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.
Click on a heading below for more information.
NHS England guidance
Contractors are strongly encouraged to read both of the below NHS England guidance documents to ensure they are fully briefed on the Quality Payments Scheme:
- NHS England – Pharmacy Quality Payments Gateway Criteria Guidance (published 23rd December 2016)
- NHS England – Pharmacy Quality Payments Quality Criteria Guidance (published 27th February 2017)
Both documents are available on the NHS England website.
Following publication of NHS England’s guidance on the quality criteria (published 27th February 2017), the following documents have been updated:
PSNC Briefing 013/17: Quality Payments – what pharmacy contractors need to do (February 2017) explains how the scheme will work and it details guidance and resources for community pharmacy contractors on what they need to do to engage successfully with it.
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 suggested below one approach which contractors may want to consider adopting. The plan covers all elements of the Quality Payments Scheme and we have prioritised the plan so that the criteria that can be achieved at both review points are generally first, as it is important that an early start is made on achieving them.
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 NHS mail (Note for the April 2017 Review, evidence of application for an NHSmail account by 1st February 2017 will be acceptable); 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.
NHS England guidance
NHS England has issued guidance on the gateway criteria and further information on the gateway criteria can also be found in NHS England’s guidance on the quality criteria. Contractors are strongly encouraged to read both guidance documents to ensure they are fully briefed on the Quality Payments Scheme.
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 are two review points during the year, at which a Quality Payment can be claimed. These are:
- Friday 28th April 2017; and
- Friday 24th November 2017.
Declarations do not need to be made on this date but they must be made during the declaration periods listed below.
To claim for a Quality Payment, contractors will need to complete a declaration via the NHS Business Services Authority (NHS BSA) website.
The website will open for declarations:
|For review point one (Friday 28th April 2017) from Monday 10th April 2017 at 9am and will close on Friday 12th May 2017 at 11.59pm|
|For review point two (Friday 24th November 2017) from Monday 13th November 2017 at 9am and will close on Friday 8th December 2017 at 11.59pm|
Please note: Claims for Quality Payments will not be able to be made outside of these dates due to the NHS BSA’s payment deadlines.
NHS England has released the declaration and evaluation questions which will be included in the declaration so contractors can view these ahead of making their declaration. PSNC Briefing 026/17: Quality Payments – Completing the NHS BSA Quality Payments declaration provides information on making the declaration and the questions which will be asked.
Contractors can start entering data for their Quality Payment declaration as the system has now gone live on the NHS BSA website for the first review point. The system will go live for the second review point on 13th November 2017. The final submission must be made before the closure of the declaration form at 11:59pm on 12th May 2017 for the first review point and at 11:59pm on 8th December 2017 for the second review point.
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.
NHS England will be evaluating the Quality Payments Scheme and one element of the evaluation is to include some questions in the declaration process. Declaration questions and evaluation questions will be clearly identified. Declaration questions are mandatory to complete.
Further information on the evaluation questions can be found in PSNC Briefing 021/17: Quality Payments – Evaluation questions when completing the NHS BSA Quality Payments declaration
Completion of both the declaration and evaluations has been encouraged by NHS England to support future developments in payments for quality.
Contractors are now able to access support on PharmOutcomes for the Quality Payments Scheme.
This support is available to all contractors as PSNC has agreed to use their licence to provide access to the Quality Payments Scheme framework and asthma referrals service on PharmOutcomes.
Contractors who own multiple pharmacies can view the progress that each of their pharmacies are making to achieving the gateway and quality criteria by using their PharmOutcomes head office/administrator viewer login.
LPCs are able to view the progress contractors are making on to achieving the gateway and quality criteria, which may help identify additional support that contractors require by using their LPC viewer login.
Quality Payments Scheme framework
A Quality Payments Scheme framework has been created on PharmOutcomes, which will allow contractors to track their progress with achieving the gateway and quality criteria criteria. The assessment also contains links to the PSNC website to provide contractors with additional information on each criterion and links to other PharmOutcomes services to assist contractors with collating evidence.
Once a contractor has logged into PharmOutcomes, the framework can be accessed by clicking on the ‘Assessments’ tab on the PharmOutcomes homepage and a User Guide for the framework is available from the Help tab on the PharmOutcomes website.
Quality criterion: asthma referrals
An asthma referral tool has also been created to assist contractors in meeting the quality criterion, ‘On the day of the review, the pharmacy can show evidence of asthma patients, for whom more than 6 short acting bronchodilator inhalers were dispensed without any corticosteroid inhaler within a 6 month period, are referred to an appropriate health care professional for an asthma review’.
This PharmOutcomes tool allows contractors to record patient details who have consented to be referred to their GP practice because of them having been dispensed more than 6 short acting bronchodilator inhalers without any corticosteroid inhaler within a 6 month period. When this data is saved on PharmOutcomes a referral will automatically be sent to the patient’s GP practice (if a secure email address is held for that GP practice on PharmOutcomes).
Once a contractor has logged into PharmOutcomes, the tool can be accessed by clicking on the ‘Services’ tab on the PharmOutcomes homepage and a User Guide for the tool is available from the Help tab on the PharmOutcomes website.
PharmOutcomes log in details
If a contractor requires PharmOutcomes login details for one of their team members, these can be obtained by sending a message to the PharmOutcomes helpdesk. Contractors will need to provide details of the pharmacy, contact information and an email address to issue the login details to.
If a contractor does not have a head office/administrator viewer login this can be obtained by sending a message to the PharmOutcomes helpdesk. Contractors will need to provide details of pharmacy sites, contact information and an email address to issue the login details to.
The Centre for Pharmacy Postgraduate Education (CPPE) has published a document which highlights their available resources and materials to support contractors in meeting the quality criteria.
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 paid with the full value of services payment for March 2018 (i.e. end of May 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.
Validation 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 local NHS England teams or to NHS BSA as requested for post payment verification.
Frequently asked questions (FAQs) on Quality Payments can be found on the Quality Payments – FAQs page of the PSNC website.
Webinar and Slide Deck
PSNC has held two webinars on the Quality Payments Scheme: the original was on 23rd November 2016 and then an update was on 16th March 2017. On-demand versions of both of these can be found on this webpage.
PSNC slide deck on Quality Payments for LPCs (PowerPoint) (updated 27th March 2017)
This slide deck is based on the presentation used in the Quality Payments webinar update.
PSNC slide deck on Quality Payments for LPCs (PDF) (updated 27th March 2017)