Prescription Switching

The following is reprinted from a PSNC letter:

Dear Colleague,

As part of ongoing work to monitor the accuracy of prescription pricing by the NHS Prescription Services, PSNC has been auditing the accuracy of prescription switching from the exempt to charge paid groups. To date approximately 690 contractor accounts have been sampled from the June, July, September, November, December 2008 and March and July 2009 dispensing months.

 ‘Switching' of prescriptions occurs if NHS Prescription Services does not agree with the charge group (paid or exempt) in which a prescription is submitted for reimbursement.  For forms submitted as exempt: if a declaration of exemption is required, but is not provided, NHS Prescription Services deducts the relevant number of charges from a contractor's payment for items on that form.  For forms submitted as chargeable: if NHS Prescription Services detects a completed declaration of exemption or the patient is age exempt with the date of birth or age computer generated on the prescription, charges are not deducted for the items on that form.

Findings

PSNC has found that although the switching was correct in the majority of bundles reviewed, in some accounts, prescriptions were identified that had been switched incorrectly and has fed this information to NHS Prescription Services so that adjustments can be made to the individual contractor accounts concerned.

It is always a human decision to ‘switch' a prescription's status therefore all errors identified in this study, which considered solely, switching from ‘exempt' to ‘charge' status were human errors. NHS Prescription Services have introduced a number of measures to minimise the risk of switching errors including:

  • Identifying best practice within the batch preparation process to ensure prescription forms are scanned in the appropriate groups.
  • Refresher training has been carried out with those operators involved in confirming the group in which the form should be submitted.
  • In addition, system changes have been introduced to make the process as clear as possible for operators.  

NHS Prescription Services' new tool to analyse contractor accounts for potential errors is able to review accounts for anomalies linked to prescription switching. PSNC is continuing to call for copies of prescriptions switched to be returned to contractors for information/education purposes.

PSNC is currently undertaking further audits on switching to monitor whether the measures taken by NHS Prescription Services to improve accuracy have been successful.

Feedback on Findings from Sampling Contractors in your LPC Area

We have written directly to the pharmacies sampled to provide feedback on our findings and to provide guidance on how to avoid prescription switching in future. I have attached an excel file (click here) with anonymised feedback from the checks undertake on prescriptions from contractors in your LPC area.

The Excel file provides information on the reason for switches that have been made correctly in line with NHS Prescription Services' processing rules. A key to the ‘correct switching' fields in the excel file can be found below:

  • Handwritten Age Not Signed: Where the patient is aged under 16, or 60 or over and the date of birth is automatically printed on the prescription, the prescription does not need to be signed. However this concession does not apply where the age/date of birth is handwritten - the exemption declaration must be completed. 
  • Ticked but not signed: Where an exemption declaration is required, the prescription should include a mark (for example tick or cross) in one of the exemption boxes and a signature. There forms have been switched because there was not a signature where required.
  • Not Ticked or Signed: This is where the prescription has been switched because no exemption category was ticked and the prescription wasn't signed (i.e. the back of the form was blank), where the exemption declaration was required.
  • Charge Paid: This is where the ‘charge paid' box has been completed indicating that this was a ‘chargeable' prescription which had been misfiled. 

The file also provides information on the number if ‘incorrect switches' - where the form should not have been switched under NHS Prescription Services' processing rules.

Where there was no switching from the charge to paid group, we have omitted the pharmacy from these results.

A detailed update on the implementation of PPD's new processing system is available on our website: www.psnc.org.uk/switching and I have attached a copy of the fact sheet on preventing prescription switching (click here) which has been sent to those pharmacies that were sampled.    

I hope this information is helpful. We will provide further feedback on the ongoing switching checks in due course.

Yours sincerely,

Helen Neat

Pricing Audit Team