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Advanced Services Funding

Quick Links

• New Medicine Service (NMS)
• Medicines Use Review (MUR)
• Appliance Use Review (AUR)
• Stoma Appliance Customisation (SAC)

New Medicine Service (NMS)

In March 2011, Bob Alexander (Director of NHS Finance) wrote to PCT Chief Executives to inform them that Ministers had agreed to invest in developments in the CPCF, namely the NMS, targeted MURs and strengthening clinical governance arrangements - up to a maximum of £55 million per year in 2011/12 and 2012/13.

As part of the 2010/11 financial settlement, changes were made to the Drug Tariff from April 2011, including:

• £20 million reduction in fees and allowances to community pharmacies
• £90 million reduction in Category M.

Further details on the settlement

Because of the above changes, PCTs will recognise that there is no extra cost pressure to the NHS and will have made the necessary alterations to their budgets to reflect these changes.  PCTs and contractors will want to note that the CPCF funding for 2011/12 has yet to be finalised and that further changes to the Drug Tariff may arise later in the year.

The following information describes the agreed payment structure.

Year One (October 2011 - March 2012)

In year one the funding structure for the New Medicine Service will be made up of two elements - a fixed, one-off implementation payment and target payments (linked to prescription volume) based on the number of NMS episodes that are completed. In year two (2012/13), the funding structure will comprise target payments only. 

Implementation payment

Each community pharmacy delivering the service will have access to an implementation payment of £750 in year one. The implementation payment will be the same for all pharmacies, regardless of prescription volume. The implementation payment can only be claimed (through the NHS Business Services Authority) in year one and will help with establishing the service, e.g. associated training costs, data collection and publicity costs.

To obtain their implementation payment, the community pharmacy must certify that the service has been delivered a minimum of 6 times prior to the 31 March 2012.  They must also certify that:

• the service will be delivered by pharmacists that have signed the self-assessment of readiness for community pharmacists;
• the premises meet the requirements of the service specification;
• a Standard Operating Procedure (SOP) is in place;
• all dispensing staff understand the aims and objectives of the service, are aware of the eligible conditions / therapies, understand the SOP, and understand their role, if any, in delivering the service; and
• the contractor or their representatives has been in communication with local GP practices about the service.

Target payments

From October 2011, each pharmacy will also be eligible to receive monthly target payments. The size of the target payment will depend on how many NMS episodes have been completed in relation to the prescription volume of the individual pharmacy.

When is the NMS complete (and payment can be claimed)?

For NMS payment purposes, a range of volume bandings has been defined. Each month, the prescription volume of a given pharmacy will fall within one of those bands. For each band, a pre-defined maximum number of opportunities to deliver the service each month has been determined.  The calculation of the maximum number of opportunities is based on the assumption that the maximum caseload for each community pharmacy will be 0.5% of prescription volume on average. This maximum caseload has been determined through modeling that included data analysis from the PMR records for a large number of community pharmacies.

It is important to note that payment is not made on a per completed NMS episode basis. Instead payment is based on the performance of each pharmacy in maximising the completions achieved from the expected NMS opportunities. For a given volume band, the highest target payment represents the maximum monthly payment a pharmacy can receive, irrespective of the actual number of completions it may have achieved.

Ideally, PSNC and NHS Employers would wish every pharmacy to achieve the maximum number of opportunities available to it.  While this may be unlikely, to incentivise improved performance we have set a range of activity thresholds or targets.  Each target has an associated payment and pharmacies will be paid for achieving a target. In year one, the targets will be 20%, 40%, 60% or 80%.

Table 1 sets out for each volume band in year one, the number of NMS completions necessary to achieve the relevant target, and in brackets the associated target payment. 

Table 1: Target Payments for 2011/12

As the table indicates, for pharmacies which have a prescription volume above 10,500 items per month, the volume bandings will continue to increase in increments of 1000 items per month.  For each increment, the number of interventions required to meet the 20% activity threshold will increase by 1 (value £25), the 40% activity threshold will increase by 2 (value £50), the 60% activity threshold will increase by 3 (value £75) and the 80% activity threshold will increase by 4 (value £100).

To determine the relevant target payment for a given month, first determine in which volume band the pharmacy falls (based on prescription item volume in that month). Then consider the range of target completions for that band and how the actual number of NMS completions compares. A target has been achieved where the actual number of completions equals or exceeds the number of completions determined by the calculation set out above.

