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Pharmaceutical Services Negotiating Committee

Other Known Issues

Item Count Errors 

A problem identified by PSNC Pricing Audit Centre (PAC) is errors in the number of items identified by NHS Prescription Services. In some cases, there has been duplication of items considered for payment, in other cases, some items have been missed. Investigation has shown that there are two main causes:

Human error: Where the rules are complicated, for example, the pricing of FP10MDA forms and multiple flavour products, there have been cases of the number of items incorrectly being input into the pricing system. NHS Prescription Services are tackling these problems through staff training and performance management.

System Error: Some items are being duplicated or missed by the intelligent character recognition. This route of the problem is linked to the way prescriptions are being generated. The ICR developer has been commissioned to deliver revised and improved versions of the software to improve consistency in data capture. NHS Prescription Services are working on guidelines for GPs/GP System Suppliers on prescription generation to try and standardise prescription generation where possible, for example the use of symbols as separators between prescription items and to signal the end of a prescription.

NHS Prescription Services have introduced checks at the batch preparation stage in the pricing process to identify any possible discrepancies in the contractor’s declaration and the system's count. Also the NHS Prescription Services’ tool to assess payments is being used to identify potential discrepancies.

PSNC has reviewed a number of contractor’s bundles for discrepancies. Although in some cases, there had been a payment error; in others the contractor had made an error in their count of the number of items.

Guidance on how to count items for declaration on the submission document is available in the online Drug Tariff Resource Centre.


Supplementary Product Information included in Dosage Instructions: Updated Guidance

In carrying out routine audit work on the CIP system, the PSNC Pricing Audit Centre (PAC) have identified a risk of payment error where prescribers have included supplementary product information, for example a brand or manufacturers name or an indication that a sugar free or preservative free prescription is required as part of the dosage instructions rather than beside details of the prescribed product, for example:

10ml Hypromellose 0.3% Eye Drops
Insert one drop into both eyes
four Times a day Preservative-Free

Where supplementary information is included in the dosage instructions rather than in the first line of the prescribing instructions, this may not be identified by the Intelligent Character Recognition software or by staff. Audit work at PAC and at NHS Prescription services has shown that in practice, this information is being collected on the majority of occasions however there have been a small number of errors identified where supplementary product information was not collected.

NHS Prescription Services changed their prescription submission requirements in April 2010. Pharmacists can now use the red separators to identify these items to processing staff during the prescription pricing process. If the pharmacist puts the prescription in the red separators when submitting their bundle to NHS Prescription Services, the prescriptions will be checked by an operative after they are electronically priced, to ensure that all information is captured and the prescriptions were priced correctly.

Contractors can also contact the prescriber to alert them if a prescription includes product information in the dosage instructions, to request that all information linked to the product is included in the first line of the request for that item. Click on the link below to download a template letter that can be used to inform prescribers of this problem:

Supplementary Product Information Template Letter (MS Word)

Initial implementation of EPS Release 2 is expected to begin shortly. Through Release 2, when electronic messages are received by NHS Prescription Services for reimbursement, payment will be based on the product code of the prescribed product, therefore, supplementary product information included in the prescriber’s dosage instructions will not be considered when calculating payment. Work done now to change prescribing practice where necessary will therefore be helpful in the long term to support the smooth implementation of the EPS.


Prescriptions ordered as a length of treatment rather than a Specific Quantity

In carrying out audit work on prescriptions priced by PPD using CIP, PSNC identified a substantial payment error in an individual contractor's account where prescriptions had been generated by the GP system as a length of treatment but no exact quantity has been specified either by the prescriber or endorsed by the pharmacist.

For example:

"Take 1 tablet TDS x 28 days"

If the prescription is written in this way, a total quantity of 84 tablets is being requested however there is a risk that this may be misinterpreted if the total quantity is not specified or clearly endorsed on the form.

When this case was fully investigated, the audit trail showed that there had been an operator error in keying the quantities into the pricing system. NHS Prescription Services have worked to address this through both targeted performance management and an alert to processing staff. NHS Prescription Services have worked with the contractor's PCT to identify and assess other contractor accounts in the locality that may have been affected.    

If prescriptions are being received as a length of treatment, we would recommend discussing this with the prescriber and requesting that prescriptions are issued as a total quantity. If necessary support should be sought from the PCT.