Background and aim
As part of the national response to the COVID-19 pandemic, in April 2020 NHS England (NHSE) commissioned a prescriptions delivery service from community pharmacies to people classed as ‘shielded patients’ who were required to self-isolate.
From April 2020 until 31 July 2020, the first national lockdown period, MDS was commissioned across all of England. During this time, the NHSBSA Provider Assurance Team (PAT) was asked by NHSE to conduct an exploratory exercise and contact pharmacies identified as the highest claimers for MDS, to understand more about their claims.
What we did
Telephone calls were made to a number of pharmacies, and it became apparent that in some cases, claims were not being made in line with the service specification.
Examples of risks identified by the team included:
- pharmacies admitting that they were not checking the patient’s summary care record as evidence they were on the shielded patient list
- pharmacies disclosing that they were submitting claims for deliveries to any patient over 60 years old
- multiple claims for the same patient in a short space of time, suggesting numerous deliveries were made when social contact was supposed to be at a minimum
- multiple claims for patients at the same address, such as a care home.
Following identification, education and 1-2-1 support to pharmacies was provided. The team regularly contributed information and articles to the Hints & Tips newsletter that is sent to 11,000 pharmacists, as well as produced separate standalone support documents that were sent to individuals needing additional clarification.
Results
Since December 2023, the team have dealt with 17 appeals lodged to NHS Resolution (NHSR) relating to MDS. It is testament to the robust processes in place that 16 of those 17 appeals have been dismissed by NHSR, with the remaining case currently on hold. This excellent appeal record demonstrates the robustness of our assurance exercises.
In total so far, all of the work on MDS conducted by PAT has produced recoveries of over £2.3m of additional taxpayer money provided by Treasury to fund MDS, and this is expected to rise further as the final phase progresses.