What comes into force in April 2017? From new business rates to a new two-year national tariff, April 2017 ushers in a raft of new measures, requirements and legislative changes that will affect NHS organisations, staff, patients and service users across England. Here we provide an overview of the main changes and where you can find out more information. This briefing covers: Arm s-length bodies Integration Charges Personal health budgets E-prescribing Quality Finance Reconfiguration General practice Workforce Innovation Other dates for your radar Arm s-length bodies New name for NHS Litigation Authority NHS Litigation Authority is changing its name to NHS Resolution and launching a five-year strategy underpinning the change. Discover more on the NHS Litigation Authority website. The NHS Resolution website will be available from 3 April. Charges NHS Injury Cost Recovery The NHS Injury Costs Recovery (ICR) scheme aims to recover the cost of NHS treatment where personal injury compensation is paid. On 1 April, the charges payable by compensators for the recovery of NHS charges under the scheme will increase. Where an injured person is provided with NHS ambulance services, the charge is increased from 201 to 205 for each occasion. Where the injured person receives NHS treatment, but is not admitted to hospital, the charge is increased from 665 to 678. The daily charge for NHS in-patient treatment is increased from 817 to 833. The maximum charge in respect of an injury is increased from 48,849 to 49,824.
Find out more on the Department of Health website. NHS prescriptions, wigs and fabric supports, and dental care The prescription charge will increase by 20 pence from 8.40 to 8.60 for each medicine or appliance dispensed. The cost of prescription prepayment certificates has been frozen for another year. Patient charges for NHS dental care in 2017/18 will be as follows: a band one course of treatment and urgent treatment will increase by 90p from 19.70 to 20.60 a band two course of treatment will increase by 2.40 from 53.90 to 56.30 a band three course of treatment will increase by 10.60 from 233.70 to 244.30 The maximum band three charge is for the approximately 5 per cent of treatments that include items such as crowns or bridges. Charges for wigs and fabric supports will rise in line with inflation. Find out more on the Department of Health website. NHS treatment given to overseas visitors New regulations will require all hospitals to check whether patients are eligible for free NHS treatment. The measure is part of plans to recover the cost of health treatments provided to patients not ordinarily resident in the UK. Hospitals and NHS bodies will also need to identify and flag a patient s chargeable status so that other parts of the NHS can more easily recoup costs from overseas visitors wherever charges apply. Full details can be found on the Department of Health website. E-prescribing Cancer Drugs Fund From April 2017 (for adults) and September 2017 (for paediatrics), restrictions will be placed on trusts ability to access and be reimbursed for Cancer Drugs Fund drugs if they fail to comply with e-prescribing requirements. Find out more Learn more on the NHS England website. Finance 2
Business rates Hospitals liable for property tax will see an increase in costs as a new set of business rates take effect. The Guardian reported in January 1,249 NHS hospitals will see their bills increasing by 322m over the next five years from April. Find out more on the NHS Property Services website. Control totals Each sustainability and transformation partnership (STP) will have a financial control total that is also the sum of the individual organisational control totals. All organisations will be held accountable for delivering both their individual control total and the overall system control total. This is explained in detail in the NHS operational guidance for 2016/17-2018/19. New two-year national tariff A new two-year tariff sets prices for NHS funded-care until April 2019, with built in inflationary uplifts. NHS prices will be based on a new currency design, known as HRG4+, which includes different levels of complexity. Four new national prices will be introduced for cochlear implants, complex computerised tomography scans, complex therapeutic endoscopic, upper or lower gastrointestinal procedures and photodynamic therapy. Cochlear implants and robotic consumables will be removed from the high cost device list Case-mix assumptions for antenatal in the maternity pathway will be updated to increase the activity allocated to intermediate and intensive levels. The fixed transfer of follow-up costs into prices for first outpatient attendances will be increased up to a maximum 30 per cent. Four new best practice tariffs will be introduced; four will be revised and one will be removed. Full details on the national tariff can be found on the NHS Improvement website. You can also find out more about HRG4+ on our website. General practice General Medical Services contract 2017/18 The contract for 2017/18 will see an investment of some 238.7 million, which includes: A pay uplift of 1 per cent and general expenses uplift of 1.4 per cent. 3
