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Prescriptions

Here we cover four elements: Journey of Prescriptions, Serial Prescriptions, Allowed and Disallowed Items, and Endorsing.

Journey of Prescriptions

Practitioner & Counter Fraud Services (P&CFS) are responsible for receiving and pricing all NHS prescriptions dispensed in Scotland to ensure that Community Pharmacists, Dispensing Doctors, and Appliance Suppliers are accurately paid on time. On average 5 – 6 million prescriptions over a 21 working day cycle are processed, from more than 1500 contractors. You can see why automation is increasing and why it is so important to endorse both your electronic messages and paper prescriptions.

  • The electronic message is sent by the prescriber and the prescription is then presented by the patient to a pharmacy of their choice
  • When the barcode is scanned it brings down the electronic prescribed message allowing for you to generate a dispensed message in the PMR containing all the relevant electronic messages and endorsements for payment
  • When you submit the paper prescription for payment it is scanned, bringing down the electronic message, and linking the two together
  • The electronic message passes through ePay and where there is information that could not be extracted, they are entered manually (e.g. barcodes) and put back into automation
  • The business rules are applied via ePay, if the ePay check fails for reasons such as the prescribed message does not match the dispensed, the claim is passed to an operator where they will use the electronic message as the primary source of payment
  • No image is presented unless it is a non-barcoded prescription, or has no electronic message

You will all have different ways of counting your prescriptions in the pharmacy, but it is important to remember what should be counted for your GP34 Declaration Form. All your prescription forms and items should be counted except for UCF.

UCF

Universal Claims Framework (UCF) supports electronic claiming for pharmacy-led services. This now includes the Pharmacy First Scotland service, Smoking cessation, Emergency Hormonal Contraception and Bridging contraception. As these are sent electronically, regardless of whether a prescription is generated by your PMR, a paper form is not required, out with those that are required to be sent to the GP practice. (If your PMR does generate a form when using UCF services then you can contact your PMR provider to get this changed as a default)

Please see this table for a full guide on the information needed for each UCF prescription type and if a form is needed for sending to the GP Practice. No UCF form or item should be recorded on your GP34.

CP3/4 forms should not be counted and the only instance for pharmacy-led services where a form and item should be counted, is when a CPUS form is used where the CHI is not available.

MCR

MCR CP3 registration forms should be counted as 1 form, 0 items. For MCR serial prescriptions, once the last instalment has been dispensed it should be submitted and counted as 1 form, 0 items. MCR items and instalments are paid electronically but the prescription is needed for auditing purposes.

For any items that have not been collected or not dispensed, ensure that the electronic message is amended before you submit the prescription.

  • The prescription form has been signed by the prescriber
  • The correct form has been used by the prescribers for their prescription. Always check that the prescriber code matches the form type. (e.g. Nurse prescribers may not use doctors’ GP10s and vice versa)
  • Please take note that a red pen should not be used on any part of the prescription form
  • All endorsements should be clear and in the correct place and that the corresponding electronic endorsement(s) has been applied to the relevant item
  • Ensure all computer printed endorsements are clear. If the endorsement is faint it may not be seen on the visual image produced by the scanners
  • Make sure the pharmacy stamp or any other markings do not cover the CHI number, prescriber code, serial number, barcode or endorsements
  • Prescriptions for schedule 2 and 3 controlled drugs, ensure the person who collects the prescription has signed the appropriate area on the back of the form
  • You have completed your GP34 fully

With the increase of automation and use of electronic messages for payment, we have developed our checking database to accommodate looking at these electronic messages to support you with accurate reimbursement and remuneration. We continue to report to pharmacy owners our observations on what we find and where applicable arrange for adjustments to be made via P&CFS.

Our prescription price monitoring includes:

  • Random price checks on submissions
  • Checks requested by contractors where there is evidence that a pricing problem has occurred or there is a concern that endorsements are not being applied
  • Investigation of electronic claim information to verify allocated standard dispensing and instalment allocations relating to the dispensing pool payment

From our checks we give members feedback on the quality of their submissions detailing our findings of anomalies of endorsing (paper and electronic), claiming of handling charges, out of pocket expenses, ePay discrepancies on pack size and quantities, whole packs, Methadone fees and missed opportunities for instalment claiming and broken bulk and any adjustments that may be made.

Allowed & Disallowed Items

At Community Pharmacy Scotland, we want to help our members stay up-to-date, informed, and knowledgeable, especially when it comes to items that will not be passed for payment on a prescription.

To support this, we provide a list of disallowed items monthly to contractors who have requested these reports, you can also see these in your eSchedules. We also review a selection of items monthly to ensure Practitioner Services’ accuracy and to keep you informed of any items which have been disallowed repeatedly. Our Services Team deals with enquiries relating to disallowed items and can help you to understand why an item has been rejected and how to avoid reoccurrence.

