| Endorsing FP10 Prescriptions
(Last updated 02/07/2008)
Learning Objectives
On
completion of this package you will
- Know
who can dispense FP10 prescriptions
- When
necessary be able to endorse prescriptions to show
what product has been supplied
- Be
able to identify prescriptions that require endorsement
because extra dispensing fees will be paid (for dispensers
in community pharmacies)
- Be
able to calculate how many professional/dispensing
fees are due and how many patient charges should be
collected if the patient pays for their prescriptions
The
package is divided into the following sections:
People
who supply drugs or appliances on FP10 prescriptions
have to hold a contract to provide Pharmaceutical Services.
The Drug Tariff published by the NHS Business Services
Authority Prescription Pricing Division sets out the
rules for the reimbursement and remuneration of contractors
who provide these services. The rules sometimes do not
apply to all types of contractors. This package is applicable
to both community pharmacies and dispensing doctors
and where the rules do not apply to dispensing doctors
this is clearly indicated. You will find it useful to
look at the Drug Tariff as you work your way through
this package. The Drug Tariff can be found electronically
at www.ppa.org.uk/ppa/edt_intro.htm
Who can dispense an FP10 Prescription?
 When
you receive a prescription from your GP, you probably
take it to a pharmacy (chemists) for dispensing.
There are a few other places where an FP10 prescription
can be dispensed. From the following list select
those places where you think they should have a
contract to dispense NHS prescriptions in addition
to community pharmacies: |
- Doctors surgery / practice premises
- Hospital pharmacy
- Post office
- Medical appliances and sundries supplier
- Family planning clinic
Follow
this link to check your answers.
 You
may want to discuss which groups of professionals
you think should have a contract to dispense FP10
prescriptions with your colleagues or lecturer.
There are different points of view about how restrictive
the NHS needs to be in awarding contracts for supplying
pharmaceutical services. Developments in IT mean
that delivery of dispensed medicines from a remote
location is a viable service, do you think the NHS
should encourage this route of supply? What are
the advantages and disadvantages for patients? |
Most prescriptions are dispensed through
pharmacies. The pharmacy has to have a contract with
their local primary care trust to provide pharmaceutical
services before payment is made to the owner of the
pharmacy for supplying drugs and appliances on FP10
prescription.
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Other
places where NHS prescriptions can be dispensed |
- Doctors
in rural areas may have a contract for providing pharmaceutical
services and such doctors are referred to as dispensing
doctors. The majority of GP practices do not dispense
FP10s for their patients. Before a patient is eligible
to receive dispensed medicines from a dispensing doctor
specific criteria have to be met. For example the
patient would have serious difficulty in obtaining
any necessary drugs or appliances from a pharmacy
by reason of distance from the pharmacy. Dispensing
doctors can supply any drug to their patients providing
the drug is not in Schedule 1.
- Patients
may require immediate treatment with a drug or appliance
at the doctor's premises. In this situation the doctor
cannot write an FP10 to receive payment for supplying
the drug or appliance. Some products that are not
needed for immediate treatment (for example vaccinations
and some forms of contraception such as IUDs) also
have to be administered by a GP or nurse and these
are included in the list of items that a doctor can
administer personally to a patient. FP10 prescriptions
are submitted to the Prescription Pricing Division
by both dispensing and non-dispensing GPs to claim
payment for personally administered items. The full
list of these items can be found in the doctor’s
Statement of Financial Entitlements
There
are several vaccines that doctors "personally administer"
in high volumes such as influenza vaccination (often
the practice nurses are responsible for giving these
to patients). The GP practice claims payment for these
specific High Volume Vaccines using the form FP34D
Appendix for Dispensing Doctors and FP34PD Appendix
for Prescribing only Doctors.
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NHS hospitals do dispense prescriptions from their
pharmacy departments but these are prescriptions written
by doctors employed by the hospital trust. Hospital
prescriptions are paid for from the hospital's budget.
A NHS hospital can not dispense FP10 prescriptions
and send them to the Prescription Pricing Division
for reimbursement at NHS expense since they do not
have a contract with their local primary care trust.
- Post
offices can not dispense NHS prescriptions. They would
not be granted a contract to provide pharmaceutical
services unless their premises were also eligible
for registration with the Royal Pharmaceutical Society
as a pharmacy.
