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Can I dispense this item on the NHS?

How can you determine what you are definitely allowed to dispense on the NHS?

PSNC advises on how to ensure you are reimbursed correctly for every prescription you dispense

We at the Pharmaceutical Services Negotiating Committee (PSNC) are commonly asked by community pharmacy teams whether certain items can be dispensed on a FP10 prescription. This is a very pertinent question, as dispensing disallowed items results in costs to your pharmacy that cannot be reimbursed. 

As it is good professional practice to ensure prescription items are allowed before dispensing them, it makes sense to start our guide here.

Is this prescription valid?

It’s important to determine whether the prescriber is entitled to prescribe the medicine. Most of the prescriptions handled by pharmacies are issued by GPs, but a growing number originate from other healthcare professionals – dentists and nurses in particular.

Different professionals hold varying prescribing rights, determining what they are permitted to include on an NHS prescription. Pharmacy staff must be able to identify these items and recognise when a prescriber has prescribed outside of their remit, to ensure the pharmacy will be reimbursed for dispensing it.

Doctors have the right to prescribe all licensed and unlicensed medicinal products, appliances and controlled drugs on an FP10 prescription, except those that appear in part XVIIIA of the drug tariff – “the blacklist”.

All other prescribers are restricted to prescribing products listed within their own formularies, found in the drug tariff. These products limit prescribers to providing treatments for conditions within their respective fields. For example:

Dentists – The dental formulary is found in part XVIIA of the tariff. This lists all the items that a dentist is entitled to prescribe on a yellow FP10D prescription form. Additionally, dentists may prescribe by brand names, so long as that medicine does not appear in part XVIIIA of the tariff – but they are encouraged not to do so.

Community nurse practitioners (CNPs) – The nurse prescribers’ formulary is found in part XVIIB(i) of the drug tariff. This lists all the items that a CNP can prescribe on a lilac FP10P form in England, as well as items that a district nurse or health visitor in Wales can prescribe on a WP10CN or WP10PN form. The formulary also outlines any prescribing restrictions linked to particular products. For example, some nurse prescribers are limited to prescribing quantities of less than 100 (see Common prescribing examples below).

Independent prescribers – The prescribing rights for independent prescribers, including community pharmacists, are outlined in part XVIIB(ii). 

Generally, these state that independent prescribers must only prescribe NHS treatments for conditions that lie within their own professional competencies. They can also prescribe some other medicines, and medicines for off-label use, but this will be under their own clinical and legal responsibility.

It’s always worth remembering that neither dentists, nurses nor independent prescribers are permitted to prescribe items found in part XVIIIA of the drug tariff.

Dispensing items

Once you have determined what a prescriber may prescribe, you need to check if the item may be dispensed on the NHS.

The flow chart below explains the process identifying whether or not an item may be prescribed, and so dispensed, on an NHS prescription.

Medicinal products

All medicinal products listed in part VIIIA of the drug tariff can be dispensed against NHS FP10 prescription forms, and contractors will be reimbursed at the price listed for the drug. 

If a product is not listed in part VIIIA, pharmacy staff must check that the drug is not listed in part XVIIIA. This section – “the blacklist” – contains the products which are not allowed to be prescribed by the NHS. If your pharmacy dispenses blacklisted items, it will not be reimbursed for them.

Medicinal products may also fall under two subcategories: the selected list scheme and the borderline substances list.

Selected list scheme

Drugs under the selected list scheme (SLS) are found in Schedule 2 of the NHS Regulations 2004 and are outlined in part XVIIIB of the drug tariff. 

The items in this list should only be prescribed for the treatment of specified ailments affecting specified patient groups, such as Niferex Elixir 30ml paediatric dropper bottles for iron deficiency prophylaxis in prematurely born infants. 

Drugs in this list may not be dispensed unless they are endorsed as an SLS item by the prescriber through writing “SLS” on the prescription. 

Any SLS products dispensed without the appropriate endorsement will not be reimbursed, and pharmacy staff may not make SLS endorsements. 

If one is missing, your staff must return the prescription to the prescriber for amendment.

Borderline substances list

There are some items – such as foods and toiletry preparations – that have the characteristics of drugs under certain circumstances.

These products are categorised as “borderline substances” and are listed in part XV of the drug tariff.

The government’s Advisory Committee on Borderline Substances (ACBS) decides which products have this classification and outlines the circumstances in which they are regarded as drugs. Prescribers should endorse these items with “ACBS”. 

If this endorsement is missing, your pharmacy’s staff can dispense the prescription and it will be reimbursed. However, your clinical commissioning group may ask why this was done at the expense of the NHS.

Appliances

Only appliances listed in part IX of the tariff may be prescribed against FP10 prescriptions. As long as the item is an exact match to the type and pack size in the corresponding drug tariff listing, it can be dispensed. An item identified as an appliance will have a “CE” mark on its packaging, or on the product itself.

PSNC dispensing guidance flowchart

Common prescribing examples

Prescriber form

YES

NO

Which of these can you dispense on the NHS?

FP10D – yellow

Ibuprofen 100mg/5ml Oral Suspension sugar-free 

Ibuprofen 100mg/5ml Oral Suspension

The sugar-free formulation appears in the dental formulary. However, the sugar-containing formulation does not, so dentists may not prescribe this.

FP10D – yellow

Paracetamol 120mg/5ml and 250mg/5ml oral suspension sugar-free

Paracetamol 500mg/5ml oral suspension sugar-free

Dentists can prescribe these suspensions in 120mg/5ml and 250mg/5ml doses. The 500mg/5ml dose is not included in the dental formulary and so it cannot be prescribed by dentists.

FP10P – lilac

Paracetamol 500mg tablets x 150 (nurse independent prescriber)

Paracetamol 500mg tablets x 150 (community nurse)

Community nurses are restricted to prescribing quantities of up to 100. However, nurse independent prescribers can prescribe larger quantities.

Where can I get more information?
3 Comments
Question: 
What are the most common issues you experience when dispensing prescriptions?

Andrew Paxton, Community pharmacist

How do I qualify as an Independent Prescriber without incurring crippling debts?

Ben Merriman, Community pharmacist

Simple tip I've always found.  If it's handwritten and not for something you'd expect to dispense for a home visit patient (antibiotics, analgesics, etc) it's probably not allowed.  GPs usually only handwrite Rx in the surgery if they can't find the item on the computer.  If it's not on the computer, it's probably not allowed...

Leon The Apothecary, Student

A lot of PMRs these days will tell you when an item isn't viable on the script, also EPS is every good at doing this as well. Good knowledge to have though.

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