Health bosses faced catalogue of problems at village practice

Reports seen by the Yorkshire Post reveal a catalogue of problems in the NHS management of its contract as pressures grew on the practice in the village of Brampton, near Wath-upon-Dearne.

The deal to run Brampton Medical Practice was awarded in December 2008 to a new business Wentworth North Primary Care Ltd, which was set up six months earlier by seven local GPs.

The surgery opened in April 2009 with the aim of eventually serving 6,000 patients fuelled by plans for 1,400 new homes in the area.

Accounts showed the company turned over £435,000 in 2009-10, running up a net profit after tax of £93,000 which was reinvested in the practice.

Its formula-based funding was paid by NHS Rotherham each month, while it also received a one-off grant of £150,000 from the Yorkshire and Humber Deanery, which is in charge of doctors’ training, as it was expected to tutor new GPs within three years.

But growth in patients was slow and by May last year, when the practice suddenly closed, only 1,112 patients had registered.

In a statement at the time, health chiefs blamed the collapse on the abandonment of housing plans which meant it would not receive the income required to sustain it and cover investment for upgrading its building.

But reports on the collapse reveal a more complicated picture.

Internal auditors from the primary care trust NHS Rotherham found the contract had been properly awarded by its board although it was acknowledged a “major risk” to the deal was that the patient list size would not increase in line with forecasts.

But due to “resourcing pressures”, the management of the contract was handed to staff unfamiliar with its terms.

Auditors found there were failures both in the contract’s financial management and with its operational management, with no continuity among staff, lack of expertise and lack of senior management involvement.

Four contract review meetings were held from July 2009 to March 2010 and “although notes of the meetings indicated that the patient list size, which was crucial to the viability of the practice, was well below target, no action was taken by the contract review group nor was the issue raised with senior management of the PCT.

“Furthermore, during this period operational management responsibility changed three times and when the latest manager went on long term sick leave it appeared that no one was then assigned responsibility for the contract.”

There was also confusion over amounts payable to the practice. “Following discovery of the overpayment to the practice in April 2011, the PCT took swift action and made every effort to try to resolve the matter and obtain a satisfactory conclusion for both parties. Unfortunately due to the terms of the contract it was not possible to come to a viable solution”, and the company ceased trading on May 27, the report said.

Two weeks earlier, the PCT had asked the internal auditors to carry out a review of expenditure incurred by the company totalling £270,000 which included £122,000 it estimated had been overpaid and the deanery’s £150,000 grant.

“The practice accounts were examined and it was confirmed that the monies were spent for the purposes of improvements to premises and patient services,” said the report.

The report made 11 recommendations covering improved documentation of its processes and better contract management.

A report by the firm’s directors following its collapse said: “Unfortunately because of the economic climate the building of new housing in the area had stopped and it subsequently proved difficult to register patients.”

A proposed merger between the surgery and a local GP practice failed. NHS Rotherham had insisted future payments should be based on the contract calculation and overpayments repaid. This meant business was no longer viable.