A. Yes, it is part of the NHS Terms of Service to have an up to date notice about the NHS prescription charge displayed in the prescription reception area. For further information, please see the clinical governance premises approved particulars.

A. There is no national guidance on this issue so pharmacy staff will be required to exercise their professional judgement. Whatever decision is taken, pharmacy staff are advised to keep a record of the amount charged and the reasons for doing so on the PMR.

A. The prescriber endorsement ‘FS’ (free supply) has been introduced to enable prescribers to indicate to pharmacy staff that the prescribed product can be provided to the patient free-of-charge (FOC).

A. Existing legislation under the NHS Act 2006 provides for free-of-charge treatment for sexually transmitted diseases (STDs). Many patients often receive treatment for STIs free-of-charge from local sexual health (GUM) clinics. Where these treatments for STI are supplied by way of an FP10 prescription form, there is currently no mechanism or operational arrangement for exempting the patient from the prescription charge, so patients may be charged for medicines that should be supplied for free. The ‘FS’ endorsement has been developed as a technical solution to allow free supply of items used for the treatment of STIs.

A. No, the ‘FS’ endorsement will operate by way of guidance, and prescribers should their clinical discretion when prescribing items for STI treatment, in accordance with their professional duties and obligations. Guidance on STIs that may be suitable for managing in primary care can be found in the guidelines section of the British Association for Sexual Health and HIV (BASHH) website and in BASHH’s Standards for the management of sexually transmitted infections.

A. As with other FOC items, such as contraceptives, there is no patient tick box on the new versions of the paper FP10 form and Token. This is because legislation does not require a patient, or their representative, to make a declaration or sign a form where the prescriber has endorsed ‘FS’. Patients are not required to provide evidence of entitlement for ‘FS’ endorsed items. In EPS, however, a new message code ‘Y’ (0017) for “was prescribed free-of-charge sexual health medication” will be added to dispensing systems. For prescriptions which only have ‘FS’ endorsed items, the message code ‘Y’ (0017) will need to be populated before an EPS claim is submitted for payment (some PMR systems may apply this code automatically if an ‘FS’ endorsed item is prescribed).

A. The ‘FS’ endorsement should not be manually added to the EPS dosage instructions field as this would not allow a pharmacy to supply any free-of-charge treatment against NHS prescriptions. Addition of any supplementary information or ‘free text’ to the dosage instruction field or other fields such as ‘additional instructions’, will not be taken into account for reimbursement purposes as this information is not captured by the NHSBSA during processing. If ‘FS’ has not been applied correctly to an item, the NHSBSA will assume the correct number of prescription charges have been collected by the pharmacy (unless the patient is exempt for other reasons) and the relevant number of charges will be deducted. If ‘FS’ is applied incorrectly, the pharmacy would need to refer a patient back to their prescriber to have their prescription amended. Prescribers wishing to use ‘FS’ endorsement for EPS prescriptions must wait until their prescribing systems are configured to apply this endorsement. Until selection of ‘FS’ endorsement has been enabled in prescribing systems, prescribers should revert to issuing paper prescriptions with ‘FS’ manually endorsed next to each applicable item.

A. All paper prescriptions with the prescriber ‘FS’ endorsement should be placed in a red separator when submitted to the NHSBSA for processing.

A. Ideally, prescribers should not include items classed as FOC (for e.g. ‘FS’ endorsed item) on the same prescription form as a chargeable item. Where such prescriptions are received, the table below highlights whether a patient would pay a prescription charge using different examples of ‘FS’ endorsed prescriptions:

A. The NHSBSA will recognise the ‘FS’ endorsement when it is correctly applied by the prescriber and treat the marked items as free-of-charge, accordingly.

A. No, if an EPS prescription for an ‘FS’ endorsed medication is inadvertently marked as ‘paid’, no prescription charge will be deducted by the NHSBSA for these FOC items.

A. No, only those items endorsed ‘FS’ should be treated as FOC. All other items would be chargeable unless the patient is exempt from prescription charges for other reasons.

