National approach to NMS PPV to start this month

National approach to NMS PPV to start this month

January 11, 2018

From mid-January 2018, the NHS Business Services Authority (NHS BSA) will start undertaking post-payment verification (PPV) of payments to community pharmacy contractors for provision of the New Medicine Service (NMS). This will involve requesting evidence from a sample of contractors to support payment claims they have submitted for NMS over a specified three-month period.

This work will follow a similar process to that implemented for the PPV of Medicines Use Review (MUR) payment claims, which commenced in October 2017.

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 the NHS BSA commenced their PPV work on MUR claims, this monitoring had been the sole responsibility of local NHS England teams; however, in many areas resource constraints had limited their ability to perform this work, which has resulted in a lack of consistency in how it was carried out across the country.

Standardising the approach

NHS England has asked the NHS BSA 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 MUR and / or NMS over a specified three-month period.

The evidence requested will be the signed patient consent forms for the services 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.

The 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, the 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 the 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 the 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 and/or NMS consent forms to NHS BSA; only contractors that are contacted by NHS BSA need to submit their MUR or NMS consent forms.

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