By 2018, all NHS pharmacies will have access to an electronic database to check a patient’s prescription charge exemption status, the Department of Health (DH) announced last month. The plans may strike fear into the hearts of pharmacists in England, who already have a high administrative burden. This sense of injustice may only be compounded by the fact that Wales, Scotland and Northern Ireland have all abandoned prescription charges.

Of course, NHS pharmacists are already required to ask patients for proof of their entitlement to exemptions in most cases. But this rarely causes significant difficulties because they can (and indeed must) dispense the prescription even if no proof can be provided. The new proposal is that there will be an electronic database available to pharmacists so that they can check “at the click of a button” whether the patient is entitled to an exemption – and if they are not, presumably refuse to provide the medicines without payment.

There is no specific information available from the DH about how this database would operate. There must be significant hurdles to cross before such a database can be constructed, given the wide variety of exemptions, and therefore the number of sources of information about exemptions that would need to be collated.

There will also presumably be the possibility (certainty?) of error due to missing information. For example, how long will it take for information about a 16 to18-year-old in full-time education to filter through from their school, college or local education authority? Will the prescription pricing division of the NHS BSA, the Department of Work and Pensions (DWP), and all the other sources of information relevant to exemptions really be able to transfer this information to another database? It has been reported that pharmacists would be able to access the DWP’s IT systems – but would those systems include all the relevant information?

If and when such a database is set up, it will raise issues such as:

• Information governance – the information on such a database will be personal, and therefore access to the database will have to be carefully controlled. Any disclosure in breach of the Data Protection Act 1998 will leave a pharmacist liable to prosecution and possible regulatory proceedings by the General Pharmaceutical Council (GPhC)
• Confidentiality – pharmacists will need to take care not to breach patient confidentiality by discussing the reason for their exemption within earshot of other customers (this is already the case, but a patient currently has more control over such disclosure). Again, any breach of confidentiality leaves a pharmacist at risk of regulatory proceedings by the GPhC
• Consent – will patients have to consent to their data being included in such a database or will they be able to opt out? What will the effect of this be?
• Refusal to dispense – if a patient states that they are exempt but the database does not confirm this, will the pharmacist be prevented from dispensing the prescription unless payment is made? If so, will there be exceptions if the medication is urgently required and how will this be assessed/monitored? Again, getting this wrong will leave the pharmacist at risk of regulatory, civil or contractual proceedings. This also poses a real ethical dilemma
• At present, the patient is responsible if they wrongly declare they are entitled to an exemption – will this change? Will the pharmacist be liable to prosecution if they dispense a free prescription when the patient is not exempt?
• Will pharmacists be in breach of any of the pharmaceutical regulations, or their terms of service, if mistakes are made in the implementation of the proposed new system?
• Practical issues – will pharmacists need another computer terminal? Another smartcard? More pins/passwords? Will the system be linked to EPS or separate? How will it tie in with EPS release 2 (if at all)? Will pharmacies have sufficient technical resources?
• How will this affect the relationship between the pharmacist and the patient? Will trust be eroded? Will patient care be affected?
• Time and administrative burden – these checks will take time (especially if the technology is not up to scratch), which would be much better spent in frontline patient care and advice.

All of the above raise potential criminal, civil, contractual and regulatory issues for pharmacists, as well as financial and practical considerations. Of course, we all want less fraud in the health service, and saving the NHS money is a laudable aim. But many believe that the prescription charge system in England is deeply flawed and that it is unacceptable to expect pharmacists to police it.

Let’s hope that this plan doesn’t cause more problems than it solves. By way of consolation, bearing in mind previous attempts at NHS IT projects, it may be some time before this plan comes to fruition.

Tania Francis is a partner at health and social care law firm Hempsons

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