Financial Framework 2017/18

Financial Framework 2017/2018

1. Advance Payment

2. Margin Sharing Arrangements

3. Dispensing Pool Payment

4. Establishment Payment

5. Pharmaceutical Needs Payment

6. Care Home Element

7. Quality and Efficency Payment

8. CMS Capitation Payment

9. Operations and Development Payment

10. Minor Ailments Service

11. Public Health Service

12. Payments to Essential Small Pharmacies

13. Payments to New Contractors

14. Training Grants

 

 

1. Advance Payment

The calculation of this payment is no longer linked to GP34 submission and Average Item Value. From April 2014 the payment is based on 90% of the previous rolling 12 month total gross amount. This should make the advance payment more predictable for contractors.

The method of calculation of advance payments to community pharmacy contractors in respect of centrally set remuneration and reimbursement for dispensing months April 2017 onwards is as follows:

The advance payment for dispensing months February – March inclusive is calculated as 90% of the 12 month mean monthly payment made to each contractor or its predecessor over the immediately preceding 12-month period for which calculated actual gross payments for the remuneration payments and reimbursements are available, at the time the advance payment is calculated.

For the dispensing month of December, the advance payment rate is 100%. For the dispensing month of January, the advance payment rate is 95%.

Where a contractor or its predecessor has a history of less than 12 months actual payments at the time the advance is calculated, it will be calculated as 90% (or 100% for dispensing month December or 95% for dispensing month January) of the mean of the number of actual months for which data is available.

For brand new contractors the advance payment will be calculated as follows:

  • Month 1 advance = (no.of days open/31) x £18,000
  • For contractors who opened on the 1st of the month, their month 2 and subsequent advance will be calculated as the % applied to advance payments for all contractors as above for that month of the mean of the number of actual months which data is available.
  • For contractors who opened on the month, their month 2 advance will equal: (no. of days /31) x £18,000; month 3 and subsequent advances until a 12 month history is available will be calculated as the % applied to advance payments for all contractors as above for that month of the mean of the number of actual months for which data is available.

2. Margain Sharing Arrangements

These arrangements, outlined in PCA (P) (2017) 13, cover:

  • The level of guaranteed minimum funding for contractors (increased from £93.5m to £110m)
  • Should market conditions permit, contractors retain 100% of margin up to £10m, above the guaranteed minimum margin
  • That any margin earned above £120m will be shared on a 50:50 basis with NHS Boards
  • The steps to ensure that amounts due to health boards in respect of previous years’ arrangements are returned within 2017/18
  • Generic clawback will be reset to zero from I June 17 for the remainder of the financial year.

3. Dispensing Pool Payment

The value of the Dispensing Pool was enhanced to a monthly aggregate pool of £6.191 from July 2017. An analysis of each contractor’s non care home prescription activity (for both standard and installment prescriptions) is carried out on a quarterly basis and the appropriate share allocated. Figures for methadone prescriptions are not included in this calculation. The timetable for this activity during 2017/18 will be:

Month when dispensing allocation is established

Month when dispensing pool payment is made

Bank Payment at Month End

September 16 – November 16 April 17 – June 17 June 17 – August 17
December 16 – February 17 July 17 – September 17

September 17 – November 17

March 17 – May 17 October 17 – December 17 December 17 – February 18
June 17 – August 17 January 18 – March 18 March 18 – May 18

4. Establishment Payment

This payment was first introduced from 1 October 2013 under stage one of the two-stage final move out of transition. The value for this ongoing fixed rate payment is £1728 (except for part-time ESPs) and it is made up from the following existing payments:

  • Payment Supplement
  • PHS Payment Core Element
  • Infrastructure Support Payment
  • Unscheduled Care Support payment
  • Plus the base level payable previously for the professional allowance (= £575).

This reallocation of payments means that there will be no more mention of the above payments on any payment schedules.

The establishment payment will be scaled for Essential Small Pharmacies in accordance with the existing provisions for opening hours.

