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Managing off-contract claims

Published
Topics: GovernanceProcurementSupplyTrusts

Best practice guidance for NHS hospital pharmacy procurement teams on managing a successful off-contract claims process.

Purchasing medicines via NHS frameworks

Hospital pharmacy procurement teams purchase most medicines in line with Medicines Procurement and Supply Chain (MPSC) framework agreements. Each of these frameworks are governed by standard NHS terms and conditions that define the legal framework for future purchases of goods and services. Suppliers agree to adhere to these terms and conditions as part of the tender process.

Within the terms and conditions for generic frameworks when a NHS Trust places an order for a contracted product, and the supplier agrees to supply. The supplier must deliver this order in full within 14 days.

If the supplier is unable to fulfil the order, the NHS Trust can procure an alternative equivalent licensed product in the same quantity as the original order. The Trust can then make an off-contract claim for the difference in cost between the contract price and the alternative purchased.

Submitting off-contract claims

There are a number of requirements the NHS Trust must comply with to successfully make an off-contract claim.  

Use this best practice guidance as a stepwise process to cover the requirements of making an off-contract claim. It aims to support a successful and sustainable off-contract claim process in NHS Trusts.

The guidance also demonstrates how to use Exend+ to record the progress of off-contract claims. Using Exend+ for this process improves national visibility on the number of claims being made and how many of these are successfully being paid.

  1. Send pharmacy orders via eCommerce platform where possible and ensure order replies are reviewed. Review electronic order replies if available to identify which product lines are unavailable. 

    Ensure back orders are activated with wholesalers and distributors. 

    Review distribution routes available for MPSC contracted line – this may not be a wholesaler; it could be another distributor or direct from supplier. 

    If the MPSC contracted line is available from another supply route, reorder the product and cancel the back order.

  2. Follow our guide Restricted to NHS: Navigating a potential supply issue (SPS page) before escalating a supply issue or shortage to the SPS Regional Procurement Team.

    It is essential to refer to MPSC Supply Issues information, as the supplier may have sourced an alternative supply or MPSC may direct the contracted region to a suitable alternative.

    Review the Medicines Supply Tool (SPS page), you need to be logged in to access this tool.

    Contact MPSC contracted supplier for further information, confirmation of the supply issue and duration of out-of-stock period.

    Inform your Regional Pharmacy Procurement team of the supply issue if this is not already recorded on MPSC Supply Issues or the SPS Medicines Supply Tool.

  3. The product line must remain on a back order.

    The quantity should be in line with normal ordering patterns for the Trust.

    Review all Trust stock locations and place back orders where appropriate.

  4. Dependent on current stock holdings it may be necessary to order alternative non-contract stock to cover the period prior to making an off-contract claim.

    A claim cannot be made for stock ordered in this period, so only order what is needed to maintain enough stock during this time.

  5. As part of the MPSC Framework NHS Terms and Condition’s, suppliers are given a reasonable time to supply the products on an order.

    If after 14 days the product has not been received by the Trust, an off-contract claim can be initiated.

    To ensure you do not run out of stock whilst waiting for an order to be delivered. Trusts must regularly monitor outstanding orders to identify when orders have been outstanding for 14 days or more.

    Keep checking the wholesaler websites or logistic providers for stock as part of the Trust’s normal ordering process.

    Keep in regular contact with the contracted supplier for supply updates.

  6. On day 14 (or later), check wholesalers and any other suppliers for an alternative equivalent licensed product.

    Identify the most cost-effective alternative to purchase. Record product details including the price.

    Contact the contracted supplier by email or telephone to request a Claims Reference Number (CRN). Contact details can be found on Exend+ in the contract details for that product Search Web Catalogue – Exend.

    Inform the contracted supplier of original order date, quantity and purchase point. Provide the details of the alternative product you intend to purchase.

    Confirm how they will make payment for the off-contract claim. This could be credit note, BACS transfer, or they may require an invoice for the value of the claim.

    Request further information on stock availability.

    Allow 24 hours for the contracted supplier to respond to the request and supply a CRN. If a response is not received in this time, notify the supplier of your intent to proceed with the claim and continue to progress the off-contract claim without a CRN.

  7. To add a new claim to your Exend+ log:

    • go to Off-Contract Claims – Exend
    • click “Log New Claim in Advance of Delivery”
    • enter the details of the original order and product, the Trust contact details and the provided CRN
    • click “Save Off-contract Claim”, this will log the claim in drafts

    If your Trust does not have access to Exend+, record CRN on Trust off-contract claim log or spreadsheet.  

    How to log a claim in Exend+

    In this short video, Natalie Bryson demonstrates how to log an off-contract claim on the Exend+ system.

  8. Place an order for alternative stock as a single line order as this makes it easier to submit the invoice later.

    Once the alternative stock has been delivered, enter the details of the alternative purchased into the draft claim on Exend+.

    Complete any other required fields on the form and then a claims letter can be generated to submit to the supplier. This can be downloaded as a PDF to attach directly to an email, you do not need to print.

    Submitting a claim in Exend+

    In this short video, Natalie Bryson demonstrates how to submit an off-contract claim using the Exend+ system.

  9. Gather the required documents to submit the claim:

    • copy of the original order or proof of back order
    • invoice for the alternative stock
    • completed Exend+ form (or BGMA form if your hospital does not have access to Exend+)

    Claims must be submitted within 90 days of obtaining the CRN. Ideally submit them as they are completed. You may wish to collate those with a lower value for one supplier so a single invoice can be raised to cover a number of claims.

  10. Once you have received the alternative stock, cancel the original back order to ensure your pharmacy system does not become filled up with old orders.

    If the supply issue is likely to continue, consider placing a new order for the contracted product so that another claim can be made when this order reaches 14 days outstanding.

    Continue to order in line with normal ordering patterns and quantities. If you normally order weekly, continue to place a back order weekly so a claim can be made for each order once it has been outstanding for 14 days.

  11. Contracted suppliers may prefer to pay off-contract claims via credit note, BACS transfer or they may require a Trust invoice for the value of the claim.

    Raising an invoice to the supplier for the value of the off-contract claim has several advantages:

    • allows the payment to be received to the correct budget in the Trust
    • provides an audit trail to be able to trace and follow up on outstanding payments
    • easier for the supplier to track through their processes so makes them more likely to pay in a timely manner
    • many suppliers now require an invoice because of auditing processes, which allows a consistent approach across all claims

    Work with your Trust finance team to develop a process for invoice creation and payment tracking. This could be pharmacy training and access to finance systems or nominated finance links who understand the off-contract claim process.

    Ensure that the Trust invoice is sent to the supplier with the required off-contract claim documentation.

    Raising a trust invoice is an additional administrative resource, we suggest a minimum value of £50 is raised on an invoice to reduce costs to the trust. Claims to the same supplier can be collated to achieve this.

  12. Once a payment is received, update the Exend+ log with date paid.

    If payment is not received within 30 days this should be followed up with the supplier.

    If a supplier refuses to accept an off-contract claim even though the correct process has been followed, escalate to MPSC. They can follow up with the contracted supplier.

    If the supplier refuses to pay, this should be updated on the Exend+ log with a date that the claim failed, and any additional information added to “Claim Processing Comments”.

    The off-contract claim can also be linked to your better value procurement contract variance data. This gives a clear picture of how much variance has been claimed for. Details of how to do this are in the below video.

    Completing a claim in Exend+

    In this short video, Natalie Bryson demonstrates how to complete the off-contract claims process in your Exend+ system