Here is a situation that will sound familiar to a lot of pharmacy owners.
A busy month. Dozens of Pharmacy First consultations completed, NMS follow-ups carried out, and hypertension checks done. The team worked hard. The patients were seen. The clinical outcomes were genuinely good.
Then the payment comes in, and something feels off. The numbers don’t quite add up. A claim appears to have gone through, but the corresponding payment isn’t there. A Pharmacy First submission needs re-examining. And there, requiring attention, is a post-payment verification request from the NHSBSA asking for clinical records to support a service delivered in 2023.
This is the quiet pressure that does not get enough airtime in community pharmacy: NHS reporting accuracy.
It is not a glamorous topic. It does not generate the same headlines as Pharmacy First clinical pathways or the supervision legislation changes. But for many pharmacy teams operating on tight margins, getting NHS reporting right and getting it right consistently is the difference between a business that is capturing the full value of the care it delivers and one that is inadvertently leaving money on the table.
Submission Windows: A System That Rewards Preparation
The rules around NHS pharmacy claims have evolved significantly in the past year, and staying across those changes takes real operational discipline.
In June 2025, a policy update tightened the submission window for Pharmacy First claims. Where contractors previously had a three-month grace period to declare their claims, all Pharmacy First consultation claims must now be submitted by the end of the month after they occurred.
The intention behind tighter windows is understandable, it helps the NHS manage financial planning and payment reconciliation more accurately. But the practical reality for busy pharmacy teams is that a tighter window leaves much less room for error.
NPA Chair Nick Picard highlighted in early 2026 that many pharmacies were unaware they had missed payments, with submission confirmations appearing on the portal yet Pharmacy First-specific payments absent, a discrepancy that was often only spotted after the claim window had already closed.
The story of a Swindon contractor who missed out on payment for consultations the NHSBSA confirmed had taken place, due to a submission being processed in a way that did not capture the Pharmacy First element correctly, illustrates just how easy it is for a genuine, completed clinical service to fall through the administrative gap. Not through any bad faith on either side, but simply because the systems and processes were not aligned tightly enough.
As the contractor himself observed, these are often family-run businesses managing a multitude of pressures simultaneously, without the large admin departments that larger organisations might have.
The answer is not frustration, it is preparation. Pharmacies that build their submission workflows around these deadlines, rather than chasing them after the fact, rarely encounter this problem.
The New Medicine Service: More Patients, More Moving Parts
The New Medicine Service underwent meaningful changes from April 2025. The payment structure moved to a split fee, with £14 paid for completion of the initial intervention consultation and a second £14 for completion of the follow-up. On paper, a logical reform that rewards completed episodes of care rather than just initial contact. In practice, it means every NMS episode now has two distinct claim points, both of which need to be accurately tracked and submitted.
From October 2025, depression medications were added as a further therapeutic area eligible for the NMS. That is a significant expansion of the potential patient cohort and a genuine opportunity for pharmacies to support a group of patients who often benefit enormously from structured medication support. It also means more clinical records to maintain, more follow-up windows to manage, and a broader scope for something to slip if processes are not watertight.
The NMS also connects directly to the Pharmacy Quality Scheme gateway requirements. Pharmacies that do not meet their minimum NMS thresholds risk losing PQS eligibility altogether and with it, a separate and meaningful income stream.
The clinical records for NMS episodes must be retained for three years from the closure of each episode and made available if requested as part of post-payment verification. The service specification is explicit on this point: accurate record-keeping is described as “an essential part of service provision,” not an optional extra.
The standard being asked for is straightforward enough when the right infrastructure is in place. The challenge comes when records are held across multiple systems, or when the documentation captured at the point of consultation does not map cleanly onto what an audit trail requires.
Post-Payment Verification: Being Confident, Not Anxious
Post-payment verification has been part of the NHS pharmacy landscape since 2017, when the NHSBSA first reviewed MUR claims. It has since expanded to cover the NMS, the Flu Vaccination Service, and, from mid-2025, Pharmacy First and the Hypertension Case-Finding Service.
It is worth being clear about what PPV actually is. The NHSBSA’s Provider Assurance Team is not looking to create difficulties for well-run pharmacies. The process exists to ensure that payments are accurate in both directions, identifying both overpayments and underpayments, and providing contractors with the opportunity to supply evidence where queries arise. Community Pharmacy England has engaged constructively with the NHSBSA to ensure PPV is appropriately targeted, proportionate, and fair.
The pharmacies that find PPV straightforward to navigate are, almost invariably, the ones that were already maintaining good records as a matter of course. When the NHSBSA requests evidence, they can produce contemporaneous, service-specification-compliant documentation quickly and with confidence because their systems were designed to capture it that way from the outset.
For the pharmacies that find it stressful, the issue is rarely that the service was not delivered. It is that the records are held across different systems, are not in a consistent format, or require significant manual effort to compile into something coherent. That is an infrastructure problem, and it is entirely solvable.
The Underclaiming Problem Worth Taking Seriously
For every query about a potential overpayment, there is a quieter issue that generates far less noise: pharmacies that never claimed everything they were legitimately owed.
