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NHS BSA forces two pharmacies to hand back £33k in hypertension fees

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NHS BSA forces two pharmacies to hand back £33k in hypertension fees

Exclusive: The NHS Business Services Authority has recovered just under £33,000 in inappropriate claims for the hypertension case-finding service from two community pharmacies in England, P3pharmacy has learned.

Data obtained through the Freedom of Information Act reveals that two pharmacies have so far been forced to hand back payments since a post-payment verification (PPV) exercise launched last October

The NHS BSA recovered £15,210 from one pharmacy and £17,610 from another, amounting to £32,820 in total. It has also requested additional evidence from a further 32 pharmacies to support their fee claims.

The NHS BSA, which declined to name the two pharmacies when asked, told P3pharmacy it could not comment on the “final outcome” of the PPV investigation as it is “still ongoing”. It initially reviewed claims submitted by pharmacies between October and December 2022.

NHS records show that of the 8,919 pharmacies that have provided the service, one has made 51,568 claims for in-pharmacy blood pressure checks in total – far higher than the second in the league table, which has made 15,976 claims. Five pharmacies have submitted more than 10,000 claims for blood pressure checks since October 2021. There is no suggestion that any of these pharmacies are among those targeted in the NHS BSA investigation. 

When the PPV exercise was announced last October, the NHS BSA said it was targeting both pharmacies with unusually high numbers of claims and those carrying out high numbers of initial checks but “disproportionately fewer” ABPM fittings, as well as those reporting significant numbers of patients with “very high” blood pressure readings.

A large discrepancy between the number of clinical checks and the number of ABPM fittings has been a feature of the service since it launched. During the October-December 2022 period targeted by the PPV exercise, there were 308,629 claims for in-pharmacy blood pressure readings and 14,855 claims for ABPM fittings. 

In January this year, there were 132,178 claims for blood pressure checks and 11,809 ABPM claims, pointing to a slight bridging of the gap between the two arms of the service.

Pharmacies providing this Advanced service can claim £15 for every patient who receives a clinic blood pressure check and £45 for the provision of ambulatory blood pressure monitoring where this is clinically indicated. From the launch of the service in October 2021 to April this year, pharmacies were also able to claim a £1,000 incentive fee in their first year of providing the service, but this has now been withdrawn.

In addition to patients referred by their GP for a blood pressure check, the service is open to patients aged 40 and over who do not have a current hypertension diagnosis. The service may “by exception” be provided to some younger patients “at the discretion of the pharmacy staff” according to NHS England. ABPM should be offered to patients with a blood pressure measurement of 140/90mmHg or higher but less than 180/120mmHg.

Pharmacies must record data for all patients accessing the service and share it with their GP surgery, and these records have played a central role in the NHS BSA investigation.  

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