NHS Payments to General Practice, England 2021/22

Prior to 2021/22, data for the NHS Payments to General Practice series of Official Statistics are taken from the National Health Applications and Infrastructure Services (NHAIS) system and NHS England’s Integrated Single Finance Environment (ISFE). In April 2013, ISFE was integrated with NHAIS and enabled more detailed information on payments to GP Practices to be collected and analysed. Data for years before this integration took place, i.e. prior to 2013/14, are not available.

In June 2021, data collection of NHAIS data moved from Exeter to Capita, as such data for the NHS Payments to General Practice 2021/22 are taken from the National Health Applications and Infrastructure Services (NHAIS) system (April and May 2021 only) and NHS England’s Integrated Single Finance Environment (ISFE) that includes Primary Care Support England (PCSE) data supplied by CAPITA (PCSE data for June 2021 - March 2022 only).

The majority of the data is taken from PCSE, a cash-based operational system in which data is signed off at the end of each quarter and financial year by the local Primary Care Support England (PCSE) office. GP practices and the other providers of general practice services included in this report should use their PCSE contact for any queries on the figures in the first instance. PCSE produces an annual statement each April which is available to practices wishing to check their payments.

ISFE records the practice-level payments made by NHS England and CCGs. Payments data from ISFE was first included in the report in 2016 and covered payments made for Local Enhanced Services (LES) – now called Local Incentive Schemes (LIS) – only. Since 2016/17, all invoices raised through the ISFE payables ledger have been extracted and included in the report to provide a more complete account of NHS payments to general practices. Although the inclusion of these ISFE data improves the completeness and coverage of the data, there will nonetheless be other payments made to practices, for example by Local Authority Public Health bodies, that are outside these two systems so other potential sources of NHS payments data will continue to be investigated.

These detailed ISFE data are not available for financial years prior to 2016/17 and users are advised not to make comparisons with payments for previous years.

NHS Digital seeks to minimise inaccuracies and the effect of missing and invalid data but responsibility for data accuracy lies with the organisations providing the data i.e. PCSE offices and NHS England. Methods for data capture are continually being updated to improve data quality. However, payments made in error may occur and, if so, may be included within the data.

Along with payment data, contract type and population information is extracted from NHAIS and PCSE data. However, some practices received no payments via NHAIS or PCSE but have payments recorded in ISFE only so are not included in the NHAIS or PCSE data extracts. GP Practice dispensing status is extracted from the NHS Business Service Authority (NHSBSA) ePACT2 system. Where possible, contextual information relating to these practices and their populations has been taken from reference data but there remains a small number of practices with unknown values for some fields such as contract type, dispensing status and number of registered and weighted patients.

Developments to the NHS Digital GP Payments NHAIS system in 2013/14 and the introduction of NHS England’s Integrated Single Finance Environment (ISFE) mean it is now possible to provide payments data in a clear and transparent format for publication.

The data in this report is at a more granular level than other GP finance-related reports. Data prior to 2013/14 are not available.

It is in the public interest to understand the amounts that providers of general practice services receive from the NHS.

Patient List Size

The National Patient Register, which is collected by NHAIS and PCSE, is intended to be an accurate count of individuals registered with each General Practice. Among other benefits, accurate patient lists should ensure that the appropriate payments are made to practices for patient care. 

However, there is a known discrepancy between the estimated size of the England population and the number of people registered at GP practices which is known as list inflation, over-coverage or ghost patients.

List inflation occurs when the National Patient Register continues to record individuals that should have been de-registered. This can happen for a variety of reasons, including - but not limited to:

• Patients move away and do not de-register when they leave
• Young, healthy people have moved to a new address but did not prioritise de-registering with their former GP practice
• Patients have left the country but did not de-register
• Shared custody of children with split residence is not flagged in the medical record resulting in double-counting
• Duplicate records, for example due to use of different names, particularly surnames
  • For example, children are recorded against their mother’s and their father’s surname, resulting in double-counting
• Patients in nursing or residential care are registered for that address as well as their original place of residence
• Death

In addition to list inflation, which incorrectly increases the count of patients, there are also issues associated with under-coverage. For example:

