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8,500 exemptions digitally checked in prescription fraud crackdown

Pharmacies still had to perform standard exemption checks in more than half of piloted cases
Pharmacies still had to perform standard exemption checks in more than half of piloted cases

Almost 8,500 exemptions were digitally checked in four pharmacies over a two-month period, as part of an NHS pilot to crack down on prescription fraud.

The real-time exemption checking (RTEC) system – which is currently being used in four pharmacies in Manchester, Oldham, Leeds and Cleethorpes – allows pharmacists to digitally check whether a patient is exempt from prescription charges, before medication is dispensed.

The four pharmacies piloted the system over a two-month period between February 26 and April 30, digitally checking for five exemption categories: maternity, medical, pre-payment certificate, HC2 (NHS low income scheme) and NHS tax credit.

After an automatic check against NHS Business Services Authority (NHS BSA) data during the prescription process (see more below), the RTEC system returns either an “exempt” or “unknown” status – never “not exempt”, the NHS BSA explained.

For those “unknown” exemptions, pharmacies have to use standard checking processes and tick the “exemption not seen” box. For those that are digitally exempt, the patient no longer needs to sign the prescription.

Of the 8,495 exemptions checked during the pilot, 3,762 were found to be exempt, while 4,733 returned “unknown” statuses.

“As more exemption types are added, fewer ‘unknown’ statuses will be returned,” NHS BSA told C+D.

RPS: What happens if “computer says no”?

An investigation by the National Audit Office found that 5.6 million penalty charge notices have been issued to patients over the past five years for wrongly claiming free prescriptions and dental work.

However, the Royal Pharmaceutical Society (RPS) stressed that it is not a pharmacist's job to become the “prescription police”.

While the RTEC system will “help speed things up” and “align with existing NHS systems”, RPS English board chair Sandra Gidley said, “you could get into situations where ‘computer says no’ but the patient is convinced they don’t have to pay”.

“Pharmacists want to use their clinical expertise to advise patients about their health, not police access to medicines through prescription fines.”

Pilot feedback “positive”

The NHS BSA said feedback from the pilot sites has been “very positive”, with pharmacies reporting that “RTEC fits well with their existing business processes and has saved them time, as well as reducing the need for paper”.

The NHS BSA and NHS Digital are reviewing the findings of the first pilot and will work with pharmacy IT suppliers to determine the next stages of the rollout beyond the original four pharmacies, it said.

How does the RTEC system work in practice?

The system uses data on people’s prescription charge exemption status, held by the NHS BSA.

The check of the NHS BSA data will usually occur automatically at the time the prescription is being processed in the patient medication record (PMR) system. However, PMR suppliers have some flexibility about the point that the data will be requested from the NHS BSA.

Pharmacy staff will not normally need to check the patient’s exemption status more than once, but a second check will be possible, if the patient queries the initial status returned by the NHS BSA system.

If the patient believes they are exempt from prescription charges, but the RTEC system returns no exemption information, the patient will complete a declaration in the normal way.

If a prescription is confirmed by the RTEC system as exempt, it will be treated as such by the NHS BSA and no further prescription exemption checks will be applied. In this instance, the patient will not need to complete a declaration.

Source: Pharmaceutical Services Negotiating Committee, October 2018

Should digital exemption checking be rolled out nationally?

Benie Locum, Locum pharmacist

This is great. the hub dispensing should free up the pharmacist to get get your head punched in by irate customers as you pry into their exemption status. Very innovative. Bravo.

N O, Pharmaceutical Adviser

"" If they fail in this "policing", they are liable to the fine themselves for not getting a signature."""

You must be kidding. 

Not getting a signature -- is not a FINE, but called a switch, where if a Rx is ticked as exempt but not signed then it is switched from exempt to paid and we lose 1 Rx charge say £9.00 and it is not called fraud but an oversight.

Next, we are not policing at the moment. We only ask them to tick a relevant box of exemption and sign. If they show proof well and good, if not we simply put a tick in the evidence not seen box. There is no further conversation. So no policing.

With this new system, we would be getting in to some kind of a conversation to match the computer generated message and what the patient is claiming. So it is Policing ( trying to find out who is lying) And is an extra burden.

Garthe Knight, Production & Technical

I'm afraid you still seem to be completely misunderstanding the new system.

RTEC returns a status of exempt or not on the system.

For those returned as exempt, happy days, no asking the patient to state an exemption, therefore an easier process than before.

For those returned as not on the RTEC system (as some exemptions are not on as yet for instance), it's exactly the same process as before - ask them to tick the appropriate box and sign the declaration, with this exemption, or non-exemption, being entered on the system as before for the purposes of claiming.

There is no additional conversation or confrontation - just exactly the same process as before; believe what the patient is saying, record that exemption and make the claim at the appropriate time.  

The benefit of the system are to do with the targeting of the subsequently returned data for fraud prevention purposes - nothing to do with any additional conversations or responsibilities for the pharmacist, because there are no additional conversations or responsibilities.

Hope this helps in alleviating your concerns and blows away some of the misconceptions which are clearly present here. 