A change in the value of a Quality and Outcomes Framework (QOF) point, as a result of a Contractor Population Index (CPI) adjustment. There will be no changes this year to the number of QOF points, indicators or thresholds. An increase in the payment for Learning Disabilities Health Check Scheme from 116.00 per health check to 140.00 per health check. Changes to the GP Retention Scheme with an additional 1 million investment. NHS Employers website has comprehensive information on the contract. Transmission of clinic letters to GPs NHS England and NHS Improvement have strengthened the requirement for transmitting letters to GPs following clinic attendance. The current timescale for production (within 14 days of attendance) will reduce progressively to ten days (from 1 April 2017) and seven days (from 1 April 2018). This is a new requirement of the NHS Standard Contract. This is explained in detail in the NHS operational guidance for 2016/17-2018/19 and in the overview of changes to the standard contract for 2017/18. Innovation Innovation and tech tariff A new innovation and technology tariff, in effect from April, aims to expedite uptake and spread of innovation across the NHS Find out more in Next steps on the NHS Five Year Forward View. Integration Connectivity funding NHS Digital s Health and Social Care Network (HSCN) aims to provide a reliable, efficient and flexible way for health and care organisations to access and exchange electronic information. From 1 April, central funding currently used to pay for NHS N3 connectivity will be devolved to clinical commissioning groups (CCGs) to pay for legacy N3 connectivity and future HSCN connectivity. All allocations will include funding to cover the costs associated with setting-up new HSCN services. Connectivity funding will be provided for GPs, CCGs and NHS trusts and NHS foundation trusts. Head to the NHS Digital website. 4
Personal health budgets Personal wheelchair budgets Personal wheelchair budgets will be rolled our nationally to cover everyone who accesses the current wheelchair voucher scheme. This includes those with both low level and complex wheelchair requirements. Discover more on the NHS England website. Quality Care Quality Commission fee increase Foundation trusts and NHS trusts are set to see a 48 per cent increase in the fees paid to the Care Quality Commission (CQC) from 1 April 2017. We have expressed concerns about the impact the increase will have on members. View our news article to find out more and head to the CQC s website for full details on fees. Healthcare Safety Investigation Branch The new Healthcare Safety Investigation Branch will be operational, undertaking up to 30 investigations where learning from patient safety can be maximised, and advising the NHS on how to improve its own investigations. Head to page 62 of Next steps on the NHS Five Year Forward View. Learning from deaths All trusts will be required to collect and publish information on deaths, with evidence of learning and improvements being made as a consequence of that information. Trusts will be expected to publish their information on deaths quarterly starting from June. Find out more on the NHS Improvement website and in Next steps on the NHS Five Year Forward View. NHS Mandate 2017/18 The Department of Health s mandate to NHS England, which outlines the objectives for NHS England until 2020, comes into effect. It is underpinned by seven short-term principles. Download our briefing. Transforming maternity services Forty-four local maternity systems will be in place from April 2017, leading and delivering transformation of maternity services by implementing Better births for their sustainability and transformation partnership. 5
Find out more in Next steps on the NHS Five Year Forward View. Reconfiguration New test for hospital bed closures Local NHS organisations will have to show that significant hospital bed closures subject to the current formal public consultation tests can meet one of three new conditions before NHS England will approve them to go ahead: 1. Demonstrate that sufficient alternative provision is being put in place alongside or ahead of bed closures, and that the new workforce will be there to deliver it. 2. Show that specific new treatments or therapies will reduce specific categories of admissions. 3. Where a hospital has been using beds less efficiently than the national average, that it has a credible plan to improve performance without affecting patient care. Head to the NHS England website for all the details. Workforce Apprenticeship levy From 6 April the way the government funds apprenticeships in England will change. Large employers will be required to contribute to a new apprenticeship levy, and funds to pay for apprenticeship training will be accessed through a digital account system. The levy will be payable by employers at 0.5 per cent of their pay bill. All employers will receive an allowance of 15,000 to offset against the levy, which means the levy will only be payable on a pay bill in excess of 3m in each year. Employers with a pay bill of less than 3m won t pay anything but will still be able to draw down funds to deliver apprenticeship training. NHS Employers has a comprehensive web section on the levy, featuring factsheets, guidance and briefings for boards. Changes to Tier 2 immigration route Three key changes to note: 1. Criminal record certificate Tier 2 visa applicants and their adult dependant(s) will be required to provide a criminal record certificate from each country they have lived in consecutively for 12 months or more in the past ten years. Head to the NHS Employers website for full details. 6
