Part XIX - Payments to Chemists Suspended by Direction of the NHS Tribunal
This Determination is made by the Secretary of State pursuant to regulation 18A of the National Health Service (Pharmaceutical Services) Regulations 19921.
1. Interpretation
1.1 Unless the context otherwise requires,words and phrases used in this Determination have the same meaning as they have in the National Health Service (Pharmaceutical Services) Regulation 1992.
1.2 Any reference in this Determination to a numbered regulation is to the regulation bearing that number in the National Health Service (Pharmaceutical Services) Regulations 1992.
2. Calculation of payments to be made to suspended chemists
2.1 Where a chemist is suspended by direction of the Tribunal, the PCT for England and LHB for Wales shall make payments to him, calculated in accordance with this Determination.
2.2 Where the suspended chemist has undertaken to provide pharmaceutical services from two or more premises in the PCT's for England and LHB's for Wales area, payments shall be calculated separately in respect of each of those premises.
2.3 Upon receipt of a claim from the chemist, the PCT for England and LHB for Wales shall pay to the suspended chemist in respect of each complete calendar month during which he is suspended an amount equal to his reference remuneration, calculated in accordance with paragraph 3.
2.4 For any calendar month during which the chemist was suspended for less than the whole month, payment shall be reduced pro rate to the number of days (including weekends and Bank Holidays) during which the chemist was suspended.
2.5 If when the chemist is first suspended, the PCT for England and LHB for Wales does not have available to it all the details of the fees and allowances which it needs in order to calculate reference remuneration in accordance with paragraph 3, it shall estimate the reference remuneration on the basis of the information which is available to it, and make payments accordingly. When the full information becomes available, it shall recalculate the reference remuneration, and adjust its payments accordingly.
2.6 The PCT for England and LHB for Wales shall also recalculate the reference remuneration (and, where appropriate, any additional payment or deduction under paragraphs 6 to 9) if the chemist ceases to be included in the pharmaceutical list in respect of any premises, or if the PCTs for England and LHBs for Wales receives new information about the fees and allowances to which he was entitled. It shall adjust its monthly payments accordingly.
3. Reference Remuneration
3.1 A chemist's 'reference remuneration' is the total of the relevant fees and allowances (as defined in paragraph 4) to which he was entitled in respect of the relevant period (as defined in paragraph 5) in relation to the premises in question, divided by the number of months in the relevant period.
3.2 For example, if the relevant fees and allowances for a given set of premises come to £12,000, and the relevant period for those premises is ten months, the reference remuneration will be £12,000/10 = £1200. If the relevant period is the full twelve months, the reference remuneration would be £12,000/12 = £1000.
3.3 Where a chemist is included in the PCT's for England and LHB's for Wales pharmaceutical list both as a person who has undertaken to provide pharmaceutical services by way of the provision of drugs and by way of the provision of appliances in respect of the same premises, and the relevant period for the two types of service differ, the two sets of relevant fees and allowances shall be calculated separately for the purposes of determining reference remuneration.
4. Relevant Fees and Allowances
4.1 Relevant fees and allowances means:
(a) Standard Professional Fees payable under clause 1 of Part IIIA of the Drug Tariff;
(b) Additional Fees payable under clause 2 of Part IIIA;
(c) Special Fees payable under clause 3 of Part IIIA;
(d) Fees for dispensing appliances, payable under Part IIIB;
(e) Payment for Additional Professional Services payable under Part VIA;
(f) On-Cost Allowance for Appliance Contractors payable under Part VIB;
(g) Payments under the Essential Small Pharmacies Scheme payable under Part XII;
(h) Payment in respect of Pre-Registration Trainees under Part XIII;
(i) Payments for Oxygen Therapy Services (including service element and hardware, but excluding compensation for financial loss in respect of oxygen equipment, paid under regulation 18(1)(i)) as determined by the PCT for England and LHB for Wales.)
4.2 For the purposes of calculating reference remuneration, relevant fees and allowances to which the chemist was entitled in respect of any part of the relevant period (as defined in paragraph 5) prior to 1 October 2000, other than those listed at (d) and (f) in the preceding paragraph, shall be increased by 3%.
4.3 For example, if the relevant period were to be January 2000 to December 2000, reference remuneration would be calculated by reference to
the relevant fees and allowances for January to September 2000, increased by 3%; and
the relevant fees and allowances for October to December 2000, without any increase.
