The Clawback Conundrum
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- Published: Tuesday, 12 April 2022 18:57
- Written by Peter Ingle
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For NHS contractors the threat of clawback feels to have grown year by year. Clawback is the process by which contactors that fail to meet UDA targets have retrospective deductions made from their scheduled payments.
These are made in the year following their under delivery. They are also deemed to have ‘breached’ their contract which can have serious implications, including loss of the contract. There is a question about what happens to the money that is recovered by NHS England from practices through clawback.
Cat Smith, the Labour MP for Lancaster and Fleetwood, like many of her colleagues has recently taken an interest in NHS dentistry. She recently received answers to two written questions that she had made to the Secretary of State for Health and Social Care. Firstly, “how much money was clawed back by NHS England from primary care NHS dental practices in England which had not met their contractual targets in each year since 2010-11.” In a further linked question she enquired, “how much money was clawed back by NHS England from primary care NHS dental practices in England which had not met their contractual targets was re-invested in dental services in each year since 2010-11.”
The Secretary of State, Maria Caulfield provided some telling figures in her response. In 2012 -2013 clawback had been £48.6 million, easing slightly to just over £45 million during the following two years. But then it began to rise dramatically. In 2015-2016 it had risen from £45 million the previous year to £80.3 million. This trend continued year on year culminating in a figure of £168.6 million in 2019 -2020. Data before 2012 -2013 was not available but it would seem likely to be at the same or lower levels. To put this into perspective the much trumpeted but poorly taken up £50 million of funding offered in early 2022, represents less than a third of the 2019-2020 clawback. And then came the pandemic. With the slashing of UDA targets, the 2020-2021 clawback figure had plummeted to just £8.3 million.
In answer to Cat Smith’s second question, the minister replied; “In cases where a provider has underperformed, clawback of payment from providers is carried out in the subsequent financial year. No estimate has yet been made for overall clawback relating to underperformance in 2021/22. The Government’s accounting rules do not allow carry forward of any unspent monies, so clawback cannot be re-invested in year. However, the NHS commits £3 billion for dentistry services each year.”
This would suggest that clawback money can go to the Treasury or the wider NHS. The late change in last quarters UDA target may have come about as it dawned upon NHS England and OCDO that, left at 85%, it would result in a massive clawback, hundreds of breaches, and a likely major loss of NHS access. Against this, given the current financial climate, and reeling after a drop from £168 to £8.3 million they may be looking for a significant increase in clawback. How NHS England negotiate this balancing act could decide the fate of NHS dentistry.
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