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Community Pharmacy Quality Payments Scheme

The Quality Payments Scheme, which forms part of the Community Pharmacy Contractual Framework, was introduced from 1st December 2016 until 31st March 2018. As part of the interim arrangements for the first six months of 2018/19, it has been agreed that a further £37.5 million is to be invested into an extension of the scheme, with a June 2018 declaration. The Quality Payments Scheme rewards contractors for delivering quality criteria in three quality dimensions: Clinical Effectiveness, Patient Safety and Patient Experience.

The details of the Quality Payments Scheme are outlined in Part VIIA of the Drug Tariff.

The declaration will open for the 29 June 2018 review point on Monday 11 June 2018 at 09:00 and will close on Friday 13 July 2018 at 23:59.

In order to be eligible for payments under the Quality Payments Scheme, contractors must meet the gateway criteria. 

Gateway criteria

The Gateway criteria are composed of four elements:

1. The contractor must be offering at the pharmacy Medicine Use Review (MUR) or New Medicine Service (NMS) or must be registered for the NHS Urgent Medicine Supply Advanced Service Pilot (NUMSAS); you can find details of how to register for the NUMSAS here.

2. The NHS Choices entry for the pharmacy must be up to date, including Bank Holiday Opening Hours for 2018/19. Contractors are required to update or validate each of the following three parts of their NHS Choices profile:

  • opening hours, including Bank Holiday opening hours for 2018/19
  • services the pharmacy provides
  • facilities available.

Contractors that do not have editing rights to their profile, will need to email the NHS Choices service desk: nhschoicesservicedesk@nhs.net.

Existing web editors, who have lost their password, can reset their passwords from the NHS Choices website.

Distance Selling Pharmacies (DSPs) do not, currently, have full NHS Choices entries, so DSPs will be required to:

  • check the name of their pharmacy on NHS Choices.
  • check the address, telephone number and website URL on their profile.
  • check the provision of Electronic Prescription Service (EPS) is correctly indicated on their profile.
  • email the NHS Choices service desk at nhschoicesservicedesk@nhs.net and confirm that the current information is correct or provide the correct information.

3. Pharmacy staff at the pharmacy must be able to send and receive NHSmail from their premises shared NHSmail account. Any problems or maintenance issues with pharmacy NHSmail accounts can be dealt with via the NHSmail helpdesk: pharmacyadmin@nhs.net.

4. The pharmacy contractor must be able to demonstrate ongoing use of the EPS at the pharmacy premises.

Quality payments are based on how many of the quality criteria the contractor achieves and declares via the Quality Payments Scheme declaration portal. The declaration portal can be found here and will be live from 11th June 2018 at 09:00 until 13th July 2018 at 23:59.

The declaration requires the contractor to confirm that they have met the four gateway criteria; this will then enable them to declare which quality criteria have been achieved and therefore claim for the associated payment.  A valid declaration can only be made via this website.

A copy of the declarations questionnaire for the June 2018 review point is available here so contractors can view the questions which will be asked ahead of making their declaration. Please note this is a PDF version and cannot be submitted.

Guidance & Useful Information

For further help and support please see the following links:

NHS England guidance on the Quality Payments gateway & quality criteria for the June 2018 review point can be found here.

The following two PDF documents outline the first steps which community pharmacies across England need to take to prepare for the Quality Payments Scheme and how to demonstrate that they meet the gateway and quality criteria.

Gateway Criteria Guidance

Quality Criteria Guidance

Passing the gateway criteria will not itself earn any payment for the contractor. Meeting the gateway criteria and achievement of some or all of the quality criteria set for the scheme, will mean a contractor is eligible for payments under the scheme.

The requirement to have an up to date NHS Choices profile on the day of the review (29th June 2018) is a gateway criterion of the Quality Payments Scheme and this must therefore be met, otherwise contractors will not be entitled to claim for a Quality Payment.

Quality payments will only be paid to LPS contractors who are eligible to claim under the terms of their LPS contract. If in doubt LPS contractors should confirm with their NHS England Regional Team whether they are eligible for quality payments.

PSNC has published a briefing with examples of what constitutes as acceptable evidence for contractors meeting the gateway and quality criteria available here.

April 2017 declaration data November 2017 declaration data
csv file providing the declaration made csv file providing the declaration made
Gateway & Quality criteria glossary Gateway & Quality criteria glossary
 

NHS England has published summary information on the number of contractors who took part in the Community Pharmacy Quality Payments Scheme in 2017/18 here.

Quality Payments Scheme April 2017 review point

Following the declaration period for the April 2017 Quality Payments Scheme closing, the NHS Business Services Authority (NHSBSA) was asked to collate information on behalf of NHS England to validate or verify contractors’ declarations.

NHS Choices gateway criterion

The first part of this process was to contact contractors who had only partly edited or validated their NHS Choices profile; for example they only edited or validated one or two of the three sections of their profile instead of the required three sections.

Those contractors who failed to update all three parts received an email on Thursday 10 August 2017 advising that they had until 10 September 2017 to edit or validate any sections of their NHS Choices profile that they failed to edit or validate by 28 April 2017, which was the deadline for meeting for NHS Choices gateway criterion.

Those contractors who did not update any sections of their profile were NOT given a second opportunity.

Read the content of the letter which was sent to contractors by email

Distance selling pharmacies

DSP contractors who provided some but not all of the required information to meet the NHS Choices gateway criterion also received an email from the NHSBSA on 10 August 2017 requesting that they provide the NHS Choices help desk with all the required information by 10 September 2017.

Read the content of the letter which was sent to contractors by email

Gateway criteria verification for the April 2017 review point

Following the declaration period for the April 2017 Quality Payments Scheme closing, NHS England worked with the NHSBSA to validate contractors’ declarations for the gateway criteria. If the NHSBSA was not able to validate that a contractor met the gateway criteria from data available, the contractor received an email from the NHSBSA in September 2017 stating the criteria that could not be validated and asking the contractor to provide information to show how the criteria was met.

NHSBSA worked with contractors to establish evidence/information to verify declarations made. This information was collated and shared with NHS England to decide on the next course of action. Where suitable information was provided the pharmacy was verified. Where insufficient or no information was provided NHS England determined a quality payment had been made where it was not due and an overpayment recovery should be progressed.

Contractors were advised to check their junk/clutter folder in case the email went into this folder.​​​​​Read the content of the letter which was sent to contractors by email

Quality Payments Scheme November 2017 review point

Verification of the QPS November 2017 declarations will be undertaken in a number of steps:

  1. Liaising with other organisations (eg. NHS Digital) to obtain data sets to validate the declarations submitted by contractors
  2. Engage with contractors to seek evidence/information where the contractor has not been verified in step 1
  3. Collate and share information with NHS England
  4. NHS England determines outcome
  5. Where an overpayment recovery is required NHSBSA will process this on behalf of NHS England

Quality Payments Scheme June 2018 review point

Verification of the QPS June 2018 declarations will be undertaken in a number of steps:

  1. Liaising with other organisations (eg. NHS Digital) to obtain data sets to validate the declarations submitted by contractors
  2. Engage with contractors to seek evidence/information where the contractor has not been verified in step 1
  3. Collate and share information with NHS England
  4. NHS England determines outcome
  5. Where an overpayment recovery is required NHSBSA will process this on behalf of NHS England