5. Relevant Period
5.1 Where, prior to the suspension, the chemist has been included in the pharmaceutical list in respect of premises for less than 12 complete calendar months, the relevant period for those premises is the number of complete calendar months during which the chemist was so included in the pharmaceutical list.
5.2 In all other cases, the relevant period is the last twelve complete calendar months immediately prior to the suspension.
5.3 For example, if a chemist is suspended on 12 November 2000, the relevant period for each set of premises would normally be 1 November 1999 to 31 October 2000 (ie 12 months). But if the chemist was first included in the pharmaceutical list on 3 March 2000, the relevant period will be 1 April 2000 to 31 October 2000 (ie 6 months).
5.4 Where a chemist has, under regulation 4(3)(a), relocated the premises from which he provides pharmaceutical services, only the period after that relocation (or the last such relocation) is to form part of the relevant period.
5.5 Where the chemist began to provide pharmaceutical services from premises in place of another chemist under regulation 4(3)(b), only the period after that change of ownership is to form part of the relevant period.
6. Additional Payments
6.1 Where the PCT for England and LHB for Wales is satisfied that, but for suspension, a chemist would have been entitled to a higher rate of payment for Additional Professional Services in respect of the month in which he was suspended than he in fact received, the PCT for England and LHB for Wales shall make an additional payment to him.
6.2 That payment shall be the difference between the amount the chemist received in respect of that month and the amount to which, by reference to payments in previous months, the PCT for England and LHB for Wales believes he would have been entitled but for the suspension.
6.3 Payment shall be made as soon as practicable after the PCT for England and LHB for Wales has available to it final details of the amount of Payment for Additional Professional Services that was actually made to the chemist in respect of the month in question.
7. Deductions from Payments
7.1 Essential Small Pharmacies Scheme
7.1.1 Where the PCT for England and LHB for Wales is satisfied that, but for suspension, a chemist would have been entitled under Part XII of the Drug Tariff to lower payments under the Essential Small Pharmacies Scheme in respect of the month during which he was suspended than he in fact received, the PCT for England and LHB for Wales shall make a deduction from its monthly payment to him.
7.1.2 That deduction shall be the difference between the amount the chemist received in respect of that month and the amount to which, by reference to payments in previous months, the PCT for England and LHB for Wales believes he would have been entitled but for the suspension.
7.1.3 Such deduction shall be made as soon as practicable after the PCT for England and LHB for Wales has available to it final details of the amount of payments under the Essential Small Pharmacies Scheme that was actually made to the chemist in respect of the month in question.
7.2 On-cost allowance for Appliance Contractors
7.2.1 Where the PCT for England and LHB for Wales is satisfied that, but for suspension, a supplier of appliances would have been entitled under Part VIB of the Drug Tariff to a lower level of on-cost allowance in respect of the month during which he was suspended than he in fact received, the PCT for England and LHB for Wales shall made a deduction from its monthly payment to him.
7.2.2 That deduction shall be the difference between the amount the supplier of appliances received in respect of that month and the amount to which, by reference to payments in previous months, the PCT for England and LHB for Wales believes he would have been entitled but for the suspension.
7.2.3 Such deduction shall be made as soon as practicable once the PCT for England and LHB for Wales has available to it final details of the level of on-cost that was actually paid to the supplier of appliances in respect of the month in question.
7.3 Chemists providing pharmaceutical services other than as a principal
7.3.1 Where a chemist contractor is suspended by the Tribunal, but there is not in force against him a declaration that he is unfit to be employed in any capacity in the provision of pharmaceutical services, the PCT for England and LHB for Wales shall reduce the payments it makes by the amount of any remuneration the suspended chemist earns by being engaged in the provision of pharmaceutical services otherwise than as a chemist contractor. The suspended chemist shall inform the PCT for England and LHB for Wales immediately of any such earnings.
8. Claims for payment
8.1 The suspended chemist shall claim payments under this determination, by notifying the PCT for England and LHB for Wales in writing. When first making the claim, and subsequently as necessary, the suspended chemist shall provide such information as the PCT for England and LHB for Wales may reasonably require for the purposes of establishing the chemist's entitlement to, or the level of, payments.
9. Arrangements for payment
9.1 Upon receipt of a claim from the suspended chemist, payments shall be made in arrears as soon as practicable following the end of each calendar month, starting at the end of the month following that in which the chemist was suspended. For example, if the chemist is suspended on 27 August, the first payment will be due as soon as practical after 30 September.
1 S.I. 1992/662. The relevant amending instrument is S.I. 1996/698
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