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PSNC: Making pharmacists digitally check exemptions is ‘positive’ step

The DH has enlisted pharmacists to check whether a patient is exempt before dispensing
The DH has enlisted pharmacists to check whether a patient is exempt before dispensing

Government plans for pharmacists to digitally check prescription exemptions should be seen as a “positive development”, PSNC has said.

Earlier this month (October 14), the Department of Health and Social Care (DH) announced a pilot – due to begin next year – which would see “data-matching technology” used in pharmacies to check whether a patient is exempt before medication is dispensed.

According to the NHS Business Service Authority’s annual report, it issued 1.3 million penalty charge notices to patients in 2017-18 for incorrectly claiming free NHS prescriptions, and recovered over £19m from prescription checks.

Alastair Buxton, director of NHS services at the Pharmaceutical Services Negotiating Committee (PSNC), said the introduction of the technology could “save patients and pharmacy staff time”.

The “real-time exemption checking” technology will enable pharmacy staff to digitally check a patient’s exemption status and apply it to their electronic prescription service (EPS) prescription, PSNC explained.

This will “reduce the number of EPS tokens which require signing by a patient, saving patients and pharmacy staff time”, Mr Buxton told C+D.

It will also reduce the risk of “contractor loss” caused by pharmacy staff accidentally submitting prescriptions with a ‘paid’ status, he added.

“I expect these benefits to contractors and their teams, alongside the potential to reduce the amount of token printing in pharmacies, will be seen as a positive development.”

RPS: Checks “could damage patient trust”

However, Royal Pharmaceutical Society (RPS) English board chair Sandra Gidley said pharmacists should “not be expected to police the prescription exemptions system”.

“There is a real concern that this move could damage patient trust in the profession,” she said.

“It also puts pharmacists in an invidious position, as we can’t deny access to life-saving medicines to someone who qualifies for free medicines just because they haven’t completed the right paperwork,” Ms Gidley added.

The RPS would like to “revisit the idea of having prescription charges at all in England”, Ms Gidley also told C+D.

“Fines, along with prescription charges in general, disproportionately penalise those on low incomes,” she added.

CCA: Workload concerns

The Company Chemists' Association (CCA), which represents the UK's largest multiples, said both patients and community pharmacy teams have a role to play in tackling prescription charge fraud.

However, expecting pharmacists to digitally check prescription exemptions could “undermine the unique relationship that pharmacy teams have in giving trusted and independent healthcare advice”, chief executive Malcolm Harrison said.

“We are concerned that checking a patient’s status and collecting the fees essentially adds to a pharmacist’s workload without benefitting patient care.

“There is a risk that the professional relationship between patients and pharmacy teams may be compromised by what patients regard as increased levels of scrutiny,” he warned.

NPA: Promote pharmacists' clinical skills instead

The National Pharmacy Association (NPA) told C+D it “understands” why the government wants to cut prescription fraud, and why it wants pharmacies to check exemptions.

However, “supporting pharmacists to fully deploy their clinical skills in the community would deliver a far greater financial return, because optimal medicines use leads to improved health outcomes and reduced spending overall”, the NPA said.

Prescription charges “should not act as a barrier to care for those on low, fixed incomes, who don’t qualify for exemptions”, it added.

Do you think digitised prescription exemptions will help reduce fraud?

Edward H Rowan, Locum pharmacist

Agreeing with various comments below. Flat fee, no exemptions. Charge a quid a time. No need for checking, no patients requesting stuff they don't need 'cos it's free.

Alastair Buxton, Community pharmacist

The media coverage on RTEC has not explained how it will work; if you want to actually understand how it will work and hence how it can benefit pharmacy teams and patients, read the article on the PSNC website: 

C A, Community pharmacist

I look forward to the extra funding from this, it should ease the pressure.

PARESH shah, Community pharmacist

If our IT systems are so advanced after spending, what was it 12 BILLION, then why cannnot the NHS  link the exemption to the patients NHS number so that whenever a patient collects a prescription and wrongly signs a prescription, a message gets flagged up at NHSBSA  and they csn send the patient a penalty notice. Why involve pharmacy/ SIMPLE!!!!!!

