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Www.england.nhs.uk Payment Process Within Primary Care Contracting and Finance 30 th January 2015.

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Presentation on theme: "Www.england.nhs.uk Payment Process Within Primary Care Contracting and Finance 30 th January 2015."— Presentation transcript:

1 Payment Process Within Primary Care Contracting and Finance 30 th January 2015

2 1Types of Payments and processes 2Payment Timetable Contents

3 Types of Payments GMS /PMS /APMS contracts Enhanced Services QoF Premises Additional Practice Payments Other - syringes

4 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

5 Types of Payments : Enhanced Services :DES’s Enhanced Services Payment schedule 2014/15 ServicePayment frequency Payment method CostPayment deadline Available on CQRS Extended HoursQuarterlyPCSS£1.90 per pt n/a PPGAnnualPCSS0.36 per pt n/a Unplanned Admissions Component 1QuarterlyCQRS£1.29 per pt31st July 2014 Component 2QuarterlyCQRS£0.57 per pt 30th November 15 Component 3QuarterlyCQRS£0.29 per pt 28th February 15 Component 4QuarterlyCQRS£0.29 per pt31st May 2015 Component 5QuarterlyCQRS£0.43 per pt31st May 2015 Dementia Component 1 Up front PaymentPCSS£0.37 per pt n/a Component 2Final paymentCQRS/PCSSTBC AlcoholAnnualCQRS£2.38 per count Learning DisabilitiesQuarterlyCQRS £ each count YES

6 Types of Payments : Enhanced Services Enhanced Services Payment schedule ServicePayment frequency /datePayment method CostAvailable on CQRS Retired Enhanced Services Improving on line Access Second and final payment in June 2014PCSS n/a Remote Care monitoring Second and final payment in July 2014PCSS n/a Risk Profiling and Care management Second and final payment in July 2014PCSS n/a Other Dispensing Quality SchemeAnnual (paid in June/July)PCSS £2.58/ dispensing patientn/a Violent patientsinvoiceSBS n/a

7 Types of Payments : Enhanced Services Public Health - Enhanced Services ServicePayment method (quarterly) Currently Available on CQRS Seasonal Influenza CQRS Seasonal Pneumococcal CQRS Rotavirus CQRSYES Shingles CQRS MMR CQRSYES Men C Adolescent Claim formn/a Hep B CQRSYES Childrens Influenza CQRS Men C Freshers CQRSYES Pertussis Claim formn/a HPV Claim formn/a Child Pneu (3 vaccs) Claim formn/a Child immunisations:Practices submit data directly to PCSS (paid quarterly)

8 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

9 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 :Premises Rent, Rates, water and clinical waste

10 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 :Premises Rent, Rates, water and clinical waste

11 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

12 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

13 Payment Timetable: East Sussex PCSS Monthly Payments Schedule - East Sussex/Brighton Types of PaymentsPCSS contact Date Claims to be received Date Payment sent Date Payment in Bank PMS Monthly Payment/ GPR RegistrarsLesley/Heather 4th working day 4 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 RegistrarsLesley/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)


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