From Spreadsheets to Streamlined Claims

In 2022, NHS Bedfordshire, Luton and Milton Keynes Integrated Care Board (BLMK ICB) set out to modernise how GP practices’ claims for local enhanced services were managed. What began as a small pilot has transformed the way the ICB manages claims across the region.

Caroline James and Clare Crosby, Primary Care Contracting Support Managers at BLMK ICB, share their CQRS Local journey.

The Challenge

Before the pilot, BLMK’s Primary Care Commissioning team used Excel spreadsheets, emails and paper invoice templates to process claims. Information had to be manually extracted from SBS (Oracle), and each locality used slightly different approaches for claims and payments.

The CQRS Local Pilot

During quarter one of 2022, BLMK ICB launched a CQRS Local Pilot with four GP practices, one from each locality: Bedford, Central Bedfordshire, Luton, and Milton Keynes. Two NHS primary care services were included in the trial: Safeguarding and SMI Annual Health Checks.

David O’Brien, Implementation and Training Lead at the CSU Collaborative, delivered short, focused training for all users, manageable sessions and supported BLMK ICB through set up.

With different claims approaches used in the four localities, configuration of each service was adapted to accommodate both monthly or quarterly payment requirements. Tier 1 or Tier 2 roles were identified which reduced the burden on only one or two people resulting in more resilience.

The result? The four GP practices involved loved the system.

Full Roll Out of CQRS Local

Following the successful pilot, CQRS Local was rolled out to all 94 GP practices with 21 Local Enhanced Services.

As both Commissioners and GP practices were learning a new way of working, the ICB spent time supporting users, building confidence and ensuring everyone understood the new functionality. ‘It was a team effort’, say Caroline and Clare.

David O’Brien played a pivotal role, running extra sessions to demonstrate complex processes such as uploading safeguarding claims with 24 components, and generating quarterly S17 and S49 reports.

Benefits for GP Practices and Commissioners

As a result, claims for services delivered by primary care have been streamlined across the BLMK region.

GP Practices enjoy having information in one place, from service specifications to claim submissions and uploading supporting data. Automatic reminders prompt timely claims while practice managers can easily track what has or hasn’t been claimed, making income management simpler.

BLMK ICB’s finance team was initially cautious about adopting a new system, but detailed technical discussions with the CQRS team and other users eased their concerns. Today, producing annual or quarterly reports and tracking unreconciled or unapproved claims is far more straightforward. The introduction of PCSE payment integration has added further efficiency.

For Commissioners, CQRS Local provides clear visibility of issues, making them easy to identify, investigate and resolve. Now, any query on part of a claim will no longer delay payment for the rest of the claim.

Caroline and Clare credit David as being a key part of the smooth implementation of CQRS Local. He offered clear explanations, provided guidance documents, and was willing to meet with practices at times that suited them.

Any ICB Commissioning team interested in running a CQRS Local Pilot, can contact the CQRS Local team to start their claims management digital transformation journey.