Ram parimi, Community pharmacist

I dont agree with this system. Pharmacist is there to advise people on health concerns and make sure that patients are getting the most benefit of their medications. We are not there to police exemptions on prescriptions. Leave some responsibility to the patients.. They should know that an valid exemption should be ticked or pay for the rx... No wonder NHS is going down very quickly.. Use the right skills at right places. Dont waste pharmacists time by making them policing exemptions!!! Whoever is trying to implement is not very good utlising skills appropriatley to save the NHS.. 

N O, Pharmaceutical Adviser

If there is no change in what we do then why spend so much on technology, just to give the fraud detectors one more instrument to bombard with??? Can't we just stay the way we are and let the fraud detectives do what they are doing on their own, don't involve us???

For a person like you, who is more in to developing technology, this may look cool. But for those who have to implement it, its not straight forward. And when we are not paid any extra money, no one cares, hence the system will collapse.

I can't believe this will be implemented through pharmacies without any clause that the pharmacies are responsible, because if we are not then we won't.

Chris Locum, Locum pharmacist

The 'clinical' future? It is nothing but a joke for the future of community pharmacy.

C A, Community pharmacist

It's interesting to see that the feedback is "very positive" when the failure rate (unknown exemption status returned) of the system is 55.7%

Daniel Pharmacist, Community pharmacist

For the pilot project, which we are still running in Leeds, only 5 of the exemptions could be checked with real time data which is why there are so many unknown exemption status results. The idea is that the other exemptions will be added once the data can be supplied to allow checks.

Lucky Ex-Boots Slave, Primary care pharmacist

More workload without being paid! First FMD now this. Though RPS has spoken up to say it's not pharamcists' responsibilities to police exemption status, we all know of its incompetence and I doubt this is going to make any tiny bit of difference to stop the pilot from rolling out nationally eventually. It is pretty much guranteed this extra workload will be placed yet again on community pharmacies with no financial reimbursement!  Not to mention the dispute and complaints arising from e.g. patients not bringing along their exemption evidences, or patients think they are exempted and not willing to pay even if they are legitimately not exempted etc. etc. you name it! Good luck fellow pharmacists in the community sector. 

N O, Pharmaceutical Adviser

Well said. After reading the article there is no mention of how the system will check exemption for FP10 green Rxs?? The above pilot is mainly based on dispensing EPS not green FP10, I suppose, because unless you feed full data (which happens in EPS) there is no way to find out the exemptions of the FP10 gree/ Dentist/ Hospital/ any handwritten Rxs.

As you rightly said, more work no pay and more headaches.

I have a solution. Just follow what you are doing at the moment and tick evidence not seen blindly on all Rxs (including age exempt :)) and let the highly paid (waste) frud detectives do the rest. Simples ??

Daniel Pharmacist, Community pharmacist

The exemption checks only apply to EPS Rxs, not paper FP10s. These are outside the scope of the project. When you are processing the Rx, you just receive a notification that the patient has been checked via RTEC. You don't find out the exemption but you don't need to capture a patient signature. There is less paperwork, and the EPS claims are quicker and easier. Positive Solutions have also implemented an EXEMPT flag on the bag label, where appropriate, so we can tell if a Rx exemption has been successfully checked through RTEC.

It hasn't given us any headaches and isn't any trouble to run at all.

N O, Pharmaceutical Adviser

Did you read my post in its entirity and did you understand what I was saying?? 

From my last post ""The above pilot is mainly based on dispensing EPS not green FP10, I suppose, because unless you feed full data (which happens in EPS) there is no way to find out the exemptions of the FP10 gree/ Dentist/ Hospital/ any handwritten Rxs.""

I will clarify. This system works only for EPS scripts and not for any other form of scripts. So, we still have to carry on the same procedures of checking the exemptions for all these kind of scripts. Unless a pharmacy is 100% EPS (don't think possible in next zillion years) the procedure of checking remains same and would become a HEADACHE if we are held responsible for checking exemptions for each and every patient. The pilot, which is based on EPS, if gets implemented to cover all types of scripts can lead to extra work and chaos, hence HEADACHE.

Can I ask you a simple question? What is wrong with the current system? Why we as Pharmacists take the extra burden of policing free of cost, when they already have spent millions on hiring people specially for checking the fraud? Next, if all pharmacies implement this system will they simply trust the Pharmacy and sack all these Fraud Detection people or they would still continue to check from their side and when they find a wrong claim fine the pharmacy as well??

Garthe Knight, Production & Technical

With respect, you seem to have misunderstood the concept behind this and also the current system.

Currently, pharmacists already "police" exemptions by asking patients whether they are exempt and then asking them to sign a declaration. If they fail in this "policing", they are liable to the fine themselves for not getting a signature.

This new RTEC system brings no additional responsibilities or burdens over and above the existing system. Instead it takes burden and responsibility away for those exemptions which are recorded centrally and electronically. It also prompts pharmacists to obtain a signature where no exemption is recorded - thereby avoiding the cost of "policing".

As to what is wrong with the current system. In a nutshell, it clearly isn't working, hence the huge amount of money estimated to being lost by fraud every year.

Something like this which can help fraud detection therefore - and also takes burden away from the pharmacist for policing - is surely a good thing, no?

Not too sure on the "highly paid fraud detectives" that you mention. Unfortunately I haven't seen any figures on how much they cost or how much they are paid etc.. Any links on this would be appreciated. If they do cost such eye watering amounts though, then it would surely be a good thing that the system is brought up to date so that it is more effective for the money.  

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