NHS demands evidence from pharmacies with high number of hypertension claims
The NHS BSA has begun verifying claims from pharmacies for delivering the hypertension case finding services, targeting those businesses that have submitted the most claims.
The NHS BSA began its post-payment verification (PPV) reviews on behalf of NHS England earlier this week, according to Community Pharmacy England (CPE), and will initially look at claims submitted between October and December last year.
As well as looking into those pharmacies with the most claims, it will target those delivering high numbers of opportunistic blood pressure checks to under-40s, those carrying out high numbers of checks but “disproportionately fewer” ambulatory blood pressure monitoring fittings and those reporting significant number of patients with “very high” blood pressure readings.
In the first instance the BSA will target a “relatively small cohort of pharmacies nationwide having very high volumes” in one of these categories and write to any pharmacies asking them to provide the records sent to patients’ GPs at the time of delivering the service. Additional information may be requested, such as whether onward referrals were made.
The negotiator said it had “been consulted on the verification process and has sought to ensure it is appropriately targeted, proportionate and fair to those pharmacy owners asked to provide records” in addition to upholding taxpayers’ interests.
It urged any pharmacies identified by the BSA “to provide the requested evidence of service provision as part of the PPV process and to fully engage with the NHSBSA provider assurance team (PAT) through the process”.
NHS BSA data indicates that during the October-December 2022 review period a total of 308,629 claims for in-pharmacy blood pressure readings were submitted, compared to just 14,855 ABPM fittings.
Since then, there has been a rise in the number of monthly claims for both clinic readings and ABPMs, although the latter continues to make up a small fraction of all claims for delivering the service. In June this year there were 155,914 claims for clinic readings and 8,428 ABPM claims.
Contractor data shows that the highest-claiming pharmacy in England by far is Rimmington Pharmacy in Bradford, with a total of 41,259 claims since the service launched in October 2021. The second highest-claiming pharmacy is a branch of Jhoots Pharmacy in Brierley Hill in the West Midlands. No other pharmacies have exceeded 10,000 claims.
CPE’s guide to payment verification explains that there are a number of possible outcomes from the exercise, ranging from no action taken (if the evidence provided matches a pharmacy’s payment claims), an “overpayment recovery” by NHS BSA if the evidence does not match the claims and, if there is a lack of clarity around the timings of service provision and when claims were submitted, giving contractors the opportunity to provide evidence for a different time period.