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Pharmaceutical Services Negotiating Committee

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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, up to a maximum of £55 million per year in 2011/12 and 2012/13.

The following information describes the NMS payment structure.

Year One (October 2011 - March 2012)

In year one the funding structure for the New Medicine Service was 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 were completed. In year two (2012/13), the funding structure comprises target payments only. 

Implementation payment

Each community pharmacy delivering the service had access to an implementation payment of £750 in year one. To obtain their implementation payment, the community pharmacy had to certify that the service has been provided a minimum of 6 times prior to the 31 March 2012.  They also had to 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.

Changes to the NMS payment structure

On 4th April PSNC and NHS Employers announced that Department of Health Ministers had agreed changes to the New Medicine Service (NMS) payment structure.  

From May 2012 contractors will earn between £20 and £28 for each completed NMS they provide depending on the total number of patients who receive the service in the month. The new structure will provide reward for each NMS provided whilst also encouraging the provision of the service to the greatest number of patients. 

In recognition of the work that contractors undertook between October 2011 and April 2012, a loyalty payment will be made to contractors for activity that fell below the first target level or between target levels. Claims for completed NMS submitted for this period which fell below the first target level will be rewarded at £20 each while those which fell between bands will be rewarded at £25 per intervention.

Commenting on the change, Sue Sharpe, Chief Executive of PSNC said:

“The NHS and the Department of Health are committed to changing funding structures away from fees per item of service, and this underpinned the original NMS funding structure. We were able to use evidence from contractors to demonstrate the problems with the structure and we are pleased to have been able to persuade NHS Employers and the Department of Health that it was necessary to change the NMS payment structure.” 

“We believe the revised arrangements we have negotiated provide a fair reward for pharmacy contractors providing the NMS. There has already been much positive feedback about the service from patients and pharmacists, and we hope the new payments will encourage all contractors to build this valuable service into their practice.”

Detailed information on the changes to the NMS funding system

The NMS was implemented as a time-limited service commissioned until March 2013; it would continue beyond this time if all parties agreed that the service had provided demonstrable value to the NHS. In March 2013 the NHS Commissioning Board agreed to extend the service for a further six monthsThis means that community pharmacies can continue to recruit new patients to the service up until September 30th and will receive payment for these patients even where the service is completed in October or November 2013. The service specification will remain the same and a maximum of £20 million in funding will be available for it during the six-month period.

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

 


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

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 NHS England Area Team (the AT 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 has been sent to the AT 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 AT, 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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