- Posted Tuesday March 16, 2021
Coronavirus has had an everlasting effect around the world, and here within the UK our Primary Care Networks are now at the front of people’s minds when, a little over 3 months ago, very few of the general public would have understood their role in General Practice. It can then therefore be assumed that they are here to stay beyond the initial 5-year funding provision.
As I write today (20th Feb) the NHS has delivered 18,197,269 vaccinations, given at the beginning of the year this was a mere 1,400,134 and this equates to about 4 injections per second!! This is a huge achievement for the NHS and Primary Care, but of course this achievement comes at a price and over the next few paragraphs I hope to add some clarity to an ever-changing picture.
Payments and the Covid Vaccination Programme (CVP)
The Item of Service (IOS) value for COVID vaccinations works out at £12.58 per doses, plus from the 15 Feb a further £10 for vaccinations administered in settings such as care homes, hostels and housebound patients. There is also additional funding for PCN’s of £950 / week (to a max of £2,500 per PCN) to support additional workforce to keep records of vaccinations up to date.
There is also a further £150m of support available via CCG’s to support the increase in work pressures caused by the vaccine roll out. This funding is designed to help practices work on weekends / evenings (when they don’t already do so), along with providing additional staff to support existing staff.
This could result (so far) in an additional £379m being pumped into PCN’s and Primary Care directly. Of course, not all vaccinations have/will be delivered by Primary Care but bearing in mind the Governments pledge to offer vaccinations to all adults within the UK by 31 July the vast majority of this funding will be heading that way.
There have also been some additional changes to funding to priorities for the Covid Vaccination Program (CVP).
- QOF (quality and outcomes framework) income protection is in place - in addition to the existing protections for 310 QOF points, the protection of the eight prescribing indicators (to be paid on the basis of historical performance), as well as full income protection for all 74 points in QI modules, to apply from January to March 2021.
- Additional funding has been made available for PCN clinical directors in those PCNs where at least one practice is participating in the CVP, to apply from January to March 2021.
- Minor surgery DES (directed enhanced service) income will be income protected until March 2021.
- The management of long term conditions should be managed on the basis of clinical prioritisation with continued recording patient contact, but this will not impact payment.
- ARRS (additional roles reimbursement scheme) staff can be deployed as required to vaccination as integral members of PCN teams. ARRS recruitment should continue with full funding entitlements remaining in place.
- The network contract direct enhanced service makes clear the number of SMRs (structured medication reviews) to be delivered will be limited by PCN clinical pharmacist capacity. It's likely that the CVP is considered a priority for deploying available clinical pharmacists in the short term.
- A PCN may use its additional roles reimbursement sum to reimburse extra hours worked by PCN staff, at plain time rates only, as long as the increase in whole time equivalent hours worked is clearly recorded on the PCN’s claim form and national workforce reporting system.
The Practicalities of Vaccines Delivery
All of the above sounds great but how does this affect your practice and the team around you?
There are several challenges in the delivery of the vaccine, do you have the resources, car parking, space, staff etc. and can these resources be kept at pace over the coming weeks / months?
We are already seeing increases in staff absence through either test and trace isolation or illness, adding further pressure to services. As staff are seconded into PCN’s to deliver vaccines, this further depletes the pool of individuals at your surgery. Planning to allow for this is crucial to ensure you are still able to deliver the day to day.
Staff seconded from Practice to the PCN will need to be reimbursed. It is important to remember that this time is potentially in addition to their usual hours, and also potentially outside of their normal working day (evening / weekend etc). There may be an expectation of additional pay on top of the norm, (increased hourly rate, travel time if working outside of normal hours etc.), so agreeing this upfront is important so that no misunderstandings arise.
You also need to be aware that the “cost” to the Practice is not just the employee’s salary. Employers National Insurance (currently 13.8% and Employers Pension at 14.38%* add a significant extra cost to a Practice which needs to be reimbursed.
(*There are increased complications for staff within and without the pension along with Full/Part time staff members. Specialist advice should be sought so that the Practice is not left out of pocket.)
NHS England (via CCG’s) are still repaying additional costs that practices have/are incurring due to COVID, making sure these claims are submitted is the only way of ensuring payment.
Logging any claim and tracking these to ensure monies are received is always a critical part of the accounting function of any practice. With everything going on at the moment keeping track of additional claims requires systems to be in place, good practice ensures these systems are monitored to ensure they are working correctly.
Cashflow is critical during this time, Practices will be incurring additional costs and then waiting for reimbursement, potentially several weeks later. Ensuring that you have sufficient cash to enable this gap in funding along with ensuring you chase the PCN / CCG etc. in a timely manner.
Recording keeping throughout this period is even more relevant than normal, claims cannot be done timely and accurately without the correct information. Time spent now will pay dividends in the future, ensuring that Practices and individual Partners aren’t left out of pocket.
Phil Harnby is Director of Mitchells Grievson Chartered Accountants based in the North East. He specialises in clients in the healthcare sector and the changing environment of the NHS, and has presented on financial topics at national events and written for various national publications.