NHS England NHS Improvement 2 November 2018
- This document contains ten helpful hints for commissioners and providers to avoid conflict.
The ten hints
- Make sure that you are familiar with national business rules (National Tariff, the NHS Standard Contract, CQUIN).
- If there is disagreement or doubt about how the national business rules are to be understood, seek advice.
- Remember that a dispute is likely to be resolved on the basis of what your local contract actually says.
- Your ability to exercise your rights under the contract may be jeopardised if you don’t follow contract processes properly.
- Disputes can often centre on whether a party can gain financial redress for a historic issue which has had a financial impact over months or even years.
- The contract rules on Managing Counting and Coding Changes (SC28) involve obligations to notify proposed changes and to neutralise their financial impact for specified period. They are carefully balanced to be fair to both commissioners and providers – but they are complex and can be a source of disputes.
- Where a disagreement arises, a local audit of the provider’s practice can often be a useful tool in reaching a resolution. External third-party audits can be arranged under GC15, or the parties can separately agree, for instance, that the provider itself will carry out an audit and report the results to the commissioner. But difficulties often arise where audits are carried out without clear agreement on their purpose and scope and on how their findings are to be given effect.
- Disputes will be minimised if commissioners and providers take a reasonable approach to inyear financial reconciliation and contesting of payment and avoid “gaming”.
- If a serious disagreement starts to emerge locally, discuss it fully with the other party, before entering the formal dispute resolution process set out in GC14.
- And – most important of all, remember that an effective contractual relationship is not all about what’s in the contract and how it is enforced.
