Flu Season 2022 – is your medical practice prepared?

Flu Season is nearly upon us and medical practices will be preparing for their annual flu vaccination campaigns. Income from the flu campaign comes in a variety of different sources and it’s the responsibility of medical practices to be aware of what is available to them.

Our specialists have put together a guide which details everything a medical practice should be aware of before planning their annual flu vaccination campaigns.

Directed enhanced service

The aim of this enhanced service is to protect those who are most at risk of serious illness or death should they develop influenza, by offering protection against the most prevalent strains of the influenza virus.

Practices need to sign up for the enhanced service each year via CQRS (Calculating Quality Reporting Service). For 2022/23, each vaccine administered attracts a fee of £10.06.

The fees are paid to the practice via the monthly contract statement and are usually one to two months in arrears. Your CQRS payment declaration reports will enable you to check when a claim was made and when it was processed. It should then be included on the next payment run.

Eligible for the NHS flu vaccine in 2022/23 are:

• those aged 65 and over
• those aged six months to under 65 in clinical risk groups
• together with a few other specified groups

NHS Business Services Authority (NHSBSA) reimbursement

Practices are then also reimbursed by the NHS Business Services Authority (NHSBSA) reimbursement for the vaccine cost at the basic price (per the drug tariff) together with a VAT allowance, however, a standard amount is deducted for discounts.

A dispensing fee is also paid: the rate of the dispensing fee varies according to volume.

Form FP34D or FP34PD are to be used for high-volume vaccine claims, such as flu. Practices should have a robust system to ensure that a claim is made for each vaccination given.

These are reimbursed 2-3 months in arrears together with other claims for personally administered items. For example, flu vaccinations claimed relating to September will be reimbursed at the end of November or the beginning of December.

Claims for the 2022/23 flu season will be accepted by the NHS Business Services Authority (NHSBSA) reimbursement within three months of administration of the vaccination or by 30th June 2023, whichever date is earlier, in accordance with the usual Drug Tariff claims process. Later claims may not be processed.

Additional funding is also generated via QOF domains and the PCN Investment and Impact fund

Vaccine purchases

Practices are required to order and pay for their own supplies of flu vaccines. Suppliers usually allow the practice an extended time to pay the invoices.

Each year the flu vaccinations are adjusted to take into account which strains are expected to be the most prevalent. The current flu vaccines are quadrivalent.

Flu vaccines need to be correctly stored to prevent them from becoming unusable, as the stock will have to be wasted and will be an additional cost to the practice. Care should also be taken to ensure that vaccines do not go out of date as the practice will not be able to claim anything for this loss.

Suppliers may also agree to give credit for returned vaccines.

It is a good idea to use a separate code on your practice accounting software for purchases of reimbursable drugs, including flu vaccines, to separate them from other medical consumable purchases.

What gross profit (GP) percentage should you expect to make on flu vaccines?

Gross profit is the difference between the reimbursement from NHS Business Services Authority (NHSBSA) and the cost of drugs that you have purchased.

From this, you can then calculate the GP percentage. This is an indicator of whether or not you are getting the correct return on the vaccines that you have purchased.

The GP percentage is the gross profit expressed as a percentage of the drug reimbursement. An example is shown below:

• Flu vaccination reimbursement £20,000
• Cost of drugs purchased £15,000
• Gross profit £5,000
• GP percentage 25%
• GP percentages can range from 25% to 40%.

How do you identify when something may have gone wrong?

Enhanced services claims

Check that the correct amounts have been paid via your NHS contract statement compared to the claims submitted through CQRS.

This should be comparable to the previous year or proportionate to changes in activity.

NHSBSA income

You should see a spike in this income throughout the winter months. Prepare a monthly summary to check that there is a marked increase in the income from say November through to February.

Compare this to the spikes in income from the previous year.

A specialist medical accountant will usually review this as part of their annual accounts work, but this may be too late to make any missed claims.

Purchases

Calculate the GP percentage to see if it is within the normal range. If the GP percentage is low, has there been any wastage to explain this?

Is there anything different with a dispensing practice compared to a prescribing practice?

There are some additional rules that affect dispensing practices due to them being VAT registered.

In terms of recovering the VAT charged by suppliers on flu vaccines and other items that have been personally administered (PA), this input VAT is regarded as exempt for VAT purposes.

Practices should ensure that this is coded to either an exempt VAT code or a PA VAT code on their accounting packages or use an alternative method when preparing their VAT returns to calculate an equivalent PA VAT adjustment.

They will not, therefore, be able to claim back the input VAT from HMRC, unless they are within the de minimis limits, which is unlikely.

Dispensing practices do not receive the VAT allowance from the NHS Business Services Authority (NHSBSA) on drugs that they dispense: they recover the input VAT from HMRC instead via their VAT returns.

Action points

As they are not able to recover the input VAT from HMRC on PA items (e.g. vaccines), they are paid the VAT allowance instead by NHSBSA, thus leaving them in a similar position to prescribing practice.

Follow up on any claims that you have submitted but have not been paid for to prevent the claims from being rejected.

It can be difficult to check what has been reimbursed by NHSBSA, but you should be able to check the pattern and see the spike.

If you are certain that claims have been made, follow up as soon as possible to avoid the claims being rejected if they are outside the usual dates. Late claims may not be accepted.

We have noticed, for the year to 31 March 2022  from our review work whilst preparing accounts, that some practices have not had the spike in their drug reimbursements we would have expected.

As they have received a similar enhanced service income compared to previous years, there may be an issue with the amount of the NHSBSA reimbursement. In some cases, it appears that some practices have made a gross loss and are potentially due several thousands of pounds in reimbursements.

Flu vaccinations given at COVID 19 vaccination sites

If flu vaccinations are being given at COVID vaccination sites, please make sure you are aware of who is able to claim the Enhanced Services fee and drug reimbursements for any vaccines used and purchased at practice level rather than supplied centrally.

Can MHA help my practice prepare for Flu Season?

Get in contact with our specialists to discuss how your practice is performing with its flu campaign and how they can help you identify any potential issues.