| Reference | FOI 2025/1408 |
|---|---|
| Description | NHS GM ever upheld a financial appeal by a partner organisation and allowed payment or part payment to proceed to this organisation? |
| Date Requested | 08/10/2025 |
| Date Replied | 21/10/2025 |
| Category | Primary Care & Strategic Commissioning |
Questions:
I would like to request the following information:
1. Has NHS GM ever upheld a financial appeal by a partner organisation and allowed payment or part payment to proceed to this organisation?
If so, please provide the following information:
a. The date of the decision
b. The enhanced service type or contract type this related to
c. The amount of money successfully appealed
d. The broad reason for the contract breach e.g. delayed claim
e. The type of organisation making the appeal e.g. general practice
f. The locality of the appealing organisation e.g. Salford locality
This information is likely found in minutes of the NHS Greater Manchester Primary Care Commissioning Committee or the NHS Greater Manchester Direct Commissioning and Contracting Panel. However, if you are aware of any other relevant sources then of course please use that.
Clarity Requested 8 October 2025:
I write in response to your recent Freedom of Information request, which was received by NHS Greater Manchester today. To be able to process your request and provide you with the correct information, I would be grateful if you would be able to share with me precise definitions and clarity to the points raised below.
1. Please can you provide more detail/prove more specific information about what it is you mean by a “financial appeal”?
2. Please can you provide more detail/prove more specific information about what is meant by “partner organisation”? Recognising your reference to the NHS GM Primary Care Commissioning Committee, please can you confirm if by this you mean GP Practices?
I am sorry we are unable to help you further at this time, and I look forward to receiving the necessary clarity to be able to action your request.
Clarity Received 8 October 2025:
Thank you for seeking clarification
In response:
1. By financial appeal I mean any application by a commissioned organisation that the ICB contracts with, where the commissioned organisation has had to file an appeal for payment. For example, relating to general practice the ICB has a “GM Primary Care Contractors Appeals Template”.
2. By partner organisation I mean any organisation the ICB commissions. The most common example would be GP practices and indeed it is these I am most interested in.
NHS Greater Manchester has considered your request and confirmed the only relevant areas of expenditure within scope of the request is in respect of Primary Care. Details requested are provided below:
| a. | b. | c. | d. | e. | f. |
| Date of the decision | The enhanced service type or contract type this related to | The amount of money successfully appealed | The broad reason for the contract breach e.g. delayed claim | The type of organisation making the appeal e.g. general practice | The locality of the appealing organisation e.g. Salford locality |
| 28-Jun-23 | QOF achievement | QI indicators (appeal did not include financial value) – to be determined | Did not provide enough evidence on initial form to warrant the indicator being met | General Medical Practice | Manchester |
| 28-Jun-23 | QOF achievement | QI indicators (appeal did not include financial value) – to be determined | EMIS information supplied suggested coding errors from previous system used | General Medical Practice | Bury |
| 07-Aug-23 | IIF achievement | PCN IIF indicators (appeal did not include financial value) – to be determined | Review of achievement and mitigating system factors influencing ability to deliver | General Medical Practice (s) | Pan-GM |
| 16-Aug-23 | QOF achievement | QI indicators (appeal did not include financial value) – to be determined | Did not provide enough evidence on initial form to warrant the indicator being met | General Medical Practice | Manchester |
| 20-Sep-23 | Vaccination claims | £6,569.18 | Late claims submission. Practice transferred to a new clinical system and the migrated data included issues. This was found to be the fault of the clinical system and not the practice. | General Medical Practice | Bury |
| 18-Oct-23 | Vaccination claims | £643.84 | Late claims submission – Practice transferred to a new clinical system and the migrated data included issues. This was found to be the fault of the clinical system and not the practice. | General Medical Practice | Bury |
| 19-Jun-24 | QOF achievement | QI indicators (appeal did not include financial value) – to be determined | Did not provide enough evidence on initial form to warrant the indicator being met | General Medical Practice (s) | Salford |