The Blacklist is published in Schedule 1 of Part 12 of the Scottish Drug Tariff and contains a list of items including medicines and/or specific brands of medicines which should not be prescribed or dispensed on NHS prescriptions.

The Selected List Scheme (SLS)

The Selected List Scheme includes drugs, medicines and other substances which should only be prescribed for certain conditions under the circumstances listed in the Drug Tariff.

Prescribers must endorse prescriptions for these products ‘SLS’ both on the electronic message and paper scripts. If the ‘SLS’ endorsement is missing, the prescription should not be dispensed as it will not be passed for payment by P&CFS. Instead it should be returned to the prescriber to be amended. Please note that the SLS endorsement cannot be added by the dispenser.

Part 9 of the Drug Tariff provides a list of the chemical reagents which may be ordered by authorised prescribers. The items in this section that can’t be prescribed on a GP10(N) by Nurse Prescribers, are indicated by the symbol ‘Nx’.

The following items are disallowed chemical reagents and will not be passed for payment. These are most commonly found prescribed on GP10A Stock Order Forms.

  • Multistix Strips
  • Novagen
  • Pregnancy Test Kits
  • Clearview HCG

Please see our section on Stock Order Forms below for more information.

General dental practitioners may only prescribe items included in the Drug Tariff on Form GP14. When ordering items included in their formulary, dentists must use the title which appears in the formulary. For example, prescriptions for Colgate Duraphat toothpaste would not be passed for payment, however generic Sodium Fluoride toothpaste is accepted.

Please note:

  • Any prescription written generically, computer generated generically or stamped with the generic name will be passed for payment
  • If the item is handwritten, computer generated or stamped with the proprietary name with no reference made to the generic item name, it will be disallowed
  • Dentists employed in the Hospital Dental Service are not restricted by the dental formulary in their prescribing on form HBP (Scotland)

From our analysis of six months of data (January – June 2018), the largest number of rejected items were disallowed as the appliance is not listed in the Drug Tariff.

Parts 2 - 5 of the Scottish Drug Tariff provides a list of dressings and appliances that may be ordered by authorised prescribers on the appropriate prescribing lists of Health Boards, against a prescription.

The items in these parts that may not be prescribed on Form GP10(N) by Nurse Prescribers are indicated by the symbol `Nx’.

The supply of any other appliance or dressing not in Parts 2 - 5 will not be passed for payment by P&CFS.

In general, if an item is allowed on a GP10 it is also allowed on GP10A but there are a few exceptions. Please refer to the Stock Orders section. 

It is important to check the size of the dressing or appliance ordered. Some items are only allowed in certain widths, lengths, etc. e.g. Inadine 10cm x 10cm is disallowed but Inadine 9.5cm x 9.5cm is allowed and is in the Drug Tariff.

Please be mindful that dressings are mainly held on file as singles. To ensure that accurate reimbursement occurs please check that the prescribed quantity reflects what was dispensed.

Stoma appliances are no longer published in the Drug Tariff but can be found in a separate section – Stoma Supplies.

This list contains items of appliances which are disallowed on NHS prescription forms in Scotland unless specified.

There are two different specifications of Nurse Prescriber – Standard and Supplementary.

Supplementary Nurses (Independent/Supplementary) may prescribe any Item Drug/Appliance including certain Controlled Drugs.

Standard Nurses (Community Nurses and Health Visitors) may only prescribe items included in the Nurse Prescriber Formulary (NPF), Drug Tariff on Form GP10N.

  • Nurses are not allowed to prescribe on a GP10 Form and a doctor may not prescribe on a GP10N Form.
  • Unlicensed products are not allowed to be prescribed by Standard Nurses.
  • All nurses are required to prescribe generically as specified throughout the NPF, except where this would not be clinically appropriate or where there is no approved generic name and should not be abbreviated. The only exception to this rule is for the prescribing of dressings and appliances where Trade Names may be used.
  • Nurses, pharmacists and allied health professionals who are qualified as Independent Prescribers may issue prescriptions for medicinal products and medical devices in line with guidance provided in Part 8C of the Drug Tariff.
  • Nurses, pharmacists and allied health professionals who are qualified as Supplementary Prescribers, may issue prescriptions for the treatment of patients who are subject to an agreed Clinical Management Plan, drawn up in consultation with a medical or dental practitioner.

