Compliance Unit

The Compliance Unit of the PPA is required to undertake an extensive range of checks on claims to exemption from prescription charges by patients in receipt of NHS prescriptions.

The Compliance Unit currently samples around 400,000 prescriptions per year, with checks across all exemption categories. Electronic links to other agencies and within the NHS facilitate this work.

Significant enhancements to the Unit's IT systems have taken place during the past 18 months.

Selected batches of prescriptions are scanned utilising Fujitsu scanners which record images of the front and reverse of each form, whilst software on the database interprets specified data fields.

Utilising a workflow system, images of the prescription forms for the required exemption categories are transmitted to the PC screens of individual Compliance Assistants for verification. These are mainly selected from forms where the pharmacist has indicated that he has not seen evidence of exemption, as required by point of dispensing checks, although a proportion of "evidence not seen" forms are included.

The Compliance Assistants add to and amend data interpreted by the scanners for each prescription, and from this completed information Patient Selection Lists are produced and sent to Health Authorities and other agencies using, where available, electronic links.

On return, the checking results from the relevant bodies, the paper Patient Selection Lists are scanned to update the individual patient records. The electronic file is loaded directly back into the system and updated automatically.

Where entitlement to exemption is confirmed, no further action is taken in respect of the individual cases.

Where entitlement to exemption is not confirmed, the computer system produces a letter to the patient (together with an image of the prescription form) and enclosing a questionnaire inviting further information.

Where evidence of exemption is subsequently provided by the patient, action is discontinued. Additional information and insistence on entitlement to exemption will result in a recheck with the relevant body.

In the event that entitlement to exemption is not established despite a recheck, the patients admits liability, or the patient fails to respond; cases are progressed to the PPA's Debt Recovery Section.

Frequently Asked Questions

Pharmacy Reward Scheme

Data Analysis