National approach to MUR PPV to start in October

National approach to MUR PPV to start in October

September 25, 2017

From next month, the NHS Business Services Authority (NHS BSA) will start undertaking post-payment verification (PPV) of payments to community pharmacy contractors for provision of the Medicines Use Review (MUR) service. This will involve requesting evidence from a sample of contractors to support payment claims they have submitted for MURs over a specified period.

Why is this happening?

NHS England is responsible for monitoring the provision of Essential and Advanced Services by contractors and they have a duty to assure themselves of the quality and probity of activity provided under the Community Pharmacy Contractual Framework.

Until now, this monitoring has been the sole responsibility of local NHS England teams; however, in many areas resource constraints have limited their ability to perform this work, which has resulted in a lack of consistency in how this is carried out across the country.

Standardising the approach

NHS BSA has been asked to pilot a national process for parts of the PPV and performance management of Advanced Services.

Taking a standardised and centralised approach to this work means the variability in the way PPV is currently carried out by NHS England will be removed and all pharmacies will be treated equally and fairly using a consistent, transparent, proportionate and evidence-based approach.

The standardised approach has been agreed by PSNC, NHS England and NHS BSA. It aims to identify any issues related to the claiming of payment for Advanced Services and to facilitate resolution of those issues with the individual contractor. Where common issues are identified, advice will be provided to all contractors on how such issues could be avoided in the future.

What will this mean for contractors?

Each month, NHS BSA will request evidence from a sample of contractors to support the payment claims they have submitted for Advanced Services over a specified three-month period.

This will start with payment claims for MURs and the evidence requested will be the signed patient consent forms for the service that correspond to the payment claims made. Contractors will be asked to submit the requested forms with their next monthly prescription bundle.

The process has been designed to be as easy as possible for contractors to provide the evidence; however, if there are any difficulties, NHS BSA will be on hand to provide assistance to the contractor.

NHS BSA will review the submitted forms against the payment claims received for the period and will share their findings with the contractor. If there appears to be missing evidence, NHS BSA will discuss this with the contractor and they will be asked if they can provide alternative evidence that the service was provided.

Once NHS BSA’s findings are agreed with the contractor, information will be shared with the relevant local NHS England team. Where necessary, the local team will contact the contractor to discuss the findings. The consent forms submitted by contractors will be returned to them once NHS BSA has finished reviewing them.

Further information on the process

What do contractors need to do now?

Contractors may want to review how they currently file signed patient consent forms; if for example, forms are filed alphabetically, by patient surname, a change to filing the forms in chronological order may be worth considering, making retrieval of forms for any specified time period easier, should the pharmacy be selected for participation in this work.

If a contractor is selected by NHS BSA to take part in this work, they will receive a letter which includes full instructions on how to submit the MUR consent forms to NHS BSA; only contractors that are contacted by NHS BSA need to submit their MUR consent forms.

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