5. Pharmaceutical Needs Payment

This element of the remuneration represents £3.845m from the global sum.

From April 2017 dispensings, all contractors on the list at the start of the dispensing month and in receipt of a Dispensing Pool Payment, will be eligible for the period April 2017 – March 2018 for a Pharmaceutical Needs Weighting Payment. This acknowledges the additional pharmaceutical needs arising from age of deprivation characteristics of the post code of presenting patients. For dispensing months April 2017 onwards, it will be calculated from a monthly pool of £0.320m.

For each contractor the following has been identified:

  • Proportion of dispensing patients aged 60 or over
  • The percentage of dispensing patients with postcodes in the two most deprived quintiles according to the Scottish Index of Multiple Deprivation (SIMD) Two indices will be calculated in accordance with the following table and those two discrete indices are averaged to produce a combined index which is the weighting to be applied.

These two factors are combined to produce a combined index for each pharmacy.

Age

Age Index

SIMD

SIMD Index

75% or more of patients under 60 years 1.0 40% or less of patients with postcode in the two most deprived quintiles 1.0
Between 65% and 75% of patients under 60 years 1.2 Between 40 and 60% of patients with postcode in the most deprived quintiles 1.2
Between 65% and 75% of patients under 60 years, with more 75+ than 60-74 1.3 Between 40 and 60% of patients with postcode in the most deprived quintiles, and more in the most deprived quintile 1.3
Between 55 and 65% of patients under 60 years 1.4 Between 60 and 80% of patients with postcode in the most deprived quintiles 1.4
Between 55 and 65% of patients under 60 years, with more 75+ than 60-74 1.5 Between 60 and 80% of patients with postcode in the most deprived quintiles and more in the most deprived quintile 1.5
Between 45 and 55% of patients under 60 years 1.6 Between 80 and 90% of patients with postcode in the most deprived quintiles 1.6
Between 45 and 55% of patients under 60 years, with more 75+ than 60-74 1.7 Between 80 and 90% of patients with postcode in the most deprived quintiles and more in the most deprived quintile 1.7
Between 35 and 45% of patients under 60 years 1.8 More than 90% of patients with postcode in the most deprived quintiles 1.8
Less than 35% of patients under 60 years 2.0 More than 90% of patients with postcode in the most deprived quintiles and more in the most deprived quintile 2.0

The combined index will be applied to the monthly pool, derived from the total transitional payments available for redistribution to determine the Pharmaceutical Needs Weighting Payment for each contractor. Contractors added to the list between 1 April 2017 and 31 March 2018 inclusive and/or without any dispensing history in the reference period will receive a proxy monthly Pharmaceutical Needs Weighting Payment calculated using a combined index of 1.0.

6. Care Home Element

The Care home element is available to any contractor whose prescriptions for care home patients represents more than 2.5% of their total activity. The sum of £3.815m has been set aside from the global sum to pay for this activity.

Every quarter each contractor’s prescriptions are analysed using the separate care home marker to find how many items have been dispensed for patients resident in care homes. Where the percentage found is less than 2.5% of total activity no further action is taken. For contractors where the percentage is more than 2.5% of overall activity, a share of the funds available is allocated in proportion to their share of the national number of items dispensed. The analysis is carried out at the same time as that for the dispensing pool allocation.

7. Quality and Efficiency Payment (Q&E)

The arrangements in place at 31st March 2017 will roll forward for the dispensing month April 2017 onwards. All contractors on the Pharmaceutical List at 1st April 2017 will receive the monthly Quality and Efficiency Payment of £150.

All contractors on the Pharmaceutical List for the dispensing months April 2017 onwards will continue to be eligible to receive a contractor specific Quality and Efficiency payment for a particular month.  Contractors will have to achieve a rate of claims of at least 90%.  At or above this threshold the contractor will receive a payment at the rate of each contractor’s own target Q&E payment. Below the threshold, contractors will not be eligible for any payment, except in the following circumstances: 

A contractor who wouldn’t otherwise receive a payment for a particular month may request the Health Board to consider failure to achieve the 90% threshold are exceptional and out with the contractors control, and authorise a special payment.  If an application is made, and the Health Board considers that failure to achieve the 90% threshold is out with the contractors control, a full or partial payment may be authorised at the discretion of the Health Board. 