- The
owner of a medical appliances and sundries outlet
can apply for a contract to dispense FP10 prescriptions.
Such Appliance Contractors can only dispense FP10s
for appliances in Part IX of the Drug Tariff.
- Family
planning clinics do supply contraceptives to their
patients but they do not use FP10 prescriptions for
the supply. They are allowed to supply drugs that
are paid for from the clinic's budget in the same
way as for drugs prescribed in an NHS hospital.
The
NHS has changed in accordance with the National Plan and
new ways of providing medical and pharmaceutical services
have been developed. For example walk-in-centres have
been established and some drugs can now be supplied to
patients under protocols known as patient group directions
(PGD). FP10 prescriptions are only used to provide drugs
and appliances where the service provider has a contract
with the primary care trust to provide medical and/or
pharmaceutical services.
Endorsing FP10 Prescriptions
The remaining sections of this package
provide the opportunity to learn more about best practice
for dispensers when endorsing NHS prescriptions in accordance
with the Drug Tariff. We have provided examples of items
that could be prescribed by GPs on FP10: you need to
decide how you would endorse the prescription. You will
find the Drug Tariff and the British National Formulary
helpful in completing the exercises.
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The remuneration paid to dispensers
differs depending on the type of dispensing contractor.
If you would like to know how remuneration is calculated
follow this link to our section on Drug Tariff Guidance:
Remuneration |
Dispensers are sometimes advised that it is better to
add too much information as an endorsement than too
little. This is because of a concern that the contractor
will receive less payment than they perhaps should receive
because of missing information. However, adding unnecessary
information takes more time for the dispenser, as all
endorsements have to be read to determine whether the
endorsement can be allowed. This slows down the processing
of prescriptions. Best practice is to add the correct
endorsements and exclude extraneous information. Pharmacy
computer systems often contain software to print endorsements
on the FP10. Dispensers still need to read each endorsement
to ensure that they are making valid claims for payment.
Claiming for an item that has not actually been dispensed
is fraud.
Endorsements That Clarify What Has
Been Dispensed
| Every
dispensing contractor will be reimbursed the basic
price of the drug or appliance that has been dispensed.
The basic price of the drug is defined in the Drug
Tariff Part II Clause 8. If the drug, appliance
or chemical reagent is included in the Drug Tariff
Parts VIII or IX, the basic price is the price listed
in the Drug Tariff. If a drug is not listed in Part
VIII of the Tariff, the basic price is the list
price, for supplying to contractors, published by
the manufacturer, wholesaler or supplier. Follow
this link for more information on Parts
VIII and IX. |
When a drug that is not in Part VIII
is available in different pack sizes, the basic price
will be based on the pack size to be used for a prescription
for the quantity ordered. For products in Part VIII
or IX the pack sizes to be used in calculating the basic
price are listed.
Sometimes
it is clear from the prescription exactly what product
and which pack size should be used to determine the
basic price. However the dispenser may need to endorse
the prescription to show more information about the
product or the pack size.
For
generic products listed in Part VIII of the Drug Tariff
no endorsement is required except for the few items
that are listed with more than one pack size.
For
generic products not listed in Part VIII of the Drug
Tariff, endorsements to show the source of supply of
the product and the pack size are required. However
if there is only one source of supply and one pack,
no endorsement is necessary.
For
proprietary products endorsement of the pack size is
only required if there is more than 1 pack size available.
If there is more than 1 pack size available and no endorsement
is present reimbursement will either be on the basis
of the common pack size (Drug Tariff Part VII) or if
no common pack size by using the next largest pack size
to the quantity ordered.
For
items that are rarely prescribed, the supplier, pack
size and basic price excluding VAT need to be endorsed.
For
products that are prescribed by a formula, the dispenser
can either supply the product by dispensing extemporaneously
in the dispensary or by asking a specials manufacturer
to prepare the product for dispensing. If a specials manufacturer
is used, the prescription must be endorsed with the relevant
details i.e. source of supply and the price.
| Consider
the following examples of products that can be prescribed
on FP10. What endorsement (if any) would you make
on the prescription? Reading the Drug Tariff Part
II Clauses 9 and 10 will help you find the answers.