Underclaiming does not trigger letters or investigations. It simply means money that was earned never arrives. A Pharmacy First consultation was logged in the clinical system but not submitted through MYS before the monthly deadline. An NMS follow-up was completed, but not linked back to the original intervention record. A hypertension ABPM provision was delivered but not claimed within the correct band. None of these shortfalls announce themselves. They are only visible when someone looks for them, and in a busy pharmacy, that often means nobody looks.
Before the April 2025 NMS fee split, data from the NHSBSA API showed that in approximately half of NMS provisions, the follow-up consultation was either not completed or not claimed. That is a significant volume of clinical work going unrecognised.
The fee split was partly a response to that data and an attempt to better align payment with actual delivery. But it also means that for every follow-up now being completed, there is an additional claiming step that needs to happen correctly.
In an environment where nearly 100% of pharmacies receive less in NHS funding than their actual cost of operation, the gap between services delivered and income received is not academic. Every legitimate, unclaimed pound is a direct cost to the business.
What Good NHS Reporting Infrastructure Actually Looks Like
Both the Government and the NHSBSA have taken steps to make the reporting environment more manageable.
The 2025/26 CPCF settlement included a commitment from DHSC and NHS England to streamline the MYS claims process through the use of payment and data APIs across all national clinical services. The NHSBSA followed through with meaningful portal updates in August 2025, redesigning the MYS interface with clearer navigation, status messaging, and help text to reduce errors at the point of submission.
These improvements matter. But the most important changes happen upstream of the portal in the workflow and documentation practices that sit between a consultation taking place and a claim being submitted.
The question worth asking honestly is whether, at the point a consultation happens, the clinical record is being captured in a format that maps cleanly onto what accurate claiming and PPV compliance require, and whether there is a system in place that proactively flags deadlines, tracks submission status, and makes the gap between services delivered and services claimed visible before it becomes a problem.
That is where pharmacy management technology either earns its place or exposes its limitations. A platform that requires manual cross-referencing between a clinical record, a PMR system, and a separate portal creates the conditions in which things slip. Not because of carelessness, but because there are simply too many handoffs, too many opportunities for a step to be missed.
Encon Pharma was built to remove those handoffs.
Because the platform starts from the services layer rather than the dispensing layer, every Pharmacy First pathway, every NMS episode, every hypertension check is structured from the outset around the documentation that accurate claiming and compliance require. Follow-up consultations are tracked against their original interventions. Submission deadlines are visible before they pass. Claims data is held in a form that serves both MYS submission and post-payment verification evidence simultaneously.
For multi-site operators, the value is even more tangible. A consistent reporting infrastructure across all branches means that whoever delivers a service, and whichever site they work from, the records are complete, consistently formatted, and ready to be produced if needed, without a frantic search through paper logs or a patchwork of systems that were never designed to talk to each other.
Accurate Reporting as a Long-Term Strategic Asset
NHS reporting accuracy tends to be framed as a compliance task, something to stay on top of to avoid problems. That framing is understandable but incomplete.
Community pharmacy is moving into a period of significant clinical expansion. Prescribing services are due to be negotiated from April 2026. Pharmacy First is growing and embedding. The NHS’s 10 Year Health Plan explicitly positions community pharmacy as central to shifting care out of hospitals and into the community, and that shift will be commissioned based on delivery data.
Commissioners and ICBs making decisions about which services to expand, which pharmacies to bring into new clinical frameworks, and where to direct investment will be working with evidence of what has been delivered. A pharmacy with a clean, well-documented record of consistent service delivery is a pharmacy that is well-placed to be part of what the NHS is building next.
Accurate reporting is not just about the payment for last month’s consultations. It is about demonstrating the credibility and capability that open doors to future services.
That is, ultimately, what a good NHS reporting infrastructure is for. Not defensive compliance but a clear, confident record of excellent care, properly evidenced, that speaks for itself.
Five Questions Worth Asking About Your Reporting Right Now
- Are Pharmacy First claims being submitted within the monthly window reliably, without manual chasing?
- Is every NMS episode, both intervention and follow-up, being tracked separately and claimed at the right time?
- If a PPV request arrived tomorrow, could clinical records for the past three years be produced quickly and in a consistent format?
- Is there visibility across all sites of the gap between services delivered and services claimed each month?
- Does your current system surface upcoming submission deadlines before they become a problem or only after?
If any of those questions give pause, the issue is almost certainly not effort or intent. It is the infrastructure that those efforts run on.
What Encon Pharma Offers
The Encon Pharma platform treats NHS reporting accuracy not as a bolt-on compliance feature, but as a core part of how the software is designed. Clinical workflows are structured around service specifications. Submission timelines are tracked automatically. Documentation is captured in a way that serves both clinical quality and NHSBSA evidence requirements from the same record.
The result is a pharmacy team that is not carrying the reporting burden in their heads, or across a combination of systems that were not built to work together, but operating on infrastructure that was designed, from the start, for the way community pharmacy works today.
Doing the work well matters enormously. So does making sure that work is properly recorded, accurately claimed, and clearly evidenced. Encon Pharma exists to make both of those things easier.
Interested in how Encon Pharma supports accurate NHS claims and audit-ready reporting for community pharmacies? Get in touch with the team to find out more.