www.england.nhs.uk payment process within primary care contracting and finance 30 th january 2015
TRANSCRIPT
www.england.nhs.uk
Payment Process Within Primary Care Contracting and Finance
30th January 2015
www.england.nhs.uk
1 Types of Payments and processes
2 Payment Timetable
Contents
www.england.nhs.uk
Types of Payments
• GMS /PMS /APMS contracts• Enhanced Services• QoF• Premises• Additional Practice Payments• Other - syringes
www.england.nhs.uk
• GMS: • Global sum based on weighted capitation - £73.56• Less OOH opt out £4.02• MPIG Payment for some Practices but this is being phased
out over 7 years from 1 April 2014 and reinvested in GMS Global sum
• PMS payments according to contracts agreed- price per capitation varies across Surrey and Sussex
• APMS contracts generally paid by invoice/ separate arrangements
• List size adjustments applied quarterly (manually PMS/APMS)
Types of Payments : GMS/PMS/ APMS Contracts
www.england.nhs.uk
Types of Payments : Enhanced Services :DES’s
Enhanced Services Payment schedule 2014/15
Service Payment frequency
Payment method
Cost Payment deadline
Available on CQRS
Extended Hours Quarterly PCSS £1.90 per pt n/aPPG Annual PCSS 0.36 per pt n/aUnplanned Admissions Component 1 Quarterly CQRS £1.29 per pt 31st July 2014
Component 2 Quarterly CQRS £0.57 per pt30th November 15
Component 3 Quarterly CQRS £0.29 per pt28th February 15
Component 4 Quarterly CQRS £0.29 per pt 31st May 2015
Component 5 Quarterly CQRS £0.43 per pt 31st May 2015 Dementia
Component 1Up front Payment PCSS £0.37 per pt n/a
Component 2 Final payment CQRS/PCSS TBC TBC Alcohol Annual CQRS £2.38 per count
Learning Disabilities Quarterly CQRS£116.00 each count YES
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Types of Payments : Enhanced Services
Enhanced Services Payment schedule 2014-15
Service Payment frequency /date Payment method
Cost Available on CQRS
Retired Enhanced Services
Improving on line AccessSecond and final payment in June 2014 PCSS n/a
Remote Care monitoringSecond and final payment in July 2014 PCSS n/a
Risk Profiling and Care managementSecond and final payment in July 2014 PCSS n/a
Other
Dispensing Quality Scheme Annual (paid in June/July) PCSS
£2.58/ dispensing
patient n/a
Violent patients invoice SBS n/a
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Types of Payments : Enhanced Services
Public Health - Enhanced Services 2014-15
Service Payment method(quarterly)
Currently Available on CQRS
Seasonal Influenza CQRS
Seasonal Pneumococcal CQRS
Rotavirus CQRS YES
Shingles CQRS
MMR CQRS YES
Men C Adolescent Claim form n/a
Hep B CQRS YES
Childrens Influenza CQRS
Men C Freshers CQRS YES
Pertussis Claim form n/a
HPV Claim form n/a
Child Pneu (3 vaccs) Claim form n/a Child immunisations: Practices submit data directly to PCSS (paid
quarterly)
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• 70% Aspiration payment paid monthly• 30% Achievement paid after end financial year
(usually June/ July)• PMS calculation adjustment: deduction £13,050 for
average Practice• Practices input data using CQRS • Commissioning team review and approve• Payment processed by PCSS
Types of Payments : QoF
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• Rent:• Notional/ Cost
• Rents require completion on CMR1 and CMR2 forms every 3 yrs- send form and returned to PCSS
• PCSS instruct District Valuer (DV)• PCSS notifies Surgery of revaluation and calculation of new rate, recovery /
arrears (cc commissioner)• Monthly payments with standard GMS/ PMS payment
• Leasehold rents• Landlord instigates rent review and tenant and landlord agree: rent review
memorandum required.• Commissioners instruct DV: if rent greater then tenant to pay difference• PCSS instructed by commissioners to calculate for arrears etc and pay new
amounts• Paid quarterly unless exception (generally a standing order)
Types of Payments :PremisesRent, Rates, water and clinical waste
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• Business rates :• Copies of Practice DDRs and their annual/ other invoices to PCSS• Generally Reimbursed in line with Practice payment schedule
ie (10 mths /12 mths DDRs or annually)
• Water rates :• Can reimburse on evidence of DDR for the year• If paid by BACs- require invoice (original) and proof of payment (bank
statements/ BACs or receipt)
• Clinical Waste:• Area team commission contracts directly and process
invoices
Types of Payments :PremisesRent, Rates, water and clinical waste
www.england.nhs.uk
• Seniority - paid Quarterly (PCSS )
• Practice provides GP details on joining Practice to PCSS• Payments cease 31 March 2020,(15% reduction each year) and no new
entrants from 1 April 2014
• Locums• Maternity/ Paternity/ Sickness etc• Application form completed by Practices and submitted with relevant
certificate of evidence to Primary Care Commissioning team• Form forwarded to PCSS (who calculate and make payments)• Contact: Laura Fernandez-Keynes (West Sussex)
Marian Ryland (East Sussex)
Helen Snelling (Surrey )
Types of Payments :Additional Practice Payments/ Other
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• PADM / Dispensing fees (2 months in arrears)• Surgery sends data to PPA (Prescription pricing authority) for
processing• PPA informs PCSS of payments to make to Practices• Note: dispensing drugs are through CCG
• Syringes :• PCSS buy syringes and issue to Practices.• Invoices received directly from Supplier and PCSS process
charges in NHSE ledger
Types of Payments :Additional Practice Payments/ Other
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Payment Timetable: East SussexPCSS Monthly Payments Schedule - East Sussex/Brighton
Types of Payments PCSS contact
Date Claims to be
receivedDate Payment
sentDate Payment in
Bank
PMS Monthly Payment/ GPR Registrars Lesley/Heather4th working
day4 working days before
21st (nearest working day)
Prescribing Drugs Payment GMS & PMS mid month- but varies due to PPA
Ophthalmic Payment 4 working days before
20th (nearest working day)
nGMS GP Contract Payments/GP Registrars Lesley/Heather/David
4th working day
4 working days before
24th (nearest working day)
Dispensing Drugs Payment GMS & PMS 4 working days before
25th/26th (nearest working day)