You will also need to consult Part VIII of the Drug
Tariff. |
Click
on the titles to find the answers e.g. on Example 1
| Endorsements
That Clarify What Has Been Dispensed |
Example 1
When
a product is prescribed by generic name you should check
whether it is listed in Part VIII of the Drug Tariff.
Codeine linctus 15mg/5ml sugar free is listed in Part
VIII as Category A. The only endorsement that might be
required would be the pack size. There is however only
1 pack size listed in Part VIII and therefore no endorsement
is necessary. The prescription will be priced using the
Part VIII price. If a pack size different from the Part
VIII pack was endorsed, it would be ignored. If a pharmacist
endorsed the FP10 with the name of a proprietary brand
of codeine linctus, this would not be accepted since the
product is in Part VIII. Products
listed in Category A are readily available from a number
of manufacturers/suppliers.
Example
2
Dexamethasone
tablets 2mg are listed in Part VIII as Category A. The
only endorsement required for products in Part VIII
is the pack size if more than one pack size is listed.
Dexamethasone tablets 2mg are listed as pack sizes of
50, 100 and 500. Depending on which pack the dispenser
used, he or she would endorse accordingly. If the pack
size were not endorsed, the prescription would be priced
using the 500 pack size because this is listed as the
common pack.
Example
3 Docusate
capsules 100mg are included in Part VIII Category C.
This means that they are priced based on a particular
brand or particular manufacturer, in this case the Dioctyl
price will be used. There are 2 pack sizes listed in
Part VIII and therefore the endorsement is the pack
size used for dispensing. If there were no endorsement,
the prescription would be priced using the next largest
size to the quantity ordered on the prescription.
Example
4
Ginger
Syrup is included in Part VIII Category E. This is an
item that is normally extemporaneously prepared. No
endorsement is required because the prescription will
be processed using the Part VIII price and pack size
stated. An additional fee will be paid if it is dispensed
in a pharmacy and the prescriber orders an extemporaneously
prepared liquid preparation to be supplied in more than
one container (see Drug Tariff Part IIIA 2C)
Example
5
This
is a preparation that has to be extemporaneously prepared
and therefore an additional fee will be paid if it is
dispensed in a pharmacy. The Dispenser needs to endorse
the prescription extemporaneously dispensed before they
will receive the additional fee. Each of the ingredients
in the formula is listed in Part VIII as Category A
with only one pack size. No endorsement is needed for
the pack or quantity supplied.
Example
6
Metronidazole
suppositories 500mg are not listed in Part VIII and
therefore Part 11 Clause 9 requires the endorsement
of the brand name or the name of the manufacturer or
wholesaler from whom the supply was purchased. There
are several suppliers of metronidazole suppositories
and either a proprietary or a generic product could
be supplied. A pack size would only need to be endorsed
if there was more than 1 pack size available.
Example
7
Nimodipine
tablets 30mg are not listed in Part VIII and therefore
Part II Clause 9 requires the endorsement of either
the brand name or the name of the manufacturer or wholesaler
from whom the supply was purchased. In this example
Nimodipine is only available as one brand (proprietary
product) and if you don’t endorse the brand name
or supplier, the prescription will be processed because
the Prescription Pricing Division will know that Nimotop
will have been dispensed. You do not need to endorse
the pack size because Nimotop 30mg tablets are only
available in 1 pack size.
Example
8
Keflex
tablets 250mg are a proprietary product that is priced
according to the manufacturer’s list price. Did
you notice that the prescriber had completed the number
of days’ treatment box? Before dispensing you
would calculate that 28 tablets are required. Many dispensers
would endorse the actual quantity given as well as the
pack size when the number of days’ treatment box
has been used. If there were no endorsement it would
be calculated that 28 tablets were required and the
common pack size would be used to price the prescription
because Keflex tablets 250mg are included in the list
of drugs with a commonly used pack size in Part VII.
Example
9
Atenolol
50mg tablets are included in Part VIII Category M. Only
one pack size of 28 tablets is listed. No endorsement
has to be made but the dispenser may wish to add one
because Atenolol tablets are supplied in a calendar
pack (see Drug Tariff Part II Clause 10C). The prescriber
has ordered 30 tablets. The dispenser could supply 28
tablets because this is the quantity in the calendar
pack. However the dispenser could also decide that the
prescriber's intention is for the patient to receive
the exact quantity ordered and therefore supply 30 tablets.