*The most commonly disallowed dressings for a Standard Nurse include (this does not apply to Supplementary Nurses prescribers where the relevant sections of the Drug Tariff should be checked):

  • Adaptic Touch
  • Aquacel
  • Askina Dressil   
  • Atrauman
  • Comfifast
  • Hydrofilm
  • K-Lite
  • K-Soft
  • Kerracel
  • Kerramax
  • Kliniderm
  • Mepilex
  • Premierpore
  • Tegaderm
  • Transpore
  • Urgoclean
  • Zetuvit
 

*Please note this is not a comprehensive list and all dressings in Part 2 of the Drug Tariff are allowed to be prescribed on Form GP10(N) by Nurse Prescribers, except those indicated by the symbol ‘Nx’.

In general, if an item is allowed on Form GP10 it is also allowed on Form GP10A. There are however, a limited number of items which may only be supplied on Stock Order Forms.

These are:

  • Adhesive Foam Pieces 22cm x 45cm x 7 mm
  • Administration Sets
  • Cryogesic (Ethyl Chloride) Direct Spray, Fine Spray 100ml
  • Fluorets Strips Histo Freezer Kits
  • Jet Nebulisers: Complete with face mask and connecting tubing replacement parts
  • Leukostrip Skin Closure Strip (6.4mm x 76mm x 3 size ONLY)
  • Lumbar Fabric Support
  • Protein Sensitisation Test Solutions
  • Steri-Strip Skin Closure Strip (6mm x 75mm x 3 size ONLY)
  • Surgical Sutures: - As listed in Part 3 of the Drug Tariff (pages 282-283)
  • Tuberculin PPD

Other Items not Allowed on GP10A Forms:

  • Finger Cots
  • Hypodermic Equipment (all items listed as Hypodermic Equipment in Part 3 of the Drug Tariff except Lancets)
  • Portable Oxygen

GP10A Forms and Quantity

We have seen an increase in the number of issues where quantities being claimed and paid differ on GP10A Stock Order Forms submitted to Practitioner Services. If you receive a stock order for dressings, please note most dressings are held on file at Practitioner Services as a single dressing (as held in the Drug Tariff). If a single number of dressing is prescribed, please ensure this is what is supplied and claimed. We have found instances where contractors are giving this quantity as number of boxes instead of numbers of individual dressings resulting in significant loss. 

If clarification of the required quantity is required, do speak to the issuing surgery and if the quantity to supply is different to that prescribed, please endorse appropriately with a PC endorsement.

Contractors are responsible for ensuring all their pharmacists who are using the National Patient Group Direction for the Urgent Supply of Repeat Medicines and Appliances have completed the PGD Authorisation Form from the pack at each update and sent it to the Primary Care Pharmacy Department of the Health Board they are working in.

Contractors who fail to ensure the completed authorisation form is returned to the Health Board should be aware that the CPUS prescriptions will not be reimbursed for the products supplied.

CPUS Prescriptions 

  • Universal Claim Forms (UCF) - This is an electronic process and is the main format which should be used. The claim is electronic and there is no requirement to send a paper copy to NSS. A copy of the script needs to be sent to the GP to inform the details of the supply for the patient’s record
  • Paper CPUS Forms - These are handwritten and should only be used where the electronic UCF is not available. Copies of the handwritten CPUS need to be sent to NSS for payment. A copy of the script needs to be sent to the GP to inform the details of the supply for the patient’s record

Please Note:

  • Levonelle One Step is not allowed as part of the PHS Emergency Hormonal Contraception Service. Any prescription written for this product on a CPUS Form will be disallowed. The only product allowed on CPUS for the EHC service is Levonelle 1500. This is a POM and therefore you must ensure that you have signed the appropriate PGD before you prescribe it.

You can find more information here on Unscheduled Care.

Unscheduled Care Ask Me Anything Event

The new Pharmacy First service now incorporates the previous Minor Ailments Service, along with the UTI and Impetigo PGDs. With the introduction of Pharmacy First, some changes were made to what is allowed to be prescribed under the three services. Now everything that can be supplied for the conditions within the scope of the service is listed in the Approved List.

As of 1st October, any items prescribed under Pharmacy First which are not listed on the Approved List, will be rejected for payment, and you may have seen some of these items appear in your eSchedule for October.

Serial Prescriptions (SRx)

Serial prescriptions (SRx) are written by prescribers for a period of up to 12 months with a set dispensing interval (e.g. every 28 days).

There are benefits for patients, pharmacies, and GPs from using serial prescriptions. For pharmacies, the team can be proactive in managing their workload as the prescription is already stored in the pharmacy and the team can plan when to dispense it. For patients, this means the prescription can be prepared before they attend the pharmacy saving time. In GP practices time saving can be found as only 1 prescription needs to be printed and signed over the period, rather than on a monthly basis.

When items are dispensed from serial prescription, the electronic claim for the items are sent to Practitioner Services and processed without the need for the paper. This means that contractors are paid at the same time as other prescriptions processed within the dispensing month (e.g. December claims are paid at the end of February). Information on endorsing MCR prescriptions is available in the endorsing guide.