• Individuals move to a new area, de-register from their former GP and do not register with a new practice in a timely fashion, if at all
• Members of the armed forces and their families are included in population estimates but are not covered in the National Patient Register. However, from a statistical perspective, adjustments are made to mitigate the effect of this
• Babies may not be included in the National Patient Register until formally registered
• New (or returning) migrants may delay registration with a practice
• Individuals may be inappropriately removed from a GP list under the “no-contact” criteria and may need to be restored

There are a large number of collection systems providing GP practice data to NHAIS and PCSE, with variation in the quality of the data recorded, and in the verification and checking mechanisms in place. 

In terms of patient information, there are a range of data quality considerations – such as when hand-written records are added to electronic systems – which could contribute to over or under-coverage.

Weighted patient counts

The weighted patient count is a constructed value that is used in the practice funding formula (the Carr-Hill formula). It considers the following six indices which are then applied to the registered patient count:

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

The weighted patient count is therefore a calculated count based upon the needs of the practice’s registered patient population.

Patient list counts in the NHS Payments to General Practice publication

For the purposes of this publication, the registered and weighted patient counts are the average of the counts at the end of each quarter (30 June, 30 September, 31 December and 31 March).

In releases prior to 2018/19, the most recently available patient counts were used, so the count at the end of quarter four was used unless no count was available (for example because the practice had closed), whereupon the count from quarter three, two or one was used.

Use of the most recent patient count can result in additional double-counting of individuals within the data beyond the issues outlined above in “list inflation”. For example, practice A may close at the end of quarter one. All patients registered at that practice will be counted against that practice along with the payments made while the practice was open. However, the patients may subsequently register with a new practice and will be counted against their new practice in later quarters thereby inflating the overall totals.

Some practices received payments from ISFE only and no information is available relating to patients that may be registered with these practices. As a result, no practice-level figures can be calculated for average payments per registered and weighted patient at these practices. However, the total money paid to these practices is included in the calculations of average payments at a CCG and national level, which again means that these measures should be treated with caution due to the uncertainty relating the patient counts used in the denominator.

Finally, as a result of the uncertainty described, CCG and England-level figures for average payments per weighted patient are likewise subject to comparable levels of uncertainty.

Some practices show no registered or weighted patients but nonetheless provide healthcare services and receive payments accordingly; these practices are identified by a “No registered patients” flag in the Atypical Characteristics column and by “N/A” in the average payments per registered patient and weighted patient columns.

Regional figures

The NHS England regional structure is subject to change, generally at the beginning of the financial year.

Figures are provided for practices, CCGs and regions according to the structure during the reporting year in question. This is to avoid any confusion which could be caused by reporting payments made during the reporting period in terms of a new structure, where characteristics of practices could differ between then and now. These could include differences in:

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

However, it may be the case that as a result of a restructure, some CCGs or regions may no longer exist.

Negative amounts

The data tables in the report include some negative amounts. The data is extracted from NHAIS, PCSE and ISFE based on the payment code used at source. Adjustments can be required to these codes for a number of valid reasons, including rectifying the use of an incorrect code. As adjustments can be either positive or negative this can result in what appears to be a ‘negative payment’.

• As some payments are made on account, negative payments may also occur where there has been an overpayment in a previous period and the money has subsequently been recovered.
• Similarly, some ‘deductions’, for example for pensions, levies and prescription charge income, could be positive amounts, once adjustments have been made.

Where a zero is shown, there is no payment for that category for the practice; it does not signify missing or unavailable data.

Additionally, some payment categories may be removed, added or altered year-on-year to reflect any changes made to services and how they are paid for.

Payment types

The data provided is analysed according to the coding allocated at the time of payment via NHAIS and PCSE or accounts payable in ISFE. These payments codes may be subsequently changed as part of normal accounting processes. However, as data is extracted from source data rather than the general ledger it is not possible to replicate such modifications to the data.

