Primary Care Appeals: getting to the heart of dispute resolution
NHS Resolution introduces its Primary Care Appeals service, helping to resolve any disputes between the NHS and dental practices.
Relationships are tricky, whether they are business or personal. In any partnership, parties share common goals. But sometimes the journey towards achieving these goals doesn’t always align.
So, when a dispute does arise, finding a fair resolution quickly is crucial.
Within the NHS, the relationship between service commissioner and service provider is critical. It achieves one major common goal: maximising resources to deliver the very best patient care.
When a contractual dispute arises, NHS Resolution’s Primary Care Appeals service can help find a mutual resolution.
‘The purpose of the Primary Care Appeals service is to ensure that any contractual disputes that occur between primary care providers and NHS England and NHS Improvement are resolved promptly and fairly’, explains Jonathan Haley, head of operations within the Primary Care Appeals service at NHS Resolution.
‘Disputes between service commissioner and service provider can arise for any number of reasons. Such as payment issues, contractual changes or, in certain cases, a decision to terminate the contract.
‘Failure to resolve a dispute quickly can lead to a breakdown in the commissioner/provider relationship. And, in some cases, pose a long-term risk to patient care.
‘Therefore, it is in the best interests of everyone to reach a fair resolution as quickly as possible.’
Primary Care Appeals service
The dispute resolution process is straightforward to follow, and either the service provider or commissioner can instigate.
If the dispute falls under the jurisdiction of NHS Resolution, the Primary Care Appeals service will run through the information provided as part of the process to check that all relevant details have been provided to enable the matter to progress.
We invite both parties (or their representatives) to provide representations and supporting material as part of the process. With a vast majority of cases resolved within a maximum of 15 weeks.
An important part of the work of the Primary Care Appeals service is to share learning and issue general guidance to those involved in the process. This ensures parties can deal with issues earlier or feedback learning to highlight how to improve decision-making.
If you would like more information on the Primary Care Appeals service, please visit resolution.nhs.uk/services/primary-care-appeals (where guidance and past decisions are published), email [email protected] or call 0203 928 2000.
Primary Care Appeals in action
One of the consequences of the COVID-19 pandemic was that, on 25 March 2020, NHS England and NHS Improvement announced the stop and defer of all routine, non-urgent dental care including orthodontics until advised otherwise. This meant that in the lead-up to year end 2019/20, some dental contract holders were unable to deliver their allocated units of dental activity (UDAs). In some cases, this resulted in NHS England and NHS Improvement seeking clawback of monies and issuing breach notices.
In the first pandemic-related dispute received by the Primary Care Appeals service, a dental contractor challenged the standard methodology adopted by NHS England and NHS Improvement in its 2019/20 year end reconciliation of activity.
The Primary Care Appeals service found in favour of the contract holder. The methodology used to calculate the UDAs was unfair and disproportionate to the contractor.
NHS England and NHS Improvement was therefore directed to undertake a revised calculation. This would reduce the amount of money clawed back from the contractor.