1. Joint LMC /NHS England Finance Workshop 3rd March 2015

2. Content Finance issues awareness Recent contractual changes to GMS/PMS/APMS Who pays what? Payment processes Premises Guide to Yearend/Legacy issues 2

3. Raising Awareness Internal issues- within NHS England’s control e.g. payment omission Issues driven by external forces e.g. national issues: Glitch on NHAIS/Exeter Technical issues on national systems such as CQRS Central directives 3

4. NHS England Response Send communication out to practices Explanation of causes Impact on Practices Advise practices on corrective actions. Working more closely with FHS teams. 4

5. Recent Contractual Changes (1) All Contract types – GMS/PMS/APMS Funding increase in core contract: 238 points reinvested at £5.15 per weighted patient. (see PMS exception) £1.35 per weighted patient reinvested from Enhanced services. Inflationary uplift of £0.27 per weighted patient. Out of Hours deduction revised from 6% to 5.46% of Global sum (£73.56 per weighted patient plus 6% of the London supplement (£2.18 per registered patient). 5

6. Recent Contractual Changes (2) Funding increase in Enhanced services: 103 QOF points reinvested into Enhanced services comprising: 100 points into a new ES “Avoiding Unplanned Admissions” 3 points to increase the tariff for Learning Disabilities from £102.16 to £116 per health check. Cessation of ‘Improving Patient Online Access’ and Remote Care monitoring on 31 st March 2014 to fund core. Risk Profiling ES now subsumed into Avoiding Unplanned Admissions ES. Reduction in QOF points: 341 QOF points retired to fund core and ES thereby reducing 900 points to 559 points. Seniority Pay: Closed to new entrants from 1 st April 2014. To be phased out by March 2020. 6

7. Recent Contractual Changes (3) GMS only: The Minimum Practice Income Guarantee (MPIG) being phased out over 7 years hence MPIG decreased by 1/7 th in 2014/15 where relevant. £0.55 per weighted patient reinvested into core funding for GMS practices only. PMS only: 238 QOF points reinvested in core at £2.93 per weighted patient to take account of PMS QOF points deduction. NO MORE QOF points deduction. 7

8. Who pays what? Primary Care Finance team Core contract calculations for payments to PMS/APMS practices List size adjustments for PMS/APMS- calculations KPI calculations Adjustments required to premises costs for rent revaluations Primary Care commissioning team Directed Enhanced services (DES) Locum re-imbursement QOF achievement and aspiration FHS/PCSS team Seniority Premises costs (in conjunction with NHS Property Services), including water and business rates PADMs Pensions & levies Public Health team All services commissioned by the Public Health department 8

9. Payment Process (1) 9

10. Payment Process (2) 10

11. Premises cost reimbursement Reimbursable costs: Rent – notional - actual Business rates Water Clinical waste 11

12. Premises cont’d Rent Notional Rents require completion on CMR1 and CMR2 forms every 3 years Commissioners to instruct District Valuer (DV) Commissioner notifies practice of new valuation and rate Commissioner authorises new rate (arrears/recovery) Quarterly/monthly payments with standard contractual payment Actual rent Landlord instigates rent review; tenant and landlord agree: rent review memorandum required. Commissioners instruct DV: if rent greater then tenant to pay difference Commissioners authorises new rate - arrears paid Paid quarterly or monthly 12

13. Year End Guide/Legacy issues Last day for Commissioners to receive claims information from practices for accrual purposes is 8 th April 2015. Any claims that predate 1 st April 2013 should be forwarded to the Central team at e.legacybalances@nhs.net 13

14. Questions ? 14