2. Immigration skills charge An immigration skills charge will be applied to employers of non-eea migrants under Tier 2 some exemptions apply. NHS Employers website has everything you need to know. 3. Minimum salary threshold The minimum salary threshold for experienced workers applying for a Tier 2 visa will increase to 30,000. New entrants to the job market, and some health and education staff, will be exempted from the salary threshold until 2019. Discover more by visiting the NHS Employers website. Gender pay gap From April 2017, it will become law for organisations with more than 250 employees to report annually on their gender pay gap. The first reports are not due until April 2018, but employers will need to understand the requirements and commence the collection and calculation of data. NHS Employers website has further information on gender pay gap reporting. International GP Recruitment Programme The International GP Recruitment Programme formally begins on 1 April. It follows the commitment in the GP Forward View to deliver a major international recruitment drive to attract at least 500 appropriately trained and qualified GPs from overseas by 2020. More information can be found on the NHS England website, alongside guidance for commissioners. New midwifery supervision model A new model of clinical supervision for all midwives in England comes into effect. Advocating for education and quality improvement (A-EQUIP) is a continuous improvement process, designed to build personal and professional resilience among midwives to enhance the quality of care provided for women and their babies. Head to NHS Employers website for more details. National Living Wage increase From April 2017 the National Living Wage increases from 7.20 to 7.50 for staff aged 25 or over. The income tax personal allowance also increases to 11,500, with the higher-rate threshold rising to 45,000. 7
The Gov.UK website has everything you need to know about the increase. NHS-funded nursing care The NHS-funded nursing care standard rate is being reduced to 155.05 to allow for lower agency costs. This reduction is partially offset by an uplift in the remainder of the rate by 1.7 per cent to reflect overall nursing wage pressures. Full details can be found on the Department of Health website. Pay rise NHS staff will see a 1 per cent consolidated pay increase. NHS Employers website has everything you need to know. Pension scheme administration levy Employers will now need to pay an administration levy to cover the cost of administering the NHS Pension Scheme. The levy will be flat rate 0.08 per cent of pensionable pay for all employers and will be collected in addition to the standard employer contribution rate of 14.3 per cent. This means employers will now pay a total of 14.38 per cent of pensionable pay. Access more details on the NHS Employers website. Pharmacy Integration Fund The fund is supporting pharmacy to transform how it operates across the NHS. From April, it will see: deployment of pharmacy professionals in care homes and funding workforce development for pharmacists who work in care homes including a prescribing qualification funding for pharmacists working in urgent care clinical hubs, such as NHS 111, integrated urgent care clinical hubs or GP out of hours services, and again this will include a prescribing qualification educational grants for community pharmacists to access postgraduate clinical pharmacy education and training courses up to diploma level a programme of pharmacy technician clinical leadership development. Find out about the fund and plans to further clinical education and development on the NHS England website. 8
Salary sacrifice New rules for salary sacrifice arrangements come into force from 6 April 2017. Head to the pay and reward section of NHS Employers website to find out more. Statutory pay Statutory pay for maternity, paternity, adoption and shared parental will rise to 140.98 a week from 2 April 2017. Discover more on the CIPD website. Tax-free childcare Tax-free childcare will become available from 28 April 2017, under a new government scheme. A list of ten things parents should know can be found on the Gov.UK website. Taxation changes for locums From 6 April, HMRC will change the way the current intermediaries legislation (IR35) is applied to off-payroll working in the public sector. The legislative change will affect all practices that contract locum GPs working through their own limited companies. Head to the HMRC website to find out everything you need to know. Sickness leave reimbursement The following changes to sickness leave reimbursement are applicable from 1 April 2017, as set out in in the General Medical Services (GMS) contract in England for 2017/18. Cover may be provided by external locums or existing GPs already working in the practice but who do not work full time. An increase in the maximum amount payable from 1,131.74 to 1,734.18 per week. Payments will no longer be discretionary. The qualifying criteria for reimbursement will commence when the absence is two or more weeks (as opposed to previous arrangements which is linked to patient numbers and the period of absence). Sickness leave payments will not be made on a pro-rata basis and will be the lower of actual or invoiced costs up to the maximum amounts as set out in the Statement of Financial Entitlements (SFE). Download NHS Employers summary of GMS contract negotiations. 9
For your radar Metro Mayors On 4 May 2017, six combined authority regions in England will hold elections for new Metro Mayors: Greater Manchester, Liverpool City Region, Peterborough and Cambridgeshire, Tees Valley, West Midlands, and West of England. While the powers the new directly-elected mayors will hold vary according to the agreed local devolution deal, areas of responsibility may include skills, housing and planning, transport, investment, criminal justice and health and care. Visit the Centre for Cities website. You can also read Metro Mayors are coming does the NHS know? on the Local Government Chronicle website (subscription required). Personal injury claims On 20 March a discount rate for personal injury claims came into effect. It is likely to add huge costs on the NHS. Visit the Gov.UK website. 10