Skip to main content Skip to footer

Contract reconciliation

In June 2017 the NHS Business Services Authority began a pilot in the South East and West Midlands to test the delivery of year-end reconciliation activity.  This was done in partnership with NHS England.

as part of the pilot, providers must take part in:

  • mid-year review
  • year-end reconciliation

This enables providers to make sure they meet their contracted activity for each financial year. 

The goal of the pilot was to:

  • enable the development of a single operating model for mid year and year-end reconciliation
  • provide consistency for providers
  • free up resources for Direct Commissioning Office (DCO) teams to focus on other activities

Following the success of the pilot, the service is being rolled out nationally.  We expect to be delivering the service to all DCO teams by September 2019. 

We’re working with NHS England to support the teams that are taking part in each phase of the roll out.

Mid-year review

The mid-year review allows providers to identify and mitigate any potential issues before the annual year-end reconciliation.

Providers who have not met their expected contracted activity for the previous year will have activity carried forward into the current financial year.  This activity must be completed first and does not count towards the mid-year review for the current year.

Any activity carried forward from the previous year will be taken away from the current year’s activity to give an adjusted figure.  All contracts are given their adjusted figure at the mid-year point.

Contracts whose adjusted activity is more than 30% of their contracted delivery at the mid-year point are encouraged to review their activity.  This will help them to deliver activity for the rest of the year that’s consistent with their contract. No further action is required.

For others, Providers will be invited to complete a mid-year review and set out their plan 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 year-end review is saved within year and available for re-investment in NHS Dentistry.

Year-end reconciliation

The year-end reconciliation is required for all dental contracts which include:

  • Units of Dental Activity (UDA)
  • Units of Orthodontic Activity (UOA)
  • Courses of Treatment that involve provision of sedation services
  • Courses of Treatment that involve provision of domiciliary services

We support NHS England to review the details of the contract against the delivered activity.  This is completed by September each year.

NHS England will contact PDS+ and advanced service providers to explain their contract attainment and the process that will be followed.

Approximate Date

Description

31 March

The final payment schedule of the financial year is available to providers to ensure they have achieved their contractual obligations.

31 May

Deadline for providers to submit claims for course of treatment with a completion date prior to 31 March.

30 June

Deadline for providers to adjust performers’ Notional Pensionable Earnings’ and ‘Notional Pensionable Earnings Estimates’ for the previous financial year.

30 June

Year-end statement is available to providers, commissioners and the Provider Assurance team via Compass

31 July

Letter will be sent to contracts’ principle practice address, detailing contractual vs delivered activity. 

Mid-August

Carry forward of under-delivered activity is entered in Compass.  Under-delivered activity amounting to more than 4% of the contracted activity will not be carried forward and will be subject to financial recovery via Compass scheduled payments.

Mid-September

Wherever possible, any outstanding carry forward of activity and/or financial recovery will be entered on Compass, available for inclusion in the mid-year review.

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.

When this happens providers should inform their NHS England local team directly as soon as the possible.

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 (e.g 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, e.g 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

Local teams will write to these practices to explain their contract attainment and the process that will be followed.

Information and data

The information and data included in the year-end reconciliation and mid-year review is submitted by providers using:

  • FP17
  • FP17O
  • FP17W in Wales

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

Claims submitted later than this will not be included in mid and year-end reviews. 

Therefore, it is advisable to submit all claims for the financial year in time for the year end cut off.

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

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. These 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 the quarterly Vital Signs report available by logging into Compass.