Funding Risks: How to Avoid Losing Out on Reimbursements

Funding Risks: How to Avoid Losing Out on Reimbursements

Overview

Notes
The 2025/26 GP contract introduces new financial structures, changes in funding allocation, and stricter monitoring. Practices must be proactive to avoid funding losses due to missed deadlines, incorrect claims, or underperformance in key areas.

 Key Funding Risks in 2025/26

  1. ARRS underutilisation – Unclaimed workforce reimbursement funds are lost if not used.
  2. Missed QOF targets – Higher thresholds could mean reduced payments.
  3. Late or incorrect Enhanced Services claims – Inaccurate submissions risk non-payment.
  4. Non-compliance with digital mandates – Failure to meet online booking and access requirements could lead to funding restrictions.

Action Points:

  1. Identify at-risk funding areas in your practice.
  2. Implement robust tracking systems for all claims.
  3. Ensure compliance with new NHS digital and access requirements.

Step-by-Step Guide to Mitigating Funding Risks

Maximise ARRS Reimbursements

  1. Ensure your PCN is fully utilising ARRS funding – unclaimed funds do not roll over.
  2. Review your PCN workforce plan to ensure all roles are fully funded.
  3. Submit accurate monthly reimbursement claims on time.

Checklist:

  1. Confirm PCN workforce planning aligns with ARRS funding availability.
  2. Ensure monthly claims are submitted without errors.
  3. Monitor staff utilisation to maximise funding claims.

Prevent QOF Income Loss

  1. Review QOF performance regularly to track progress against targets.
  2. Ensure coding and reporting are accurate to capture all eligible patients.
  3. Focus on new high-value indicators, particularly CVD prevention and chronic disease management.

Checklist:

  1. Monitor QOF performance monthly to identify at-risk areas.
  2. Ensure all activity is coded correctly to meet QOF targets.
  3. Prioritise clinical areas with the highest QOF points value.

Submit Enhanced Services Claims Accurately

  1. Late or incorrect Enhanced Services (ES) claims risk delayed or non-payment.
  2. Use CQRS and ICB portals to track claim deadlines and required documentation.
  3. Keep detailed audit trails to support claims in case of dispute.

Checklist:

  1. Ensure all ES activity is recorded accurately in clinical systems.
  2. Submit claims on time via the correct NHS portals.
  3. Retain evidence of service delivery for financial audits.

Meet NHS Digital & Access Mandates

  1. From October 2025, practices must offer online appointment requests throughout working hours.
  2. Failure to comply could impact access-related funding streams.
  3. Ensure your clinical system and website allow for digital booking.

Checklist:

  1. Confirm online booking is enabled and working correctly.
  2. Train staff on managing online appointment requests.
  3. Monitor patient access feedback to ensure compliance.

Next Steps & Deadlines

  1. Monthly – Submit ARRS and Enhanced Services claims on time.
  2. April 2025 – Ensure QOF performance tracking is fully operational.
  3. October 2025 – Meet NHS digital access mandates.

Immediate Actions:

  1. Identify key financial risks and implement tracking processes.
  2. Ensure all reimbursement claims are accurate and timely.
  3. Monitor QOF and Enhanced Services performance to prevent income loss.