Primary Care Appeals

About

We are responsible for ensuring the prompt and fair resolution of appeals and disputes between primary care contractors or those wishing to provide primary care services and the commissioners of primary care services, such as: NHS England and NHS Improvement (NHSEI) and Clinical Commissioning Groups (CCGs). Pharmacy appeals relate to applications to open NHS community pharmacies, to relocate or change listing and against breach or remedial notices. Disputes relate to entitlement to payments including GP premises rent, against breach or remedial notices, variation or termination of contract and regarding suspension payments (GPs and Dentists only).

We are also the recipient of notifications of any decisions relating to Performers and Pharmaceutical Lists and those applying to enter them and we shall keep a record of such notifications. Before determining new applications to enter the Lists, NHS England is required to check with NHS Resolution for any facts relating to investigations or proceedings involving the proposed applicants. This process provides a centralised system for the disclosure of relevant information enabling NHS England to make informed decisions regarding the suitability of those applying to join the relevant list. For more information, please go to Performers lists checks.

We are independent of both NHSEI and the Department of Health and Social Care and are able to bring to bear longstanding expertise when interpreting and applying complex primary care regulations alongside consideration of public law issues.

We have vast experience in primary care contracting disputes and have built this while remaining a constant entity in the health service landscape.

Given our functions cover all of England, we see the full range of disputes and as such, are in a position to inform system changes.

We are open and transparent in the way in which we determine cases and routinely publish decisions.

Without Primary Care Appeals’ effective dispute resolution service managed within the NHS, parties would have no other recourse but to the courts which is expensive and time consuming.

Fairness and equalities

We ensure that local decisions taken by the commissioner regarding contractual matters are lawful, fair, reasonable and proportionate.

Insights and Learning

We provide learning to help develop capability and robust local decision making by the commissioner which supports fair and just outcomes for those involved in disputes.

We provide information regarding our work, our procedures, our approach and relevant decisions to those interfacing with our services in order they are best placed to make informed decisions and to understand the processes involved. We also publish guidance based on our insights from decision making.

We provide a range of on-line resources including publishing all our decisions and guidance to support learning for both commissioners and contractors.We provide insights to identify where the system is not working to inform commissioners and those delivering services in order to pre-empt issues/address concerns earlier which can save resources and be deployed elsewhere.

We provide insights on regional differences in disputes allowing opportunities for further analysis to address why there are disparities.

Efficiencies

We demonstrate what good local dispute resolution looks like which enables the commissioner to follow a consistent approach meaning that time/effort is not wasted by parties involved in disputes and that positive outcomes are achieved.

We provide confirmation of approaches so that monies are awarded or recovered and deployed to patient care.

We determine case precedents for contractors and the commissioner to follow meaning that time/effort is not wasted by parties involved in disputes.

Primary Care Appeals has recently created a video regarding its role and the NHS dispute resolution procedure.  Whilst the content references dentistry, many principles apply regardless.