Sally Harrington, Transformation Lead in the North East Essex (NEE) Primary Care Team at Suffolk and North East Essex ICB shared her experience of using Calculating Quality Reporting Service (CQRS) Local to manage GP practice claims.
The NEE Team in the ICB has been using CQRS Local for the past twelve months. Sally manages how the NEE team strategically use CQRS Local and administer its contracts to providers. However, during a period of recruitment earlier in the year Sally has been supporting with Tier 1 approvals and managing claims submitted from their 32 GP practices in the North East Essex region.
Sally has found her experience of the CQRS Local system to be very user-friendly, intuitive, and easy to navigate around. “This is really useful if a member of the team is on leave, off sick or leaves the organisation as anyone can step-in and use the system. The user guidance is very clear and if any technical help is required. The CQRS Local team are always on hand.” said Sally.
David O’Brien, CQRS Local Training and Implementation Lead, works for Midlands and Lancashire Commissioning Support Unit (MLCSU) and has been involved in the programme since the launch of CQRS Local in 2021. He works closely with commissioners to support their transition to the claims processing system and set up their localised schemes. David not only supports the commissioner, but also provides training to GP practice team members on how to use CQRS Local to submit claims.
Sally added: “David really knows the subject matter inside out and despite running various training sessions for users, responds very quickly to any requests for support.”
Key benefits of CQRS Local
Sally shared some of the key benefits her team have experienced from using CQRS Local:
“It’s a robust online platform and is intuitive to use for both providers and commissioners. We no longer process thousands of emails or manage claims in a spreadsheet. You know exactly where claims are, as the system manages the process for you. It also reduces the risks of any user errors and claims aren’t ‘lost’ or saved in the wrong folder because it’s fully automated.”
Built in reporting tools
CQRS Local has the functionality to allow commissioners to effectively manage their local commissioning schemes by creating defined parameters. For example setting a claims window which reduces potential duplicate claims.
“If we want to know how much we spent on fitting ring pessaries in primary care last quarter for example, I can easily set the parameters for a report, and it processes the data for me in seconds. It’s fantastic!”, said Sally.
For an example of how the reporting feature helps save significant administrative time, Sally told us about when the ICB needed to audit a defined category of minor surgery items that had been claimed for, by a single provider practice, over a specific period of time. By setting the parameters, the report was generated very quickly allowing for easier auditing by her team.
She added: “I feel like I have control of claims and it really helps us with our budget management.”
Suffolk and North East Essex ICB now uses CQRS Local to reimburse GP practice providers for safeguarding work they undertake on behalf of the local authority, under a collaborative arrangement. These are quite complex claims as there are multiple components within one service. Including child reports, conference attendances and adult reports for specific aspects only.
CQRS Local functionality has supported the ICB to create a dedicated component and claims window to capture a particular set of approved retrospective claims. To help keep these separate from the other claims, to support accurate monitoring and reporting of spend to budget holders.
“This is where CQRS Local really comes into its own, when you have complicated criteria that providers need to work within. It would be very difficult to manage these claims without a system like this.” explained Sally.
Service specification governance/compliance
CQRS Local can also help with governance by supporting practices to comply with the inclusions and exclusions criteria within the service specifications. When submitting a claim, the North East Essex Team has set the claims process up to require a declaration from the provider. Which confirms they have read the declaration guidance and they are meeting the terms and conditions of the specification. This is particularly useful as it provides an audit trail should the ICB need to challenge a claim.
The CQRS Local system also allows commissioners to add supporting documents. Making them readily available for quick reference in a central location, which helps GP practices when submitting their claims. This reduces administrative time responding to requests for documents and supports more accurate claims being submitted for processing.
If an inaccurate or incorrect claim is submitted, a decline button enables the commissioner to provide feedback on why the claim is being declined. Which helps the provider submit more accurate claims in future and reduces admin management for the commissioner.