners and contractors. By fostering mutual accountability and improving processes, practices and commissioners alike can avoid unnecessary disputes and focus on delivering exceptional patient care.
The practice name has been withheld to prevent further reputational damage. Link to appeal are available upon request.