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The Prescription Pricing Authority has designed its operational systems. This was done to ensure that the task of capturing prescription data, and processing that data, achieves a high standard of accuracy.
Levels of performance are detailed in a service level agreement between the NHSE and the PPA. Similar agreements are in place within the various directorates of the PPA. Performance targets and standards are constantly monitored.
Both Prescription Processing Services (the processing divisions) and the Computing Services Division have accredited Quality Management Systems in place.
There are a number of ways in which quality is achieved.
- All data input staff receive specialised modular training. Standards are set which must be achieved before anyone can move from a training post to a substantive post.
- Continual monitoring of performance of staff in terms of accuracy and speed.
- Use of Technical Procedure manuals to ensure uniformity of interpretation and processing of all prescriptions.
- Controls built into PPA databases provide validation of data capture.
- Checks are made on individual prescription data where quantities of costs appear to be unusual.
- In house quality control checks at each processing division to monitor accuracy and consistency of data capture.
- Reprocessing of a statistically significant sample of all prescriptions from all processing divisions by the Central Quality Assurance Division. Samples are selected at random from all accounts processed and then re-input. The results are checked against the original input. Any differences found are investigated and where errors are confirmed these are reported to the appropriate processing division. In addition to identifying specific errors, areas of concern are highlighted to the processing divisions to enable remedial action to be taken.
- All the processes of the PPA, including computer systems and databases, are subject to checks by both internal and external auditors.
- Additionally the National Prescription Research Centre takes a sample of prescriptions for reprocessing. This independent check provides confirmation of the activities of the PPA.
As will be seen from the above there are a number of checks and controls in place to help ensure the maximum possible level of accuracy and consistency in the work of the PPA.
Quality assurance and the PPA
Reimbursement for personally administered items
Endorsing prescriptions is an essential activity for pharmacists. This ensures that correct data is captured at the PPA for the accurate and timely reimbursement and remuneration of pharmacists for NHS dispensing.
This information sheet seeks to clarify what endorsements are required.
- All prescriptions, other than those for generic products listed in Part VIII of the Drug Tariff as one pack size, require endorsement of the pack size used for dispensing. If no pack size is endorsed and the preparation is listed in Part VII of the Drug Tariff, the pack size listed in Part VII is used as the basis for calculating reimbursement.
- All prescriptions for generic products listed in Part VIII of the Drug Tariff, and listed as two or more pack sizes, must be endorsed with the pack size used for dispensing.
- All prescriptions for generic products not listed in Part VIII must be endorsed with the source from which the stock was purchased. The pack size used for dispensing must also be endorsed.
- Where preparations packed in special containers are dispensed, then the number of containers containing the quantity nearest to the quantity ordered must be supplied. It is helpful to endorse the number and size of the containers dispensed. (Drug Tariff Part II Clause 10B)
- In the case of preparations packed in calendar packs it will be assumed that prescriptions for such preparations not endorsed have been met. This will be done by dispensing the number of packs/sub packs containing the quantity nearest to that prescribed. (Drug Tariff Part II Clause 10C)
- Where a quantity is prescribed and dispensed, which does not equate with the quantity in packs or sub packs, an appropriate detailed endorsement must be made.
- When endorsing prescriptions, it is preferable to state the number and quantity in each container eg 2 x 15g, 1 x 100ml rather than use the abbreviation O.P. This is particularly important for products such as OCs where there is a potential for confusion between 1 x 21 and 3 x 21 as the OP.
- ZD should be endorsed whenever an item listed in the Zero Discount list is dispensed and no discount was obtained. This is at the time the product was purchased from the manufacturer or wholesaler.
- A claim for broken bulk payment is intended to apply when having purchased a pack, or packs, from an order where a surplus is left which it is anticipated cannot be used within six months. Broken Bulk claims are not acceptable where the item is packed in a special container. Also not acceptable is a dressing or chemical reagent, or when there is an established demand for a product. (Drug Tariff Part II Clause 12)
- Exceptionally out of pocket expenses incurred in obtaining a product (excluding Drug Tariff Part VIII Category A and Part IXR items) can be claimed by endorsing the prescription form with details of the expenses. (Drug Tariff Part II Clause 12)
- Claims for additional professional fees must be made where applicable in accordance with Part IIIA of the Drug Tariff.
Quality assurance and the PPA
Required endorsements
Paragraph 44.5 of the Statement of Fees and Allowances allows GP's to claim direct reimbursement for certain items personally administered to their patients.
The items are vaccines (other than those childhood vaccines listed in Paragraph 44 Schedule 5), anaesthetics, injections, diagnostic reagents, intrauterine devices. These include drug release IUD systems, contraceptive caps and diaphragms, pessaries which are appliances and sutures including skin closure strips.
The childhood vaccines for which reimbursement cannot be claimed are:
- Hib
- MMR
- Rubella
- BCG
- Diphtheria
- Diphtheria/Tetanus
- Diphtheria/Tetanus/Pertussis
- Pertussis
- Polio Oral
- Polio Inactivated
- Tuberculin PPD
Claims are made by completing a prescription form for each patient, or in the case of named high volume personally administered vaccines bulk claims on Form FP34D.
The eight high volume personally administered vaccines for which claims are made on Form FP34D are Influenza, Cholera, Hepatitis A, Hepatitis B, Tetanus, Typhoid, Pneumococcal and Meningococcal vaccines.
GPs submit claims to the PPA at Newcastle upon Tyne.
Prescribing only doctors submit their claims as one batch. Dispensing Doctors submit their claims along with their prescription forms, which have been dispensed under Pharmaceutical Services.
There is no liability for patients to pay prescription charges for Personally Administered items.
The payment calculation for personally administered items is as detailed in the SFA paragraph 44.2.
Prescriptions for Small Quantities
Within Dispensing Doctors batches are found numerous prescriptions where the quantity prescribed is one. This includes one tablet, one suppository, one sachet, one enema, one minim eye drop, one piece of melolin dressing, one impregnated gauze dressing, one albustix, etc.
Similarly there are further prescriptions for small quantities of other items.
In general it seems unlikely that a patient would be prescribed and have dispensed only one of most of these items, particularly when the patient may be liable to a prescription charge.
The conclusion is therefore reached that these prescriptions for small quantities are one of two things. It is either, attempts at claiming payment for the use of small quantities of items, such as dressings in the surgery (under SFA paragraph 44.5 such claims are not allowed), or alternatively, the claims could be for drugs supplied for the immediate treatment of the patient. In these situations a GP may not claim direct reimbursement of costs. Such costs are reimbursed indirectly through the provision made for practice expenses in fees and allowances.
Quality assurance and the PPA
Required endorsements
Reimbursement for personally administered items
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