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The 'responsible' health authority normally makes all payments to which a GP is entitled apart from rural practice payments, which may be made by the health authority that determines eligibility for these payments even though it is not the GP's 'responsible' authority. The 'responsible' authority will obtain from any other authorities in whose lists a GP or his or her partners are also included the information needed to determine eligibility to receive:
• basic practice allowance and related allowances
• allowances for employing associate doctors and locums employed by rural single-handed GPs on study leave
• payments during sickness, confinement and prolonged study leave
• capitation fees, deprivation payments and child health surveillance fees
• inducement payments and initial practice allowances
• rural practice payments (except as described above)
• registration fees and payments for minor surgery sessions, health promotion and chronic disease management
• target payments for vaccinations and immunizations and cervical cytology
• payments under the GP registrar scheme
• doctor's retainer scheme sessional payments
• postgraduate education allowance
• reimbursement for staff and premises
• reimbursement of computer costs
• payments under the out-of-hours development scheme.
GPs should claim the following fees from the health authority for the locality where a patient lives or is temporarily residing, or in the case of emergency treatment for the area where it is provided:
• maternity medical services fees
• contraceptive services fees
• night payments
• temporary resident fees
• emergency treatment fees
• immediately necessary treatment fees
• fees for the arrest of dental haemorrhage
• anaesthetists' fees
• vaccination and immunization fees.
The health authorities receiving claims check them and notify the responsible health authority of the amounts to be paid.
Capitation fees, deprivation payments, child health surveillance fees and practice allowances will be paid no later than the last day of the quarter in which they are due.
Claims for most item of service fees (night consultation payments, vaccinations etc.) are accepted if made within six months of the service being provided, or in the case of MMS within six months of the expected date of confinement if this is later. Practices should submit claims as quickly as possible.
The health authority may accept claims made up to six years after the service was provided; its decision will depend on why the delay occurred. Only the Secretary of State can exceptionally approve claims after six years.
Box 36.1: Payment arrangements
All fees and allowances are paid by the responsible health authority except, in some circumstances, rural practice payments. However, some claims have to be submitted to the health authority for the area where a patient lives
Arrangements for making provisional payments or withholding payments where eligibility is in doubt are described in Red Book paragraph 75.6. The arrangements for paying dispensing doctors are in paragraph 75.7.
If two or more practitioners are in partnership:
• claims for services provided by either or any of them may be submitted as a single claim in the name of the partnership
• payments may, if the partners wish, be made as a single payment to the partnership.
Box 36.2: Submitting claims
• item-of-service claims must be submitted within six months of when the service was provided
• health authorities have discretion to accept claims made within six years
Advance payment can be obtained for capitation fees, child health surveillance, deprivation payments, allowances and certain payments under the GP registrar scheme. Advances may be made either:
• midway in the quarter, when the advance will not exceed half the estimated payments for the quarter, or
• monthly, when the advance will not exceed one-third of the estimated payments for the quarter.
Advances can also be claimed for rural practice payments, temporary resident fees, rent and rates and practice staff payments. Advance payments improve a practice's cash flow; GPs should ensure they claim these and review them regularly so as to reflect increases in practice income.
Box 36.3: Advances on account
• advances can be made for most health authority payments, including direct reimbursements
• advances improve a practice's cash flow
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| Book Title: Making Sense of The Red Book | ||