Provider assurance work to commence
The NHS Business Services Authority (NHSBSA) Provider Assurance Team (PA Team), commissioned by NHS England, will soon start to undertake provider assurance work (post-payment verification (PPV)) with pharmacy owners providing the Smoking Cessation Service, the Pharmacy Contraception Service, Pharmacy First and the Hypertension Case-Finding Service.
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.
The process
The PPV approach for all four services will begin by engaging with a relatively small cohort of pharmacies nationwide, where very high volumes of claims within the defined categories have been identified over the review period.
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 affected claims. They will request additional information or evidence to provide assurance that the consultations were made in accordance with the service specification.
As part of the PPV process, additional information or evidence may be requested by the NHSBSA PAT Team to enable them to verify service remuneration claims submitted by pharmacy owners.
Post Payment Verification
The NHSBSA PAT undertake PPV at the request of NHS England. The Team will provide advice and support to pharmacies if they are unsure what evidence is required.
Integrated Care Boards (ICBs) have a duty to assure themselves and NHS England of the quality and integrity of the activity provided under the Community Pharmacy Contractual Framework; PPV is one way in which this monitoring is undertaken.
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.
Further information on PPV processes can be found on Community Pharmacy England’s PPV webpage and in the drop-down menus below.
The reviews will engage with 31 pharmacies who have been identified in the following categories:
- Highest claimers (consultations);
- Highest claimers (NRT products);
- Claims for high quantities of products supplied for individual patients;
- Claims for multiple initial consultation fees for the same patient; and/or
- Manual claims made not using an approved pharmacy clinical IT system.
The initial review period is for claims between April 2023 and September 2025.
The reviews will engage with 27 pharmacies who:
- Appear to have made unexpectedly high number of claims;
- Claims that appear to have been made outside of the PGD; and
- Claims for 3 or more consultations for the same patient within one month
The initial review period is for claims between April 2023 and June 2025.
The reviews will engage with 19 pharmacies that have a high number of claims, which suggests that the quantities supplied are greater than the amount allowed in the PGDs.
The initial review period is for claims between January 2024 and December 2025.
The next phase of the review of the Hypertension Case Finding Service will be split into two. The first will expand on previous phases and will engage with 147 pharmacies whose claims fall into the following categories:
- Highest claimer for blood pressure checks & ABPMs;
- High volumes of blood pressure checks in those under 35 years of age with no referral;
- High numbers of clinic blood pressure readings but disproportionately fewer (or no) ABPMs;
- Very high clinic blood pressure, which does not appear to have been signposted or escalated, as appropriate; and/or
- Duplicate claims for same patient, same day.
The second will engage with 18 distance selling premises (DSP) pharmacies where claims for the service have been made since 1st October 2025. From 1st October 2025, regulations came into force that prevent DSP pharmacies from providing Directed services (Advanced, National Enhanced and Enhanced Services) face-to-face with patients at the pharmacy premises.
