Manage claw back negotiations wisely and you could come away smiling, says Amanda Atkin
One of the many things that can cause distress to those running dental practices is the subject of claw back. This arises when the NHS England believes you've been underperforming and effectively demands a refund. They are, of course, quite within their rights to reclaim monies overpaid where UDAs or UOAs were not delivered.
However, there can be many a slip twixt cup and lip – for want of a better expression. For various administrative, rather than sinister, reasons the amount you are asked for may be incorrect. And there may be mitigating circumstances to be taken into account.
My first piece of advice is don't simply pay up without doing further research and/or taking advice from someone who has dealt with many claw back situations. With some careful research and thoughtful negotiation, the amount being claimed may be reduced or even eliminated.
Is your data correct is the key initial question. You need to check with both BSA Dental Services and your Local Area Team that your data has been collated accurately.
These are some of the things to look for:
- not a full year of activity
- computer glitches causing data to be lost
- lost in the post, if not computerised
- not all your FP17s recorded or accepted
It is also possible that the claw back amount has been rolled forward over one or more years and that the figures for earlier years are incorrect.
Then there are other factors which may have influenced your activity. Examples of these could be:
- illness of performer(s) or a bereavement
- a move of premises or disruptive alterations
- practice closures as a result of something outside your control – for instance, flooding (as a topical example)
Armed with this information, consider carefully whether you feel a claw back is justified and the amount accurate. BSA Dental Services may be able to help you get a clear understanding.
Now request a meeting with your Local Area Team and present your arguments and supporting data. If you wish to argue that some or all of the underperformance activity can be made up for in the next financial year, you will need a business plan that supports this. This plan will need to show how you have or intend to overcome whatever problems resulted in the underperformance.
More than that, you'll need to show how the practice will deliver the extra UDAs or UOAs. Essentially, this means planning for additional treatment hours through such measures as evening and/or weekend opening, the use of a part-time locum and so on.
You will also need to show that you will be able to monitor accurately performance against contract (on a month by month basis) and make adjustments as necessary. You should, of course, do this anyway and take action if you begin to underperform.
Having agreed a sum of claw back, it may be possible to negotiate staged payments over a number of months. This will reduce the impact on the practice cash flow and, again, a business plan should be prepared so that you know the practice can afford the payments. The income of most practices varies from month to month so smaller repayments may be wise during periods of reduced cash flow – such as the Christmas and New Year break, for example. Offset these with larger repayments during months where cash flow is, from past trends, greater.
Remember, also, that claw back (or indeed an agreed rise in the contract value) can affect the pensionable earnings ceiling for each performer on the contractor's GDS/PDS contract. A new Annual Reconciliation Report (ARR) needs to be completed.
And my second piece of advice? Don't panic! I have experience of supporting practice owners in these situations and, if handled correctly, the outcomes can often be favourable – reduced or even cancelled claw back.
Amanda Atkin is an experienced healthcare management consultant with extensive experience within dentistry from both a clinical and managerial perspective.
Her website is: www.atkinspire.co.uk