Global sum makes up the bulk of payments to practices. It is calculated based upon each practice’s patients according to the Carr-Hill formula, which includes patients’ age, gender and health conditions. Two practices with the same count of registered patients may have very different populations with very different needs; this is partially reflected in the weighted patient numbers. These practices, while apparently similar in terms of list size, may thus receive very different levels of funding.

Practice types

The data includes all GP practices, Walk-in Centres and (combined) Walk-in Centres and Out-of-Hours practices that received a payment through the NHAIS, PCSE or ISFE systems between 1 April and 31 March. Any practices which have received total payments between £-1.00 and £1.00 have been removed from the data.

Walk-in Centres may have low numbers of registered patients but apparently receive large amounts as they deliver a variety of services.

Some practices may provide a broader range of healthcare services than others, for example undertaking diabetic retinal screening for patients across the wider community rather than solely their own patient base; such practices are likely, therefore, to receive additional funding.

Prescribing and dispensing

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 should be considered when comparing them with non-dispensing practices, which rely on community pharmacies to provide dispensing services for their patients.

Regardless of their dispensing status, all practices receive fees for any personally-administered items such as vaccines and inoculations.

Prescribing costs have been categorised as Prescribing Fee Payments, Dispensing Fee Payments and Reimbursement of Drugs Payments.

PMS practices, however, may capture additional payments over and above their core services which are recorded in "Balance of PMS expenditure". These “Balance” payments could include figures relating to prescribing costs but cannot be further broken down.

Since the first publication of 2013/14 data in February 2015, a report covering the previous financial year has been published annually.

The publication consists of provider-level payments data for England only.

Data prior to 2013/14 is not available at a level sufficient for extraction. Therefore figures cannot be provided for any earlier years.

A similar publication is published annually for practices in Scotland and is available from:
http://www.isdscotland.org/Health-Topics/General-Practice/Publications/

This is an annual series of NHS Payments to General Practice statistics, using data directly from NHAIS, PCSE and ISFE, which have not undergone any amendments or adjustments such as for accruals. These figures are not directly comparable with other GP finance statistics, but do provide a basis for the figures which feed the England data for the Investment in General Practice report. Please note that from 2019/20, the UK-level Investment in General Practice report was discontinued. NHS England publish an investment report for England. Links to their publication are provided on the NHS Digital website.

Specific differences between this report and the Investment in General Practice report are:

• accounting adjustments - the data are cash payments or based upon invoices raised, whereas the data provided in the Investment in General Practice report is on an accruals basis
• not all payments in the investment report are paid directly to providers of general practice services and are therefore not paid through NHAIS or PCSE or analysed at GP practice level in ISFE. These include, for example, some Information Management and Technology (IM&T) costs and some premises costs although, overall, these are a relatively small proportion of overall investment in general practice
• some payments which are made by NHS England on behalf of GPs and other providers cannot be broken down to practice level. For example, payments for clinical waste and IT services are centrally procured and cannot be accurately allocated to each individual provider;
• income from Local Authority Public Health Grants for the provision of public health services will not be included in this report but is included at an aggregate level in the Investment in General Practice report.

Assessment of User Needs and Perceptions

Comments and feedback are welcomed by email to [email protected] or [email protected], or by telephone 0300 303 5678.

User needs and feedback are taken into consideration during the production process.

The data is extracted from NHAIS, PCSE and ISFE as part of the operational processes of the systems and are a secondary use of the data. There is, therefore, no additional burden on NHS organisations, GP practices or other providers to complete and return the data from which the report is developed.

Published GP payments information is derived from NHAIS, PCSE and ISFE. Users of these systems (appropriate persons from practices and Clinical Commissioning Groups (CCGs)) can monitor their own PCSE information on a continuous basis throughout the year and also have access to an annual statement from PCSE. NHS England and CCG purchase invoices recorded in ISFE are visible to the bodies making the payments.

The standard NHS Digital data security and confidentiality policies have been applied in the production of these statistics. The data contained in this publication is Official Statistics. The Code of Practice for Statistics is adhered to throughout the publication cycle along with NHS Digital’s Statistical Governance Policy.

All publications are subject to a standard NHS Digital disclosure risk assessment prior to issue. Disclosure control is implemented where judged necessary.