Pharmacies will be paid each month for the highest target they achieve. Each month is considered separately and NMS completions from one month cannot be carried over to improve performance in later months.

Year Two (April 2012 - March 2013)

In year two, pharmacies will continue to be eligible to receive target payments.  As before, the size of the target payment will depend on the number of NMS completions relative to the prescription volume of the individual pharmacy. However, to further incentivise pharmacies to build the service into their core service delivery, the 20% band will be removed. Thus, in year two, the target thresholds will be 40%, 60% and 80%.

Table 2 sets out for each volume band, the number of completions necessary to achieve the relevant target, and in brackets the associated target payment. 

Table 2: Target Payments for 2012/13

PSNC and NHS Employers are working with the Department of Health and the NHS Business Services Authority to ensure that the above pricing structure is implemented. Contractors will be paid by making a claim to the NHS BSA in the usual way.

 Medicines Use Review (MUR)

The fee for delivering the Medicines Use Review and the Prescription Intervention Advanced Service is set out in Part VIC of the Drug Tariff. These fees are claimed via the FP34C Submission Form.

 The fee an MUR is £28. Pharmacies that made arrangements to provide Advanced services before 1 October 2010 are able to conduct and be paid for a maximum of 400 reviews in the financial year 2010/11 (1st April 2010 - 31st March 2011). The limit for pharmacies that enter arrangements on or after 1 October 2010 is 200 for the financial year 2010/11.

The Department of Health has issued guidance to PCTs on the procedure to follow in the event that a pharmacy contractor claims payment for MURs in excess of the annual cap:

DH Guidance to PCTs on Contractors Exceeding the Annual MUR Limit

Claims made by pharmacy contractors for MURs are paid on trust. However, the NHS Counter Fraud and Security Management Service have confirmed that as with other systems where remuneration is paid based on a self declaration, the NHS has monitoring arrangements in place to detect fraudulent activity. To avoid any suggestion of a fraudulent claim, or simply poor practice in making claims for payment, PSNC recommends carrying out the following checks:

1. Before submitting any claim for payment of MURs (using Form FP34C), contractors should ensure that copies of the certificates of accreditation for every pharmacist who may undertake MURs at the pharmacy have been sent to the PCT (the PCT may monitor this during the monitoring visits);

2. Each month, carefully check the pharmacy records of MURs undertaken that month, to ensure that the pharmacist who undertook the MUR consultation is accredited (and the certificate sent to the PCT as above);

3. Each month count carefully the number of MUR reports for consultations carried out that month, to ensure that an accurate claim is made. These reports should be filed safely as they are the main evidence that an MUR has been carried out. Contractors may be required to produce them in the event of a Counter Fraud investigation;

4. Maintain a cumulative log of numbers claimed, so that the limit is not exceeded (currently 400 reviews per year);

5. If any MUR consultations are to be conducted away from the pharmacy premises, contractors should check that they have written confirmation of the consent of the PCT, which should be carefully filed in the pharmacy.
 

Appliance Use Review (AUR)

The fees for delivering the Appliance Use Review Service are set out in Part VIE of the Drug Tariff. These fees are claimed via the FP34C Submission Form.

The fee for an AUR is £28 for an AUR conducted on pharmacy premises or £54 for an AUR carried out in a patients home. If more than one AUR is conducted in the same location within a 24-hour period then £54 will be paid for the first AUR, and £28 for each subsequent AUR.

The maximum number of AURs for which claims for payment may be made is not more than 1/35 of the aggregate number of specified appliances dispensed during that financial year.

Stoma Appliance Customisation (SAC)

The fees for providing the Stoma Customisation Service are set out in Part VIE of the Drug Tariff. When this service is provided, £4.32 is paid per qualifying* Part IXC item dispensed, regardless of whether customisation was required.

*Qualifying Part IXC items for stoma customisation are one-piece closed bags (under “colostomy bags” chapter heading of current Drug Tariff), drainable bags (under “ileostomy bags” chapter heading) and bags with tap (under “urostomy bags” chapter heading), items under “two piece ostomy system” and “flanges” chapter headings, as well as Skin Protectors and Stoma Caps.

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