We are very sorry that you are experiencing this challenge. You are not alone.
This claim affects the ICB / ICS prescribing budget (not the IOS or CQRS claim) because it relates to the medicines used. There appears to be an internal driver within NHSBSA to ensure that they are aware of this before the claim is processed. This is why their request for prior authorisation is from the ICS and not Public Health or NHS England.
This is admirable but without a formal standard operating procedure, this causes confusion within ICBs / ICSs.
We are trying our hardest to find out why NHSBSA believe they require pre-authorisation. A recent Freedom of Information request (see below) has demonstrated that there is no Standard Operating procedure requiring this. We have raised this again with NHSBSA.
In the interim, a member of the ICB/ICS simply needs to acknowledge the claim and authorise that it can be paid in accordance with the Statement of Financial entitlement. NHSBSA will do their usual checks to ensure the claim is valid.
We are very happy to arrange a teams meeting to discuss this with the ICB / ICS. This can be arranged by contacting us through the email address listed on the claim.
Freedom of information request:
Dear Mr Vincent
Thank you for your request for information about the following:
Please could you supply any SOPS / Guidance on the management of GP Practice Historic Personally Administered Drug Reimbursement Claims.
You clarified your request on 5 June 2023:
I’m afraid the SFE is not what I require. This is fairly clear that historic claims can date back 6 years.
What I would like is sight of any internal policy / standard operating procedure or any other document that details how NHSBSA handle historic claims i.e. historic claims for items on the FP34D high volume vaccines form that span many years.
This request is driven by an instruction from the NHSBSA team that these claims must be “authorised” by the ICB before the NHSBSA team will process them. This is a very frustrating process for the practices, the ICB teams no nothing of this need, and we would like to better understand the NHSBSA process.
Your request was received on 16 April 2023 and has been dealt with under the terms of the Freedom of Information Act 2000.
Response
The NHSBSA is an Arm’s Length Body of the Department of Health and Social Care, and we process reimbursement and remuneration claims from GPs and Dispensing Practices on behalf of NHS England. We are directed to process claims as described in the GMS SFEs (see Part 4 (Payments for Specific Purposes), section 16, paragraph 16, below), and the rules detailed in the NHS England and Wales Drug Tariff. Once submitted and processed, the NHSBSA cannot make changes, alterations or adjustments to prescription endorsements or the FP34D/PD as it is incumbent on the contractor to submit true and accurate claims. Historic claims can be made by GPs and Dispensing Practices using the appropriate claim forms however these forms must be submitted to the NHSBSA within the time limits described in Part 7 (Supplementary Provisions), section 22, paragraphs 10 and 11 (see below) of the GMS SFEs
General Medical Services Statement of Financial Entitlements Directions – GOV.UK (www.gov.uk)
Preconditions before payments under this Section are payable
(16) The payments listed in paragraph (3) are only payable if the contractor has—
(a) noted, counted and sent all the prescriptions in respect of drugs or appliances in respect of
which it wishes to claim reimbursement to the NHS Prescription Services part of the NHS
Business Services Authority, Bridge House, 152 Pilgrim Street, Newcastle-upon-Tyne,
NE1 6SN, not later than the 5th of the month following the month to which the
prescriptions relate; and
(b) included all the claims under cover of a single claim form, and divided all the
prescriptions into two bundles (for the calculation of the dispensing fee), and
(i) one of these two bundles must be prescription forms in respect of which no charge is
payable, because—
(aa) the patient is entitled to an exemption;
(bb) the drugs or appliances were no-charge contraceptives, or
(cc) the drugs or appliances were personally administered items, and are in the list
in paragraph (4), and
(ii) the other of these two bundles must be of prescription forms in respect of which a
charge is payable, whether or not the charge has been collected (if the prescription
form is for more than one item, at least one of which is chargeable, it should be
included in this bundle),and if the claim is in respect of the following high-volume personally administered
vaccines – influenza, typhoid, hepatitis A, hepatitis B, and Meningococcal – it must be
made in the form of bulk entries on the claim form.
Time limitation for claiming payments
(10) Payments are only payable if claimed before the end of the period of six years beginning with the date on which they could first have fallen due (albeit that the due date has changed pursuant to paragraph (5)).
(11) Paragraph (10) does not apply to any claims for payments which fall due under a provision of the SFE in respect of which an alternative time limit for making claims for such payments is imposed unless, in the opinion of NHS England, exceptional circumstances exist which make it reasonable for that time limit to be disapplied.
Dispensing Contractors with specific queries relating to claims, submission and payments on their accounts can contact the NHSBSA directly at Nhsbsa.repricingrequest@nhs.net
The NHSBSA follow the guidelines in the GMS SFE and the Drug Tariff, and do not have any internal policies or Standard Operating Procedures for the management of GP Practice Historic Personally Administered Drug Reimbursement Claims.
Please note that this request and our response will be published on our Freedom of Information disclosure log at:
https://opendata.nhsbsa.net/dataset/foi-01106
“NHSBSA Copyright 2023” This information is licenced under the terms of the Open Government Licence:
http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/