Pharmacy First payments “may be withheld by the NHSBSA while…claims are investigated”, Community Pharmacy England (CPE) last week (January 23) revealed.
The negotiator said that “new wording” on next month’s drug tariff will highlight that Pharmacy First service payment claims “may be investigated” by the NHSBSA.
Read more: ICB investigating plunge in Pharmacy First GP referrals
It added that the tariff will warn that investigations may happen “where claims are submitted for Pharmacy First and the data provided indicates the service was not provided in accordance with the appropriate patient group direction (PGD) or service specification”.
“The payments may be withheld by the NHSBSA while the claims are investigated,” CPE said.
“Excessive” drug supply
“Following the outcome of the investigation, payments will only be made to pharmacy owners if determined to be lawful according to the appropriate PGD and service specification,” CPE said.
It added that a claim might be unlawful “if an excessive quantity of medicine has been supplied, for example, outside that stipulated in the PGD”.
Read more: MP: GPs need ‘financial incentive’ to engage with Pharmacy First
It listed another example as claiming payment when a patient is “outside the age range of the PGD” such as a woman aged 65 or over being treated for an uncomplicated urinary tract infection (UTI).
Another example of an unlawful claim would be if “an acute otitis media pathway was provided by a distance selling pharmacy (DSP)”, according to CPE.
Thresholds, caps and suspensions
The move comes as the minimum number of Pharmacy First consultations pharmacies must complete to qualify for a monthly payment is set to increase to 30 in March.
At the same time, new caps on the maximum number of Pharmacy First consultations that pharmacies can be paid for were introduced last month, rising between 55% and 94% across different types of pharmacies.
Read more: Pharmacy First consultation payment caps rise up to 94%
In September, C+D exclusively revealed that commissioners had suspended four pharmacies from the Pharmacy First scheme, all of which were leading providers of minor illness referral consultations.
And C+D reported in November that a fifth pharmacy had been suspended from the Pharmacy First service, with its integrated care board (ICB) citing “high volumes” and “the types of conditions referred” as reasons for suspension.
Read more: UPDATED: Pharmacy First thresholds slashed until March
Meanwhile, NHS North East London told C+D earlier this month that it is investigating a local and national “decline” in Pharmacy First referrals from GP practices and a “general reduction in Pharmacy First activity across all community pharmacies”.
The comment comes as an MP this month called for “financial incentives” to be introduced to encourage GPs to “work with pharmacies” and engage with the Pharmacy First service.