| 19-Jun-24 | QOF achievement | QI indicators (appeal did not include financial value) – to be determined | Did not provide enough evidence on initial form to warrant the indicator being met | General Medical Practice (s) | Oldham |
| 19-Jun-24 | Dental activity and performance | £7,589.26 | The practice was not made aware of the missing claims so could not complete the appropriate action within the allotted time frame. Incorrect advice from the NHSBSA was also given to the practice which also delayed the process to rectify the claims. | General Dental Practice | Wigan |
| 17-Jul-24 | Dental activity and performance | £7,922.72 | Practice new performer had issues connecting to the system. Additionally, the system them closed for a period of two weeks for updates. Practice did seek help from BSA | General Dental Practice | Manchester |
| 19-Jun-24 | QOF achievement | QI indicators (appeal did not include financial value) – to be determined | Did not provide enough evidence on initial form to warrant the indicator being met | General Medical Practice (s) | Oldham |
| 21-Aug-24 | QOF achievement | QI indicators (appeal did not include financial value) – to be determined | Did not provide enough evidence on initial form to warrant the indicator being met | General Medical Practice (s) | Salford |
| 21-Aug-24 | QOF achievement | QI indicators (appeal did not include financial value) – to be determined | Did not provide enough evidence on initial form to warrant the indicator being met | General Medical Practice (s) | Oldham |
| 21-Aug-24 | QOF achievement | QI indicators (appeal did not include financial value) – to be determined | Did not provide enough evidence on initial form to warrant the indicator being met | General Medical Practice (s) | Manchester |
| 21-Aug-24 | Dental activity and performance | £8,493.88 | Software issue caused issue with processing claims. As practice had to liaise with Software company directly the claims were then outside the allocated window of time for submission | General Dental Practice | Tameside |
| 21-Aug-24 | Vaccination claims | £110.66 | Practice flu data had been extracted incorrectly | General Medical Practice | Bolton |
| 18-Sep-24 | QOF achievement | QI indicators (appeal did not include financial value) – to be determined | Did not provide enough evidence on initial form to warrant the indicator being met | General Medical Practice (s) | Manchester |
| 18-Oct-24 | QOF achievement | QI indicators (appeal did not include financial value) – to be determined | Did not provide enough evidence on initial form to warrant the indicator being met | General Medical Practice (s) | Manchester |
| 21-Aug-24 | Vaccination claims | £30.18 | Practice flu data had been extracted incorrectly – appeal partially upheld. | General Medical Practice | Wigan |
| 15-Jan-25 | Dental activity and performance | £5,055.70 | Claims were not received by NHS BSA due to technical difficulties with the software, provider was not made aware of issue until outside the allocated timeframe for submission | General Dental Practice | Stockport |
| 15-Jan-25 | Optometry CPD grant | £598 | Optometrist failed to click complete when submitting their CPD grant, evidence of continuing personal development was documented. | General Optometry Practice | Manchester |
| 19-Feb-25 | Dental activity and performance | £7,863.24 | Claims made through software only sent in batches of 100, anything over did not process which practice was not made aware of. No warning of this on current software used. | General Dental Practice | Stockport |
| 26-Feb-25 | Optometry CPD grant | £598 | Optometrist failed to click complete when submitting their CPD grant, evidence of continuing personal development was documented. | General Optometry Practice | Manchester |
| 26-Feb-25 | Vaccination claims | £1,428.52 | Incorrectly extracted Flu Data for vaccines administered | General Medical Practice | Oldham |
| 19-Mar-25 | Optometry late claims | £211.77 | Locum Optometrist failure to report activity | General Optometry Practice | Manchester |
| 21-May-25 | Dental activity and performance | £3,192.26 | Error in software system relating to a national PIN update | General Dental Practice | Trafford |
| 20-Aug-25 | Dental activity and performance | £329.76 | Error in adding performer to system whereby some claims were accepted and others rejected. | General Dental Practice | Tameside |
| 20-Aug-25 | Dental activity and performance | £20,671.98 | IT issues encountered when submitting the activity claims which were outside the practices control. | General Dental Practice | Trafford |
