Each month, NHS Resolution publishes decisions on disputes between GP contractors and commissioners. The latest round of determinations offers valuable lessons about compliance, evidence, and clarity of process. Here are three cases that illustrate the importance of rigour in managing contracts and claims.
1️⃣ Missed QOF Submissions: When Good Work Isn’t Enough
In the first case, a GP practice completed its Quality Improvement (QI) projects for the 2022/23 Quality and Outcomes Framework (QOF), focusing on prescription drug dependency and optimising access.
The practice attended the required peer review meetings and carried out the improvement work. However, they failed to submit the mandatory QI templates by the deadline. The reasons included an unanticipated email request sent to a practice manager recently returned from long-term sick leave and then on annual leave. Despite reminders and phone calls, the submission was never escalated to GP partners.
The outcome was clear: no submission, no payment. NHS Resolution determined the commissioner had acted properly. The regulations explicitly allow commissioners to request evidence of QI work, and the practice did not demonstrate exceptional circumstances justifying late submission. The fact that the improvement work had been completed did not override the contractual requirement to provide evidence.
2️⃣ Maternity Locum Claims: Sessions vs. Hours
Another practice disputed how their maternity locum reimbursement had been calculated. They argued that they should be able to claim reimbursement for the actual hours the absent GP worked each week—even if this meant employing more sessions, or overlapping sessions, to cover the same hours.
The commissioner had calculated payments based on the number of sessions the GP normally worked. The practice countered that the Statement of Financial Entitlements (SFE) does not mention sessions, only the maintenance of “normal service levels.”
While NHS Resolution agreed that sessions are not explicitly mandated, it found they are a reasonable and practical basis for assessing entitlement unless robust evidence shows they are unsuitable. In this case, the practice failed to provide convincing evidence that additional or overlapping sessions were necessary, or that they directly corresponded to the absent GP’s workload.
The claim for extra reimbursement was therefore refused.
3️⃣ Dispute Over Notional Rent
In the third case, a practice challenged the commissioner’s notional rent valuation. They argued that the premises should have been valued significantly higher. An independent RICS advisor was appointed to assess the evidence and recommended an intermediate figure.
NHS Resolution accepted the advisor’s recommendation and set the notional rent at £17,520 from January 2019. Neither party objected to the advisor’s report, and the matter was resolved.
🌟 Cross-Cutting Lessons and Takeaways
These decisions, though different in nature, share several themes worth highlighting for every practice:
- Evidence is Everything.
Whether it’s QOF submissions, reimbursement claims, or rent valuations, you must keep clear records and submit them accurately and on time.
- Deadlines Are Real.
Even where work has been completed, failing to meet contractual deadlines can mean forfeiting payment. Robust internal processes—like escalation protocols when staff are absent—are essential.
- Interpretation Must Be Justified.
In the maternity claim case, the practice was right that the SFE doesn’t mention sessions. But simply asserting this wasn’t enough—concrete evidence showing why hours-based calculation was more appropriate was needed.
- Independent Expertise Holds Weight.
For premises disputes, impartial RICS valuations can break the deadlock. Commissioners and contractors should be prepared to defer to such advice if it is reasoned and fair.
- Proactive Communication Matters.
Waiting to raise concerns until after decisions have been made rarely helps. Early dialogue with commissioners and timely appeals are always preferable.
Conclusion
Primary care contracts are complex. But these cases underline a simple principle: clarity, timely action, and evidence underpin everything. Practices should take stock of how they manage contractual obligations and submissions, ensuring that internal systems don’t leave them vulnerable to avoidable losses.