Performance of all contractors against the target electronic claims rate of 90% will continue to be monitored throughout 2017-18.

8. CMS Capitation Payment

This payment was first introduced in October 2011 and each contractor was notified of the amount that had been set aside from their then transitional payment for redistribution as a CMS capitation payment. That money was then pooled. The size of this pool was doubled in October 2012 to £3M per month. Each contractor is given a share of the pool depending upon the activity carried out around CMS in their pharmacy.

At the end of each month the number of CMS registrations across Scotland, where the initial assessment process on the Pharmacy Care Record (PCR) has been completed, is established both for the individual contractor and nationally. The contractor’s share of the pool is then calculated.

Each contractor’s share is not allowed to deviate by more than 10% either way from the amount that the contractor had allocated to the central pool.

Contractors who have not signed up with the NHS Board to provide CMS as an additional service will not be eligible to receive the CMS capitation payment. Community Pharmacy Scotland advises all contractors to check their position with their NHS Board if they have been granted a contract or where a contract has changed hands.

9. Operations and Development Payment

From October 2013 dispensing, pharmacy contractors became eligible for the new Operations and Development Payment (OD Payment) which replaced the CMS Phasing Payment. There is a fixed and a variable element to the payment.

Fixed elements

Gluten Free Food Service

  • The fixed element for all contractors will remain at £125. This element supports contractors who have agreed to offer the Gluten Free Foods additional pharmaceutical service from 1 April 2017.
  • All contractors, who are on the list on the 1st day of the dispensing month concerned in the July – September 2017 dispensing quarter and who have accepted their Heath Board’s invitation to offer the Gluten Free Foods additional pharmaceutical service, will automatically receive the fixed element payment.
  • All contractors providing the GFFS must ensure that patients’ full and accurate CHI numbers are provided when making claims.

Quality Improvement

  • Contractors on the pharmaceutical list from 1 April 2017 and who have completed the Scottish Patients Safety Climate Survey will be entitled to a fixed fee of £220 from October 2017 for the continued implementation of quality improvement activities across the pharmacy team. This builds upon the Scottish Patient Safety Surveys undertaken in 2016/17. The surveys highlighted that pharmacy teams felt they needed support in identifying the contributing factors and underlying causes which lead to near misses or patient safety incidents.
  • Contractors will have made available basic learning materials and templates to aid in quality improvements driven by near misses and patient safety incidents when learning’s from SPSP surveys undertaken in 2016/17 are applied utilising the Pharmacy Action Plan resource.
  • Further details on activities and tools to support contractors along with details on declarations will be outlined in a separate circular to follow.

Variable Element

  • For the dispensing months October – March 2018, the variable element of the target will be targeted to:
    • Implementation of Standard Operating Procedures (SOP) for serial dispensing.
  • A monthly payment of £60 will be made to contractors to ensure that full and proper Standard Operating Procedures for serial prescribing are implemented across the pharmacy.

10. Minor Ailment Service

Minor Ailments capitation payments are based on the number of patients registered with the pharmacy. The table below shows the bands and corresponding payments:

Changes in ownershipWhere a pharmacy changes hands over the course of a month the MAS capitation payment is made to the contractor on the pharmaceutical list on the last day of the month.Payments to Essential Small Pharmacies for MASPayments to Essential Small Pharmacies are scaled in accordance with the existing provisions for opening hours.

