Hypertension Case-Finding Service: Commencement of PPV activity

From 9th October 2023, the NHS Business Services Authority (NHSBSA) Provider Assurance Team (PAT), will start to undertake post-payment verification (PPV) reviews of pharmacy owners providing the Hypertension Case-Finding Service.

The reviews, commissioned by NHS England, will look at the following categories:

• Highest claimers of blood pressure checks;
• High volumes of opportunistic blood pressure checks in those under the age of 40 years;
• Pharmacies with high numbers of clinic blood pressure readings but disproportionately fewer (or no) ambulatory blood pressure monitoring (ABPM); and
• Pharmacies that have reported higher volumes of identified patients with very high clinic blood pressure readings.

Community Pharmacy England has 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 (as well as fair to the commissioner and public purse).

The process

The initial review period is for claims between October 2022 and December 2022

The PPV approach for the Hypertension Case-Finding Service will begin by targeting a relatively small cohort of pharmacies nationwide having very high volumes over the review period in one or more of the above categories. The NHSBSA will shortly be writing to the selected pharmacy owners, setting out the process for reviewing their claims submitted over the review period.

NHSBSA will provide a summary, to each selected pharmacy owner, of the number of blood pressure checks that were claimed and ask for the corresponding records that were sent to the patient’s general practice for entry into the patient record. As part of the PPV process, additional information, such as appropriate referrals made etc., may be requested to provide additional evidence to support these claims.

Post Payment Verification

Integrated Care Boards (ICBs) are responsible for monitoring the provision of pharmaceutical services by pharmacy owners, and with NHS England, have a duty to assure themselves of the quality and probity of activity provided under the Community Pharmacy Contractual Framework; PPV is one way in which this monitoring is undertaken. The NHSBSA PAT undertake PPV at the request of NHS England.

Community Pharmacy England would encourage any pharmacy owners who are selected, to provide the requested evidence of service provision as part of the PPV process and to fully engage with the NHSBSA PAT through the process. The NHSBSA PAT will provide advice and support to pharmacies if they are unsure what evidence is required.

Further information on PPV processes can be found on our PPV webpage.