The Department of Health (DH) has introduced a Quality Payments Scheme as part of the Community Pharmacy Contractual Framework in 2017/18. This will involve payments being made to community pharmacy contractors meeting certain gateway and quality criteria, with funding taken from the overall funding for 2017/18 of £2.592 billion.
The Quality Payments Scheme has now ended for 2017/18. The review points have now passed and contractors can no longer claim payment for the scheme.
No decisions have been made by the Department of Health and NHS England on the future of the Quality Payments Scheme beyond 2017/18.
Click on a heading below for more information.
NHS England guidance
NHS England has published new guidance ahead of the November review point of the Quality Payments Scheme:
- NHS England – Pharmacy Quality Payments Guidance for the November 2017 declaration (published 2nd October 2017)
The November guidance should be read in conjunction with NHS England’s gateway criteria guidance and the quality criteria guidance which was issued ahead of the April review point:
- NHS England – Pharmacy Quality Payments Gateway Criteria Guidance (published 23rd December 2016); and
- NHS England – Pharmacy Quality Payments Quality Criteria Guidance (published 27th February 2017).
All three documents are available on the NHS England website.
PSNC strongly encourages all contractors to read the new NHS England guidance, as well as the previous guidance, to ensure they are fully briefed on the requirements of the Quality Payments Scheme ahead of the November review point.
PSNC Briefing 074/17: Quality Payments – Checklist for the November review point (October 2017)
Community pharmacy contractors and their teams will need to decide how to approach achieving the gateway and quality criteria in a way that works for them. There will be no ‘one size fits all approach’, but we have produced a checklist for contractors to use to tick of as they meet the gateway and quality criterion.
PSNC Briefing 075/17: Quality Payments – PSNC resources (October 2017)
This PSNC Briefing provides a list of all the PSNC resources available to community pharmacy contractors to assist them with meeting the gateway and quality criteria for the November review point of the Quality Payments Scheme.
To be eligible to collect the points necessary to claim a Quality Payment, the contractor must meet four gateway criteria (click on the links below for more information):
- provision of at least one specified Advanced Service;
- have their NHS Choices entry up to date;
- have the ability for staff to send and receive NHSmail; and
- ongoing utilisation of the Electronic Prescription Service.
Contractors passing the gateway criteria will only receive a Quality Payment if they meet one or more of the quality criteria listed in the table under the ‘Quality criteria’ subheading below. Therefore, meeting the gateway criteria will not, in itself, attract a Quality Payment; it is subject to how many of the quality criteria the contractor meets.
Contractors passing the gateway criteria will receive a Quality Payment if they meet one or more of the quality criteria listed in the table below. DH has weighted these based on an assessment of the difficulty of achieving them and the benefit to patients for doing so, with each criterion being designated a number of points.
The total number of points that each contractor can qualify for over the two reviews is 100. Three of the quality criteria, which account for 45 points between them, only need to be met once in the year and therefore can only be claimed for once at one of the two review points.
Click on the links below for more information on each of the quality criteria.
Claiming Quality Payments
There were two review points during the year, at which a Quality Payment can be claimed. These were:
- Friday 28th April 2017; and
- Friday 24th November 2017.
To claim for a Quality Payment, contractors will need to complete a declaration via the NHS Business Services Authority (NHS BSA) website.
PSNC Briefing 078/17: Quality Payments – Completing the NHS BSA Quality Payments declaration provides information on making the declaration and the questions which will be asked.
Important: Once a contractor has submitted their online declaration it cannot then be altered. The contractor is responsible for the information included in the submitted declaration. It is therefore imperative that contractors check their declaration thoroughly before submitting their declaration.
Contractors will need to confirm that they have met all of the gateway criteria before they can access the most detailed questions for the quality criteria.
Once the declaration has been submitted the contractor will receive an email from NHS BSA confirming that the declaration has been successfully submitted and confirming the details that have been declared. This email should be retained by the pharmacy as proof that the declaration was submitted and the date of submission. The email will show how contractors have responded to each of the gateway and quality criteria.
For the November declaration, contractors have the option of providing an additional email address so proof that the declaration was submitted can be sent to another in the organisation such as a pharmacy’s head office.
NHS England is carrying out an evaluation of the Quality Payments Scheme to learn from this scheme and to assess its effectiveness.
When completing the April declaration, contractors were asked a number of questions specifically to inform the NHS England evaluation of the Quality Payments Scheme. The same questions will not be repeated for the November declaration.
DH has said it will allocate £75 million to fund the Quality Payments in 2017/18, which will be funded from the overall funding for 2017/18 of £2.592 billion.
Payments will be made to eligible contractors depending on how many quality criteria they have met (and therefore how many ‘points’ they achieved). DH expects the value of each point to be set at £64. This is set at a level that would deliver £75 million assuming 100% of pharmacies achieved all 100 points.
Payments due from each review point will be paid as part of the full value of services for that month, i.e. payment from April 2017’s review point will be paid at the end of June 2017 and payment from November’s review point will be paid at the start of February 2018.
However, it may be the case that not all pharmacies will achieve all of the quality criteria across the two review points. Therefore, after the two review points, there will be a reconciliation process, at which the remaining funding will be divided between qualifying pharmacies based on the number of points they have achieved over the two review points. This reconciliation payment will not have to be claimed and will be made on 1st June 2018).
To ensure the overall amount earned by one contractor for Quality Payments remains proportionate, a cap of £128 per point will be allowed in totality including the reconciliation payment. To reach the cap would require less than 50% of pharmacies achieving less than 50% of the quality criteria.
Pharmacies that are part of the Pharmacy Access Scheme (PhAS)
When the ‘top-up funding’ that PhAS pharmacies receive is calculated, it is assumed that the contractor will achieve 100 points within the Quality Payments Scheme and the value of those points is deducted before the final PhAS payment is set. This is described in the following diagram:
As with all other pharmacies, PhAS pharmacies should therefore seek to meet as many quality criteria as possible and should claim the appropriate funding in the same way as all other pharmacies.
Validation and verification of claims
Validation of the declarations submitted by contractors will be carried out using nationally and locally available information. Contractors who appear not to have met the criteria in relation to their declarations may be required to provide further evidence to NHS BSA as requested for post payment verification.
Further information on the validation and verification process can be found on the NHS BSA website.
Declaration data for the April and November review points
NHS BSA has published the declaration data for the April review point of the Quality Payments Scheme.
No information has been published yet for the November review point.
Further information can be found on the Quality Payments Scheme – Statistics page.
Frequently asked questions (FAQs) on Quality Payments can be found on the Quality Payments – FAQs page of the PSNC website.