Band

Number of Registered Patients

Capitation Payment Annual

Capitation Payment Monthly

1 1-250 £7300.92 £608.41
2 251-500 £9,253.92 £771.16
3 501-750 £11,208.00 £934.00
4 751-1000 £13218.00 £1101.50
5 1001-1250 £15228.00 £1269.00
6 >1250 Band 5+£8.04 per patient beyond 1250 Band 5+£0.67 per patient beyond 1250

Changes in ownership

Where a pharmacy changes hands over the course of a month the MAS capitation payment is made to the contractor on the pharmaceutical list on the last day of the month.

Payments to Essential Small Pharmacies for MAS

Payments to Essential Small Pharmacies are scaled in accordance with the existing provisions for opening hours.

11. Public Health Service

Patient Centred Services

It has been agreed to maintain the payment of the intervention fee for the smoking cessation and the EHC service where treatment is supplied. Any contractor asked to provide the Chlamydia Testing and Treatment service should ensure the local NHS Board has agreed a service specification and payment structure with the local Community Pharmacy Health Board Committee.

The fees agreed are as follows:

Smoking Cessation Service under service specification in place from 1st July 2014

Quit attempt event

MDS submission

Remuneration

Event A
Submission of the MDS information with confirmed quit date (normally first return appointment)
To be electronically submitted once the quit-date is confirmed with client. This will form the basis of the timelines for the four-week and twelve-week post-quit date follow-ups.  £30
A count will be made on the central smoking cessation database of patients for MDS submission for new quit attempts that meet the validation requirements that have not been remunerated.
Event B
Four week post-quit date
To be electronically submitted immediately after the four-week post-quit date and not later than six weeks from the confirmed quit-date. £15
A count will be made on the central smoking cessation database of patients for MDS submission for new quit attempts that meet the validation requirements that have not been remunerated
Event C To be electronically submitted immediately after the twelve-week post-quit date and not later than sixteen weeks from the confirmed quit-date. £35
A count will be made on the central smoking cessation database of patients for MDS submission for new quit attempts that meet the validation requirements that have not been remunerated

Sexual Health Service - Chlamydia Service

This service will be subject to local negotiations. It no longer forms part of the national specification.

Sexual Health Service Part B-Provision of Emergency Hormonal Contraception

Payment Element

Amount

How to Claim

Fee per Intervention £25 per intervention where a patient is prescribed and supplied treatment for Emergency Hormonal Contraception Claim forms to be sent to Pharmacy Payments at PSD by the 7th working day of the month.

CPUS scripts for Levonorgestrel and Ulipristal Acetate should be submitted to PSD for payment in the bundle

PHS Provision of Prophylactic Antipyretic (Paracetamol) following Meningococcal Group B Vaccine

All contactors who have arrangements with their NHS Board for the provision to support for Meningitis B vaccination programme will receive with April 2017 dispensings a reduced monthly payment of £20. The balance of the monies from this pool will be redistributed to the Establishment Payment.

Contractors should note that following a change in licensing the National Patient Group Direction (PGD) outlined in circular PCA(P)(2015)25 is no longer required for the dispensing of Prophylactic Antipyretic (Paracetamol).

12. Payments to Essential Small Pharmacies

Guaranteed Minimum Target Income for Essential Small Pharmacy (ESP) – annualised pool £0.124m.

The total Establishment Payment plus Dispensing Pool plus Pharmaceutical Needs Weighting Payment made to an ESP each month, from July 2017 dispensing, are subject to a guarantee minimum target income of £3,804 for full time contractors.

An equivalent guarantee for part time contractors is calculated as follows :

Hours Contractor Open

% of Single Flat rate Payment

>5</=10 60%
>10</=15 75%
>15</=20 85%
>20</=25 90%
>25</=30 95%
>30 100%

The total of Establishment Payment plus Dispensing Pool plus Pharmaceutical Needs Weighting Payment to be made to an ESP each month will be calculated as for all other contractors and if that aggregate is less than the level of the guaranteed minimum payment at a top up – the Essential Small Pharmacy Allowance – equivalent to the shortfall will be paid for the months concerned.

Eligibility for the ESP requires a contractor to be included on the register of essential small pharmacies held by their host NHS Board. Contractors taking over an existing ESP must have their continued inclusion in the ESP register approved by the Health Board.