If the dispenser supplies the exact quantity, the quantity
must be endorsed e.g. 30/28 or 30 ex 28. If there is
no endorsement of the quantity, it will be assumed that
the number of packs or sub-packs nearest to the quantity
ordered has been supplied.
Products
listed in Category M are readily available from a number
of manufacturers/suppliers. The Department of Health
determines the price they will pay for a product in
Category M.
Example
10
Trinordiol
tablets are a proprietary product and therefore the
prescription must be endorsed with the pack size. They
are available as a calendar pack containing 3 strips
of 21 tablets. The difficulty for the dispenser is what
did the prescriber mean by 3 x OP. The abbreviation
OP is usually understood to mean original pack. Did
the prescriber intend 3 strips i.e. 63 tablets or 3
packs i.e. 189 tablets. 63 tablets provide 3 months
treatment and 189 tablets provide 9 months treatment.
If the prescription is not endorsed to show how many
tablets have been supplied, it will be referred back
to the dispenser to clarify the quantity.
The
abbreviation OP is best avoided since it causes confusion.
Example
11
Oilatum
Emollient bath additive is a proprietary product and
therefore the prescription must be endorsed with the
pack size. The GP has prescribed 300ml but the product
is actually available in 250ml and 500ml packs. The
arrangements for supplying special containers apply
to this product (see Drug Tariff Part II Clause 10B)
because it is not appropriate to repack the product.
The dispenser should supply the quantity in the special
container (or containers) nearest to that ordered and
endorse the FP10 with the number and size of those containers.
In this case the endorsement should be 1 x 250ml.
Example
12
Easifix
Crinx bandage is an appliance in Part IX of the Drug
Tariff. No endorsement is required because the prescription
provides sufficient information for the product to be
priced.
Example
13
Bordered
Granuflex is an appliance in Part IX of the Drug Tariff.
If no endorsement is present, the prescription will be
priced on the assumption that 2 individual dressings have
been supplied not 2 boxes of 10 dressings. The dispenser
cannot endorse the prescription to show that 2 boxes were
dispensed because the prescriber has not clearly specified
that his or her intention was to prescribe 20 dressings.
Endorsements for Claiming Additional
Fees
This section only applies to dispensing through
pharmacies and not to dispensing doctors.
Prescriptions
for particular types of products attract additional
fees because they involve more work for the dispenser
than the average prescription. Some of these additional
fees are paid automatically by the Prescription Pricing
Division but for others the dispenser needs to endorse
the prescription appropriately to claim the fee.
| Consider
the following examples of products that attract
additional fees when prescribed on FP10. What endorsement
(if any) would you make on the prescription? Reading
the Drug Tariff Part IIIA will help you find the
answers. If you use the most recent edition of the
Drug Tariff, you can also check how much the additional
fees are worth. |
You
would also need to endorse the supplier and pack size
when necessary but for the purpose of this exercise
just comment on the additional fee endorsement.
Example
14
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Tab
Ritalin 10mg x 30 (thirty)
Take 2 twice daily
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Example
15
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Sodium
Benzoate Soln 250mg/5ml as directed |
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Example 16
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Single
(left side) femoral spring truss |
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Example 17
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Amitriptyline
Oral Solution 10mg/5ml sugar free x 300ml –
please dilute Sig 10ml tds
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Example 18
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Tabs
buprenorphine 200 micrograms x 28 (twenty eight)
Sig 1 sl tds |
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Endorsements for Claiming Additional
Fees |
Example 14
Ritalin
(methylphenidate) is a Schedule 2 controlled drug.
Example 15
If
the dispenser prepared this Sodium Benzoate Solution
in the dispensary, the prescription should be endorsed
“ED”, indicating extemporaneously dispensed
.
Example 16
It
is likely that the dispenser will need to measure the
patient to determine the appropriate size of truss to
supply. The FP10 should then be endorsed "MF", indicating
measured and fitted. NB training is required to measure
and fit trusses correctly.
Example 17
Amitriptyline
is not available as an oral solution in a strength of
10mg/5ml and therefore this would have to be prepared
by diluting one of the higher strength oral solutions
that are available. The prescription should be endorsed
ED”, indicating extemporaneously dispensed. This
prescription is probably for an elderly person.