Serial prescriptions should still be submitted at the end of the dispensing period, and for prescription counting purposes, an MCR master is counted as 1 form with 0 items.

The management of serial prescriptions, housekeeping and payment processing are all covered within the MCR implementation pack by logging into TURAS Learn.

Endorsing

Did you know that when you submit your prescriptions to Practitioner Services for payment, barcoded GP10 scripts are paid using only the electronic claim where it is available? 

If you need to change the electronic claim for any reason you can do so by canceling the electronic claim, amending it, and resubmitting it ideally while the prescription is in the pharmacy. It could even be done up to 14 days after the prescription has been sent to P&CFS so long as it has not already been processed for payment.

This is really helpful for prescriptions that are not dispensed or not collected where both paper and electronic messages should be amended. If you decide not to dispense an item or if the patient doesn’t collect and the paper form is not to hand, you can still adjust the electronic claim to ensure accurate payment.

You can find out more on our Quick Guide to Accurate Payments.

Everything you need to know to support you with accurate reimbursement & remuneration can be found in the Endorsing guide. And any guidance relating to applying endorsements on your electronic messages can be found in your PMR suppliers user guides.

To help you on your way, here are some areas to be mindful of:

Electronic Claiming

  • As the electronic message is the source of payment, remember to endorse everything and ensure the paper prescription endorsement matches

  • When an item is not dispensed (ND) or not collected (NC) ensure the electronic message has this annotated. Endorsing on the prescription alone will not suffice and could lead to inaccurate payment

  • MCR claims can only be made electronically. You must submit the master prescription at the end of the dispensing period, this, however, will not be used for payment, please ensure all information is captured on the electronic form

  • For non-Part 7 items ensure the item you select in your PMR is the item you dispensed, as this is what you will be paid

Quantity and Pack Sizes

  • For non-barcoded prescriptions, add the manufacturer you supplied from and pack size used in dispensing as there may be more than one size available. Add these endorsements along with any others on the right-hand side of the prescription using black ink

  • Where the quantity prescribed is not clear, especially on a Hospital (HBP) prescription, endorse what you dispensed for accurate reimbursement

  • You do not have to endorse the paper prescription if the quantity dispensed is an exact match to the quantity prescribed

  • Quantities prescribed as ‘OP’ or ‘original pack’ should be clarified as there may be more than one pack size available – ensure the pack size endorsed is the pack size used

  • Where the quantity differs, this change must be endorsed on the prescription, this will be due to the nature of the pack when the exact amount cannot be dispensed. The quantity change that is allowed is related to the type, size and number of packs available in line with the pricing rules. You can refer to the different pack types and rules to help you or call the Pharmacy Services Team at 0131 466 3540 or email pharmacy.services@cps.scot if you need any assistance

Additional Endorsements

  • Where the prescriber requests instalment dispensing, remember to endorse in the electronic message for the fees to be allocated. This can be done by adding the endorsement during the dispensing process using your PMR, with the correct quantity, number of instalments and number of supervisions e.g. 28-4-0 (quantity-instalments-supervisions). This should also be annotated on the paper prescription so that if the electronic claim fails, you will still be reimbursed accurately.
    Note - If the prescription is for a controlled drug, the PC70 form is not used for allocation of fees, however, it is a legal obligation to submit them

  • For unlicensed or imported medicines not in Part 7S or 7U, where pre-authorisation from the Health Board has been sought, as detailed in the Drug Tariff, all relevant endorsing should be made electronically and on the paper prescription where applicable

      • SP – Invoice price less any discount or rebate obtained

      • HC3000 – £30 payment for sourcing the most cost-effective product

      • XP – Any Out of Pocket expenses or wholesaler handling charges

  • You cannot claim Out of Pocket expenses (OOPs) for any item in Parts 2 – 7 and 9 of the Scottish Drug Tariff

  • Remember to claim your £25 for Measured and Fitted items using the ‘M & F’ or ‘F’ endorsement. You cannot claim for items that have been Made to Measure

  • When claiming Broken Bulk (BB) for a full pack when only part is prescribed and dispensed, and no further prescription forms are expected, remember to endorse on the electronic message and the paper prescription the pack size dispensed, as this is the full pack you will be paid from, and add the ‘BB’ endorsement with the claimed date

  • Use a PC or PMR endorsement for any changes made having spoken with the prescriber

Captivate - Endorsing Guidance

This 20-minute video from Practitioner & Counter Fraud Services contains everything from electronic claiming, the Dictionary of Medicines and Devices, helpful tips on endorsing and much more. Whether it be used for an induction to new members of your team, pre-registration students or just a refresher to support the knowledge you already hold, we hope this supports you further on everyday endorsing and accurate claiming of items for reimbursement.