13. Payments to New Contractors

New contractors will be eligible to receive:

Establishment payment £1730
Dispensing Pool Allocation* £750pm for 3 months.
£750 per month for next quarter or calculated amount due from dispensing pool whichever is the greater.
Calculated amount due from dispensing pool.
Pharmaceutical Needs Payment Amount due for a contractor with a combined index of 1
CMS capitation payment Minimum monthly payment of £600
Q&E Payment Target payment of £150
MAS Payment In line with number of patients registered
PHS Payment In line with activity

* Dispensing Pool payment – special arrangements for contractors recently added to the Pharmaceutical List, and/or with incomplete dispensing history, or whose dispensing pool payment would otherwise fall below a minimum target

A minimum monthly payment of £750 will apply for dispensing months April 2017 onwards in respect of eligible contractors who were not on the list, or who did not have a predecessor contractor on the list for the relevant prior reference period used when calculating dispensing pool payments. That minimum payment would then remain in place until the contractor has 3 (three) consecutive months dispensing activity to be used for the determination of the dispensing pool payment.

However, where a contractor recently added to the list considers that the £750 payment does not fairly reflect their share of overall dispensing activity in the first 3 months of operation they may make a specific request to ISD within 9 months of the dispensing months concerned for a retrospective adjustment calculation to be carried out. This would establish whether an adjustment calculated by reference to the previous quarter’s dispensing pool would be appropriate. Where the total amount due is less than the £750 already paid no further action will be taken. Where the amount due exceeds £750 an adjustment will be made as soon as practical for the dispensing months concerned and if necessary as a retrospective payment. This provision is back dated to apply for payments related to dispensing month April 2016 onwards.

14. Training Grants

Funding for staff training is available to community pharmacy contractors in two parts: Part A is financial support for specific courses; Part B is financial support to facilitate effective uptake of Over the Counter (OTC) Consultations training. 

PART A: SUPPORT FUNDING FOR SPECIFIC COURSES

Contractors will once again be able to apply for a training grant of up to £800 for a member of staff who has commenced a course booked after 1st April 2017. Only one grant is available per contractor. Eligible courses include:

  • Pharmacy Services Level 2 or 3 (S/NVQ)
  • Accredited Checking Technician: NPA Accuracy in dispensing Training Module or equivalent
  • SQA Higher National (HN) Unit: Procedures for Pharmacy Dispensary Checking Technicians.

The claim and payment process is managed by NHS Education for Scotland (NES) Pharmacy. Claims should be submitted, on the form attached at Annex A of PCA (P) (2017) 11 (available on our website), together with the required documentation by 30th November 2017 to:

Anne Watson
NES Pharmacy
3rd Floor, 2 Central Quay
89 Hydepark Street
GLASGOW
G3 8BW

Part B: Financial support to facilitate effective uptake of over the counter (OTC) consultations training

Circular PCA(P)(2017)1 provided details of a new training resource for community pharmacy staff, ‘Effective management of over-the-counter (OTC) consultations’, developed to help optimise management of OTC consultations.  A hard copy of the resource was sent to every community pharmacy.

 A second part to this training is currently in development by NES.  This will comprise a workbook, ‘Improving the quality of over-the-counter (OTC) consultations’ with which community pharmacists can engage their team members to develop their practice and knowledge.  The resource will focus on OTC product requests i.e. consultations which involve a customer/patient requesting a product by name, rather than seeking advice for the treatment of a condition or symptom.  Product requests constitute the majority of OTC consultations and are associated with lower quality management compared with advice requests.

A copy of the workbook will be sent to every community pharmacy in Scotland in February 2018.

Payment for Part B

Contractors on the Pharmaceutical List as of 1 January 2018 will be entitled to a one-off payment of £100 which is a contribution towards releasing staff time to undertake the training pack.  The payment will be made in January 2018 dispensing, paid at the end of March 2018.