C A, Community pharmacist

"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 PMR system to produce dispensing labels" - From PSNC

So if your PMR does it automatically at the time of labelling it could be useful, depends on the speed of it!

Leon The Apothecary, Student

"The introduction of the technology could “save patients and pharmacy staff time""

Here is proof that the PSNC has no idea what goes on in Pharmacy. Perhaps we should lay down some truths. No-one in Pharmacy polices exemptions, we only care about a prescription not being switched, so no-one in their right mind is ever not going to let a patient not sign for their prescription.

C A, Community pharmacist

Agreed Leon -

"Enable a reduction in the number of EPS tokens which have to be printed, completed by patients and then be sent from pharmacies to the NHS BSA"

Again it shows they don't know how pharmacies work - all the tokens get printed all the time! Granted we already don't send off age exempt tokens - but that actually takes pharmacy time - I sometimes think it would be quicker to send them all and let the BSA deal with them.

Paul Dishman, Pharmaceutical Adviser

I'm not surprised that the PSNC is taking it's usual supine attitude to the DoH. Shouldn't the first question be-How much are you going to pay pharmacists to carry out this extra work?

H Saw, Community pharmacist

Wonder why in England we still have to take prescription charge (in expense of  budget on fraud detection cost, IT development, pharmacy's time and effort and risk of being charged as fraudster) whilst EVERYONE else in UNITED KINGDOM don't have to? Why can't we all have the SAME system, may it be charge for all, free for all, or standardise the charge says £1 for each item and cap it like TFL?

Leon The Apothecary, Student

Universal Prescription Fees is the way forward. There's literally no reason not to. I've not had a legitimate challenge on it anyway.

Chris Locum, Locum pharmacist

It is like the other positive development - no increase in funding.

geoffrey gardener, Community pharmacist

Time to bring England in line with the rest of the UK and abolish this tax on sickness.

Leon The Apothecary, Student

Universal fee, or completely free, why does no-one seem to champion either of these?

Arvind Sami, Locum pharmacist

This is fantastic news you know...just the other day I was thinking "I've got so much free time...I've got plenty of flu vaccines, no one is barraging me with questions about the availability of epi-pens stock shortages etc. , and I'm adequately reimbursed for the best use of my time :) ".....oh wait...

Leon The Apothecary, Student

Oh, have you heard? We're supposed to decide who gets epipens too.

Richard Judge, Manager

It would be better to have the exemption added to the EPS scripts by the data spine without any "Checking" required at the pharmacy.

Leon The Apothecary, Student

Indeed, manage it at the source. Less equipment required then, one surgery vs 20 pharmacies.

N O, Pharmaceutical Adviser

""This will “reduce the number of EPS tokens which require signing by a patient, ""

How on earth will this happen?? We are still expected to submit, signed and dated,tokens for those who fall in the category of patients claiming an expemption (except where they are under 16 or over 60)

And who will pay for this extra load of policing work??

Dave Downham, Manager

So...1.3m penalty notices garnered £19m. That's £14.62 per notice. I can't imagine that the cost of the process to identify, investigate, issue notice and chase if necessary makes this particularly cost effective.

If only there was some group who would take on an extra onerous, non-cost effective duty on free of charge for no thanks no compensation...

Rememeber they only check a sample at the PPA so the true cost figure maybe a lot more than £19 million.  Also, they issue £100 fine plus script charges (one charge would be a £108.80 fine) so the number of notices that generated the £19 million was likely to be a lot less than 1.3 million. A lot of the notices were not enforced after a patient appeal e.g. the patient made a genuine mistake and ticked E instead of F on the script.

You are right though, its not for pharmacists to act as tax fraud officers. Also, I don't know about anyone else but I always check against a token to make sure the directions have been enterpreted correctly from the original prescription e.g. 2 puffs BD hasn't become 2 puffs daily.

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