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Mid-year Review

In order to identify and mitigate any potential issues before the annual year-end reconciliation, Providers are asked to participate in a mid-year review of contracted delivery.

The Provider Assurance team currently deliver this on behalf of some NHS England Local teams. All teams will be supported in this way from the mid-year point of 2019/20 financial year.

Any activity brought forward from the previous  year-end reconciliation should be  delivered as a priority and does not count towards the current year’s mid-year review.

For example, a Provider delivered 97% of their contracted activity in 2017/18.  Therefore, 3% of activity is activity is carried forward into 2018/19 which must be delivered first to achieve a ‘zero’ position in 2018/19.  Activity delivered from this point will be considered 2018/19 delivery for the purposes of the mid-year review.

The table below explains how delivery is calculated at the mid-year point: 

2017/18 Year-End Delivery

2018/19 scheduled 30 Sept

Less Activity carried forward from 17/18

Adjusted 2018/19 Mid-Year Delivery

96%

33%

4%

29%

97%

33%

3%

30%

98%

33%

2%

31%

99%

33%

1%

32%

100%

33%

0%

33%

101%

33%

-1%

34%

102%

33%

-2%

35%

All contracts are notified of their adjusted delivery at the mid-year point.

Contracts whose adjusted delivery is more than 30% of their contracted delivery at the mid-year point are encouraged to review the position to ensure consistent delivery up to and including 31 March.  No further action is required.

For others, Providers will be invited to complete a mid-year review and detail their planned actions to deliver activity the following December and March.

For a very small number of Providers, failure to provide or deliver against their action plan may result in the withholding of contract payments.

By doing so, money that would have potentially been recovered from Providers as part of a subsequent year-end reconciliation is saved within year and available for re-investment in NHS Dentistry.

Information and data

The information and data included in the year-end reconciliation and mid-year review is submitted by Providers via FP17 and FP17O in England and FP17W in Wales.

Claims are accepted in CoMPASS up to two months from the date of completion of the course of treatment.

FP17/FP17O claims submitted later than this will not be included. 

Therefore, it is advisable to ensure that all claims for the financial year have been submitted in time for the year end cut off.

Providers are encouraged to discuss this with members of their teams responsible for submitting claims. 

Submissions made after two months will not be included in the year-end final reconciliation.

Only claims submitted within time and in CoMPASS up to and including 30 September are included in the mid-year review.

‘Late claims’ should still be submitted to ensure accurate reporting of patient treatment and will be processed for patient charge revenue but will not count towards delivery figures.  This includes when a course of treatment is closed before completion.

This information is available to Providers in July every year on the Year-End statement. Providers also have access to monthly schedules and quarterly Vital Signs report available by logging into CoMAPSS.

These reports do not included activity bought forward from a previous financial year.  When this is included it is referred to as adjusted activity.  Adjusted scheduled activity takes in to account any activity brought forward as underperformance (to be delivered in the following financial year) or as over performance (to be deducted from the following financial year)

Exceptional Circumstances

Occasionally there are unforeseen circumstances that a practice or Provider may experience which may have a detrimental effect on the delivery of contract activity.

Where Providers experience an exceptional event or circumstance they should inform their NHS England Local team directly as soon as the event or circumstance occurs.

In some cases where financial recovery of under delivery applies, it may be possible for Local teams to agree a carry forward of this activity

Once considered, NHS England  Local teams in England will update the Provider Assurance team of any actions required in relation to year-end and mid-year processes.

Providers will be required to document their request in an ‘exceptional circumstances report’ and provide evidence to support their report.

 Some examples of what may be considered ‘exceptional’ are 

 

Circumstances that may be considered exceptional subject to the provision of supporting evidence

Non-allowable circumstances

Death of, or serious accident or illness to, contract holder (or close relative of contract holder)

Death of, or serious accident to, distant relative or friend of either contractor holder or performer

Death of, or serious accident or illness to, main or significant performer (or close relative of same)

Failure to register with CQC, or comply with CQC registration requirements

Serious fire or accidental damage to practice premises rendering building unfit for business

Minor fire or damage to premises

Recruitment difficulties resulting from undue delay on the local office’s part (eg admission to the dental performers’ list)

Re-decoration of premises

Move to a new premises resulting in operational delays, due to circumstances beyond the contractor’s control, eg unforeseen planning controls

Recruitment difficulties

 

Holidays and other absence such as paternity/maternity or CPD events for provider

 

Patient failed to attend (FTAs)

 

High-needs patients

 

Failure to understand contractual obligations

 

IT system failure

 

Planned absence of a performer

 

Vocational dental practitioner activity taken into consideration

 

A letter will be sent to these practices directly from their Local team explaining their contract attainment and the process that will be followed.