Example 18
Buprenorphine
is a Schedule 3 controlled drug.
Other
circumstances when an additional fee could be claimed
include
-
Dispensing of elastic hosiery that requires measuring
the patient
- Where
a preparation that requires the addition of a vehicle/diluent
by the pharmacist results in a liquid of stability
of less than 14 days, and for pharmaceutical reasons
necessitates supply in more than one container
- Semi-solids
or solids prepared by dilution or admixture of a proprietary
product
See
the Drug Tariff for how to claim additional fees when
the situations described above apply.
There
are also some prescriptions that attract additional
fees for dispensing where no endorsement is necessary.
The fee will be added automatically by the Prescription
Pricing Division.
Examples of these include:
- Where
the prescriber orders an extemporaneously dispensed
liquid preparation to be supplied in more than one
container
- Prescriptions
where the net ingredient cost (basic price) of the
item exceeds £100.
Endorsements to prevent the dispenser
from being out of pocket
There are 3 types of endorsement that
could be made to ensure that the dispenser has been
reimbursed appropriately for the cost of the products
on the FP10. These are:
Clicking
on the topics above will take you to an explanation.
Broken bulk
| When
a dispenser supplies a product for which there is
little demand and needs to obtain a larger pack
size than will cover the quantity on the FP10, the
dispenser may be able to claim for the reimbursement
of the cost of the complete pack. In this situation
the prescription is endorsed "broken bulk".
The dispenser should use the pack size that will
leave the minimum balance after supplying the drug. |
Broken
bulk claims should not be made where there is an established
demand for the product. The Prescription Pricing Division
monitor how often broken bulk claims are made by a contractor
and will ignore claims that are inappropriate.
The
only Drug Tariff Part IX products for which broken bulk
claims can be made are for stoma and incontinence appliances.
Claims are not allowed for drugs packed in special containers
apart from calendar packs. Claims will also not be accepted
for a manufacturer's shipping outer e.g. 27 x 200ml
Maxijul Liquid.
Discount not given
| For
specials, other than those containing Controlled
Drugs in schedules 1, 2 and 3 of the Misuse of Drugs
Regulations 2001, where discount has not been obtained
from specials manufacturers, contractors need to
endorse 'DNG' for 'discount not given' to avoid
discount being removed. If discount was obtained
by the contractor no endorsement should be made. |
Endorsements to show the number of
professional fees and patient charges
Dispensing contractors are usually paid
one professional fee (dispensing fee) per item on the
FP10. The number of professional fees is entered in
the box at the bottom left hand corner of each prescription
form. Patients who pay the prescription charge usually
pay one charge per item on the prescription form. There
are, however circumstances when the number of professional
fees and/or prescription charges are more or less than
you might expect.
| For
the following prescriptions decide how many professional
fees would be due and how many prescription charges
should be paid. Reading the Drug Tariff Part XVI
will help you find the answers. |
Follow
this link to check your answers.
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Tab
Prempak-C 0.625
3 x 40
Take 1 as directed
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Tabs
 Dianette
3 x 21 |
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Maxijul
Liquid ACBS
Assorted flavours x 24
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Tabs Bezalip 200mg x 60
Tabs Bezalip Mono x 30
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Tabs Phenindione 10mg 60
Tabs Phenindione 50mg 60
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1
pair Below knee stockings Class III |
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The number of professional fees and prescription
charges due are as follows: |
Prempak-C
0.625 - two fees and two charges. This is a combination
pack containing two different tablets.
Dianette
tablets - without the symbol
there would be one professional fee and one charge;
with the symbol
there is still one professional fee but there is no
charge to the patient. The symbol
shows that Dianette is being prescribed as an oral contraceptive
and oral contraception is dispensed free of charge.
Maxijul
Liquid - one prescription charge and up to 4 professional
fees. The dispenser receives a fee for each flavour
dispensed. The number of flavours dispensed should be
endorsed on the form.
Bezalip
Tablets 200mg and Bezalip Mono - two fees and two charges.
Bezalip Mono is a different formulation of bezafibrate
than Bezalip tablets.
Phenindione
tablets 10mg and 50mg - two fees and one charge. These
are different strengths of the same formulation of a
drug.
1
pair below knee stockings - one fee and two charges. More
than one piece of elastic hosiery has been supplied.
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