A. No, only prescribers can apply the ‘FS’ endorsement. Without the ‘FS’ endorsement, the prescribed treatment would be treated as a chargeable item, and patients would be advised that unless they are exempt from charges for another reason, they will have to pay the appropriate charge. If a patient claims that their prescribed item(s) is to treat an STI but the item has not been endorsed ‘FS’ by the prescriber, the prescription would need to be returned to the prescriber for the correct endorsement

A. The EPS message code ‘X’ (0010) for “was prescribed free-of-charge contraceptives” will remain on EPS systems that usually display it. This message code remains on EPS systems because population of a message code field is mandatory before an EPS claim is submitted for payment to the NHSBSA. However, the category ‘X’ for “was prescribed free-of-charge contraceptives” has been removed from the reverse of the new version of FP10 forms and Tokens.

A. There is no longer a requirement to include any Tokens with FOC items only (e.g. contraceptives) along with other Tokens normally submitted to the NHSBSA at the end of the month. If, however, the prescription contains other items for which a charge should normally be levied, the prescription should be processed as either charge paid, or the appropriate exemption category should be selected (and where required, any corresponding Tokens should be submitted to the NHSBSA).

A. Ideally, prescribers should not include items classed as FOC on the same prescription form as a chargeable item. DHSC guidance states that “free-of-charge items should not be included on the same prescription form as items for which a charge is usually applicable”. NHSBSA’s “Requirements and Guidance for Endorsement in the EPS” also states “prescribing systems should assist prescribers by splitting items onto separate prescriptions where a combination of [FOC such as contraceptives] and other chargeable medication items are prescribed at the same time”. Where prescribing systems have not been updated, it may be technically possible for pharmacy teams to receive prescriptions with both FOC items (e.g. contraceptives) and chargeable items despite this guidance.

A. Ideally, prescribers should not include items classed as FOC (for e.g. contraceptives) on the same prescription form as a chargeable item. Where such prescriptions are received, the table below highlights whether a patient would pay a prescription charge using different examples of contraceptive-containing prescriptions:

A. The Drug Tariff (Part IXA and Part XVI) lists FOC contraceptive items which do not require a prescriber endorsement. Items prescribed for contraceptive purposes but not listed in the Drug Tariff need to be annotated by the prescriber with initials ‘CC’ or the female symbol (♀) so that a charge is not levied for any items so marked. The NHSBSA automatically identify the FOC contraceptives listed in the Drug Tariff and those marked for contraceptive purposes accordingly, to ensure no prescription charges are deducted regardless of paid/exempt status declared by the patient.

A. Contraceptive drugs and appliances listed in the Drug Tariff (Parts IXA and Part XVI) and items endorsed ‘CC’ are automatically treated as FOC by the NHSBSA regardless of a patient’s exemption or charge status. So, if an EPS prescription for a contraceptive listed in the Drug Tariff (or item endorsed ‘CC’) is inadvertently marked as ‘paid’, no prescription charge will be deducted by the NHSBSA for these FOC items.

A. Yes, there may be a risk of an incorrect number of prescription charge deductions being made against such prescriptions based on the category selection made via the EPS submission for entitlement to free prescriptions. For example, if an EPS prescription includes a FOC contraceptive and another chargeable item, and the prescription is submitted with the “was prescribed free-of-charge contraceptives” message code ‘X’ (0010) applied to the EPS message, a charge deduction will apply to the chargeable item even if the patient was exempt from prescription charges for other reasons, for e.g. medical exemption. An EPS prescription of this type should have been submitted with actual exemption reason which is applied at a form level rather than the item-level, “was prescribed free-of-charge contraceptives” reason for entitlement to free prescriptions.

A. Some PMR systems may auto-populate the required EPS message code in the appropriate way to simplify pharmacy processes. PMR systems may also provide support to minimise the risk of pharmacy staff making incorrect category or EPS message code selection errors which may result in inappropriate charge deductions (for e.g. by preventing selection of the ‘contraceptive’ status to the whole prescription if other chargeable items are ordered on the same prescription). If your PMR provider does not offer such safeguards, you may choose to speak to your PMR supplier to see if they can support further improvements to reduce reimbursement risks around inappropriate EPS message code selection. Read more about making suggestions and feeding back to your PMR supplier at: psnc.org.uk/reportIT.