Here we look at the guidance policy provided by NHS England to ensure that all parties to GDS and PDS contracts understand the process and procedures that must be followed when mid-year reconciliation and financial recovery are applied to dental contracts.
The policy removes any deviation from the regulations and provides a fair and equitable process for all contract holders. Is also provides an element of proportionality when dealing with contractors.
The policy will be used to implement the contractual and regulatory processes required to:
– Review activity at mid-year.
– Make the required financial recovery.
– Issue a breach notice, in line with requirements as set out in part 5, paragraph 19 of the National Health Service (General Dental Services Contracts) Regulations 2005, and part 5, paragraph 15 of the NHS (Personal Dental Services Agreements) Regulations 2005.
The mid-year review looks at delivery against the contract and taking action where necessary. It must be undertaken by 31 October of the financial year to which it relates.
The regulations stat that mid-year processes can apply where a contractor has provided less than 30 percent of the activity that it is required to deliver in that financial year scheduled by 30 September.
The figure has to be used in this calculation is the figure given to the area team by NHS Dental Services (NHS DS), which is based on the FP17s transmitted by the contractor for completed/incomplete courses of treatment. If a contractor disputes this figure it is up to them to liaise directly with NHS DS for resolution of this dispute.
Mid-year reconciliation and financial recovery policy:
The GDS regulations, in schedule 3, part 5 (38) and PDS regulations in schedule 3, part (59) states that transmission must be within two months of a completed course of treatment. If this time passes then NHS England does not have to pay for this activity nor take into account its delivery and therefore does not have to have it included within the activity report.
The area team will identify contractual activity using reports available from NHS DS. Following identification of delivery the process below will be followed.
Contractors who have delivered at least 30 percent of their activity (GDS, PDS and PDS Plus):
Send the contractor the standard letter in annex 2. It is also important to identify if over-delivery is apparent and include this in the letter.
Contractors who have delivered less than 30 percent of their activity (GDS, PDS and PDS Plus):
If a contract has achieved less than 30 percent of its contracted units of activity at 30 September, the area team need to carry out a mid-year review meeting with the contract holder. This meeting does not necessarily need to be face to face and be conducted on the telephone if appropriate. The review may be followed by an action plan to identify how contracted activity will be delivered by year end and/or a withholding of monies as described in schedule 3, part 8 (59) (3) of the GDS and PDS regulations.
If there are reasonable explanations and remedies given at the review meeting, then the area team is able to take no further action at mid-year. However, the area team should be satisfied that the contract is on target to deliver at year-end.
Process for area teams to follow:
– Send a letter asking the contractor to arrange a review meeting.
– During the review, discuss any written evidence put forward to demonstrate. Greater achievement and consider any reasons stated for delivery at current level.
– A final copy of the notes of the meeting, if the area team is still concerned about contract delivery it may request an action plan to be followed.
– Following the review meeting, if the area team is still concerned about contract delivery it may request an action plan to be followed.
– Following the review meeting the area team may withhold any monies as appropriate and make any adjustments to the payment.
Mid-year and year-end reconciliation and financial recovery policy:
– System in accordance with schedule 3, part 8 (59) (3) of the GDS and PDS regulations.
– Area team to send a written copy of the review and any feedback from the action plan to the contractor.
Reductions to payments following a mid-year review
Any withholding of monies needs to be calculated in line with schedule 3, part 8 (59) (3) of the GDS and PDS regulations as below:
The maximum amount that may be withheld pursuant to sub-paragraph (2) (b) of the GDS and PDS regulations is:
– The amount that is payable under the contract is respect of the number of units of dental activity or units of orthodontic activity required to be provided in a financial year.
– The amount that would be payable under the contract as a relevant proportion of that amount if the contractor provided in the whole of the financial year only twice the number of units of dental activity or orthodontic activity that he provided between 1 April and 30 September.