Download Payment Process Within Primary Care Contracting and Finance

Payment
Process Within
Primary Care
Contracting and
Finance
30th January 2015
www.england.nhs.uk
Contents
1 Types of Payments and processes
2 Payment Timetable
www.england.nhs.uk
Types of Payments
•
•
•
•
•
•
GMS /PMS /APMS contracts
Enhanced Services
QoF
Premises
Additional Practice Payments
Other - syringes
www.england.nhs.uk
Types of Payments : GMS/PMS/
APMS Contracts
• 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)
www.england.nhs.uk
Types of Payments : Enhanced
Services :DES’s
Enhanced Services Payment schedule 2014/15
Service
Payment
frequency
Quarterly
Annual
Payment
method
PCSS
PCSS
Quarterly
CQRS
£1.29 per pt
Component 2
Quarterly
CQRS
£0.57 per pt
Component 3
Component 4
Quarterly
Quarterly
CQRS
CQRS
£0.29 per pt
£0.29 per pt
31st July 2014
30th November
15
28th February
15
31st May 2015
Component 5
Dementia
Quarterly
CQRS
£0.43 per pt
31st May 2015
Extended Hours
PPG
Unplanned Admissions
Component 1
Component 1
Component 2
Alcohol
Learning Disabilities
www.england.nhs.uk
Cost
Payment
deadline
£1.90 per pt
0.36 per pt
Up front
Payment
PCSS
£0.37 per pt
Final payment CQRS/PCSS TBC
TBC
Annual
CQRS
£2.38 per count
£116.00 each
Quarterly
CQRS
count
Available
on CQRS
n/a
n/a
n/a
YES
Types of Payments : Enhanced
Services
Enhanced Services Payment schedule 2014-15
Service
Payment frequency /date Payment Cost
method
Available on
CQRS
Retired Enhanced Services
Improving on line Access
Second and final payment in
June 2014
PCSS
n/a
Remote Care monitoring
Second and final payment in
July 2014
PCSS
n/a
Second and final payment in
Risk Profiling and Care management July 2014
PCSS
n/a
Other
Dispensing Quality Scheme
Violent patients
www.england.nhs.uk
Annual (paid in June/July)
invoice
PCSS
SBS
£2.58/
dispensing
patient
n/a
n/a
Types of Payments : Enhanced
Services
Public Health - Enhanced Services 2014-15
Service
Payment method
(quarterly)
Seasonal Influenza
Seasonal Pneumococcal
Rotavirus
Shingles
MMR
Men C Adolescent
Hep B
Childrens Influenza
Men C Freshers
Pertussis
HPV
Child Pneu (3 vaccs)
CQRS
Child immunisations:
www.england.nhs.uk
Currently Available on
CQRS
CQRS
CQRS
YES
CQRS
CQRS
Claim form
CQRS
YES
n/a
YES
CQRS
CQRS
YES
Claim form
n/a
Claim form
n/a
Claim form
n/a
Practices submit data directly to PCSS (paid quarterly)
Types of Payments : QoF
• 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
www.england.nhs.uk
Types of Payments :Premises
Rent, Rates, water and clinical waste
•
•
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)
www.england.nhs.uk
Types of Payments :Premises
Rent, Rates, water and clinical waste
•
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
•
Some PMS (W Sx)Practices were reimbursed monthly estimates with
reconciliations at year end but this is being phased out by 31st March- now
requiring original copies plus proof of payment to be submitted to PCSS for
reimbursement
www.england.nhs.uk
Types of Payments :Additional
Practice Payments/ Other
• 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
)
www.england.nhs.uk
Types of Payments :Additional
Practice Payments/ Other
• 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
www.england.nhs.uk
Payment Timetable
PCSS Monthly Payments
Schedule - West Sussex
Date Claims
to be
Date Payment
received
sent
Date Payment in
Bank
Types of Payments
PCSS contact
Adhoc GMS & PMS
Lesley/Michael/Chris/David
Week 1
Week 1
(up to 10th of a month)
Chris Jarrett
4 working days
before
15th
(nearest working day)
PMS Monthly Payment
4th
16th
(nearest working day)
Prescribing Drugs Payment GMS & PMS
Chris Muir
GP Registrars Payment GMS & PMS
Chris Muir
4 working days
before
20th
(nearest working day)
Ophthalmic Payment
Lindsey/Jean
4 working days
before
20th
(nearest working day)
nGMS GP Contract Payments
Chris Jarrett
4 working days
before
25th
(nearest working day)
Dispensing Drugs Payment GMS & PMS
Chris Muir
4 working days
before
28th
(nearest working day)
www.england.nhs.uk
12th