The Department of Health and Social Care (DHSC) is responsible for reviewing the NHS Funded Nursing Care (FNC) rate annually. The definition of FNC, its intended purpose and what FNC is designed to cover, have been a source of concern for care providers and ICBs in England. This briefing note reflects upon the above questions, informed by discussions with the DHSC.
The following briefing can also be viewed, and downloaded as a PDF, by clicking here
Funded Nursing Care
The following outlines the legal definition of what falls within the scope of FNC.
Regulation 28 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 (the Standing Rules) does not specifically use the term “FNC” or “funded nursing care”. The legislation refers to the flat rate payment in respect of “nursing care.”
Regulation 20 of the Standing Rules states that “nursing care” means nursing care by a registered nurse; and “nursing care by a registered nurse” has the same meaning as in Section 22(8) of the Care Act 2014.
Section 22(8) of the Care Act 2014 states that:
“A reference to the provision of nursing care by a registered nurse is a reference to the provision by a registered nurse of a service involving—
(a) the provision of care, or
(b) the planning, supervision or delegation of the provision of care, other than a service which, having regard to its nature and the circumstances in which it is provided, does not need to be provided by a registered nurse.”
Section 22(8) refers to a service, rather than equipment or other material (such as incontinence aids). Section 22(8) of the Care Act, clarifies that the rate of FNC paid to care providers is for the services provided by a registered nurse, for the provision of care only or the planning, supervision, or delegation of the provision of care, and not the consumables used in the provision of care.
The DHSC worked with NHS England to explore how care providers may source consumables and incontinence products. The FNC practice guidance, specifically paragraphs 85 and 86, refers to continence services:
“85. Residents of care homes, including those providing nursing care, should have access to professional advice about the promotion of continence. See Excellence in Continence Care: practical guidance for commissioners, and leaders in health and social care
“86. As well as prevention and advice services, the continence service should also include the provision of continence products, subject to a full assessment of an individual’s needs. Continence products or payments should be made available by the ICB to care home residents, including those who are also receiving NHS-funded nursing care, if required.”
For the avoidance of doubt, Section 22(8) of the Care Act confirms that the FNC rate covers the cost of nursing only, and the FNC practise guidance, paragraph 86, is clear that continence products or payments should be made available by the ICS to care home residents including those receiving FNC.
Care providers should also be aware of the Guidance provision of incontinence products V19.march 2021 report which explains that the funding and mechanisms to provide continence products vary across the country.
ICBs may commission Continence Services which, once an individual is assessed, may enable them to receive free continence products to meet their needs. If this is not the case locally, then the NHS Supply Chain could be used: NHS Supply Chain. The NHS also produces the following guidance to support individuals and local systems:
The DHSC also worked with NHS England to advise how care homes can access other materials and equipment used for nursing care, such as syringes and wound dressings. NHS England has confirmed that care homes should be able to access equipment and materials through other NHS funds and commissioned services e.g., district nursing would provide these for residential care, but how these are commissioned and from which service is not standardised across the country.
Certain dressings and consumables are available under the national drug tariff (Section IX) for an individual using a prescription which, dependent on their circumstances may be free of charge (Drug Tariff | NHSBSA); consumables cannot be prescribed on their own and cannot be written by the prescriber on the FP10 as a separate item (Information on the container allowance and consumables); and the only syringes which are allowed on an FP10 will be listed in the appliance Section of the Drug Tariff, under:
- Hypodermic Equipment: including single-use insulin syringes with needles.
- Syringes: including bladder/irrigation, ear, enema, and vaginal pipes
- Small, 1ml or 5ml plastic syringes are not allowed and can be covered by the payment for consumables. (Are syringes allowed on a prescription?)
The NHS Supply Chain enables providers to receive competitive rates if consumables need to be purchased.
We hope this information is helpful and confirms the position regarding FNC, continence aids and medical consumables.