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Understanding your payment statement Marj McAvoy Operations Manager PSD

Understanding your payment statement Marj McAvoy Operations Manager PSD. The relationships. Scottish Government Health Department 14 Territorial NHS Boards 8 Special Health Boards. 8 Special Health Boards. Scottish Ambulance Service NHS 24 The State Hospital NHS Health Scotland

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Understanding your payment statement Marj McAvoy Operations Manager PSD

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  1. Understanding your payment statementMarj McAvoyOperations ManagerPSD

  2. The relationships • Scottish Government Health Department • 14 Territorial NHS Boards • 8 Special Health Boards

  3. 8 Special Health Boards • Scottish Ambulance Service • NHS 24 • The State Hospital • NHS Health Scotland • NHS Quality Improvement Scotland • NHS Waiting Times Scotland • NHS Education Scotland • NHS National Services Scotland

  4. Health Facilities Health Protection ISD NSD SNBTS CLO CFS NISG National Procurement SHSC PSD National Services Scotland

  5. Practitioner Services • Document processing • Data capture and verification • Maintaining patient registration database • Payment schedules • Clinical Governance for Dental services Our services are designed to enable contractors to be paid accurately and promptly for medicines and services supplied on behalf of the NHS.

  6. How Primary Medical Services Payments System (PMSPS)WorksEduardo Zanré

  7. PMSPS Overview

  8. Scotland Wide Payments • Global Sum • Superannuation • Seniority

  9. Global Sum • Global Sum Fund • The Scottish Allocation Factor (SAF) • Factors and Weighting • Data Required for Global Sum Calculations – Community Health Index (CHI) ISD File • The Calculation • Temporary Patient Adjustment • Minimum Practice Income Guarantee >> Correction Factor

  10. Superannuation • Background - New Contract 1st April 04 - Tiering 1st April 08 • Timeline • Estimated Interim Earnings • GP Annual Certificate (GAC)

  11. Seniority Seniority Payments are designed to reward experience, based on years of Reckonable Service and the current arrangements came into force from April 2003. • Reckonable Service • Calculation

  12. Trish Morgan Primary Care Contracts Manager

  13. Enhanced Services • GMS Contract • DES • NES • LES

  14. Enhanced Services

  15. Enhanced Services What does this mean? • Change in contract process • Activity • Resource • Time

  16. Enhanced Services PRESSURE • CHP • Practice Managers • PCCT • PSD • Finance

  17. Doctors Dentists Opticians Primary Care Contracts Team Pharmacists

  18. PCCT ADMINISTRATION • General medical services • General pharmaceutical services • General Dental services • Ophthalmic services

  19. PCCT • PCC Medical Team • Changes to Contract Process • Future proposals • Partnership working

  20. Enhanced Services Contracts • Contract Monitoring Group Chair Norma Buschman • Enhanced Services Group Chair Bob Liddell • Local Medical Council Chair Neil MacRitchie

  21. Primary Care Resources • Bob Sivewright – Finance Manager • Jacqueline Gall – Accountant • Sheila Roberts – Resources Manager • Lorraine Grant – Assistant Accountant • Elaine Leslie (Keith) – Assistant Accountant

  22. Enhanced Services • Directed enhanced services • National enhanced services • Local enhanced services

  23. Directed Enhanced Services • Influenza and Pneumococcal • Minor surgery injections and invasive procedures • Childhood immunisations and preschool boosters including Pneumococcal Child Vaccine (PCV)

  24. Directed Enhanced Services • Osteoporosis • Ethnicity • Palliative Care • Management information • Better Working • Extended Hours

  25. NES • INR Anti Coagulation • DMARDS • IUCD (insertions and failed)

  26. LES • Drugs misuse • Care homes • Minor Injury • Orthopaedics (Aberdeenshire only) • Dermatology (Aberdeenshire only) • Keep Well (Aberdeen City only) • Referred Minor Surgery

  27. LES • Implanon • Ring shelf pessary • Neo natal checks • Violent and difficult patients • Diabetes • Alcohol • Cardiac Failure

  28. Board Administered Funds • Seniority • Associates • Locum allowances, sickness, maternity, paternity and adoption • Career start • Golden Hello • Contingency Fund

  29. Premises reimbursements • Rent • Domestic Rates • Water Rates • Trade Refuse Collection • Improvement Grants

  30. Other payments • Miscellaneous payments funded source • Periodic Payments • HCH practice staff • Levy Deductions

  31. WEBSITES • Show website • http://www.show.scot.nhs.uk/publications • Statement of Financial entitlements • http://www.sehd.scot.nhs.uk/pca/PCA2009(M)10.pdf • BMA • http://www.bma.org.uk/

  32. QOF Review Process2009/10 Susan Harrold Practice Development Support Manager PSD/PCC Workshop for Practice Managers 29 October 2009

  33. Aspiration & Achievement Payments • QOF introduced as part of 2004 GMS Contract • QOF Payments divided into aspirational and achievement payments • Aspiration points – practices receive monthly payment based on 70% of the previous year’s achievement • Actual achievement against QOF calculated at year end.

  34. QOF Changes 2009/10 • Changes to QOF (reallocation of 72 points) • Changes to current prevalence • Square rooting removed from 1 April 2009 • True disease prevalence used to determine QOF payments from 1 April 2010 • Progress towards reducing GMS practices’ reliance on correction factor payments

  35. QOF Indicators removed • PE2 – patient survey • PE6 – Priorities and plan from survey • CON1 – Emergency Contraception Policy • CON2 – Pre-conceptual advice • COPD11 – Inhaler technique

  36. Reallocated points to be invested in following areas:- • Advice on long term contraception • CVD primary prevention • New depression indicator • Beta blockers for heart failure • Improvement to CKD indicators • Improvement to Diabetes indicators • Improvement to chronic lung disease indicators

  37. QOF Review in Grampian • Winter 5 Guidance – National working group provides framework for visits • QMAS reports reviewed annually for every practice • CHP’s responsible for organisation of QOF review process • All practices (with exception of Section 17c) receive a QOF review visit every 2 years • Practices with QPA V7-11 exempt from review of the organisational domain

  38. QOF Review Visits in Aberdeen City • CHP Contract/QOF Group establish schedule of visits (usually Sept – Dec) • Proposed introduction of QOF+ visits during 2009/10 (more focus on QDA and review of additional data) • Usually approximately 15 visits each year

  39. Core Grade A Evidence 2009/10 • Practice Leaflet • Survey of notes for medication review, clinical summaries, new patient summaries and indication for drug • Significant Event Reviews • Additional material – consultation length statement, prescribing actions, review of complaints, survey report and actions

  40. Development of QOF Plus • Enables wider discussion • Use of QOF Data Analyser (QDA) – practice demography, disease prevalence, comparison with other practices • Format and duration of the visit remains the same

  41. QOF Review Visits 2009/10 • Routine QOF review visits deferred due to H1N1 Vaccination Campaign • Option for a small number of practices to be a ‘pilot QOF plus’ visit (Jan – Feb 2010) • Winter Guidance recommends QOF + visits undertaken every 3 years • All visits 2010/11 will focus more on QDA and broader discussion across all disease areas Website http://qofanalyser.dundee.ac.uk/

  42. Questions Thank you

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