Following the introduction of the Dispensing Services Quality Scheme (DSQS) in 2006, checks are now made by PCTs to ensure that claims by practices are accurate. The post-payment verification visit is a part of this process.
As with the post-payment visits for the quality framework, the number of practices visited is open to local PCT interpretation. There is a national framework within which visits must fit but there are local variations. Approximately five to 10 per cent of dispensing practices that claim this extra payment are visited annually to ensure the information provided is accurate.
These visits take place three to four months after the collection of data at the end of the financial year. The practices are chosen at random and, as with QOF review visits, there is a 'light touch and high trust' ethos.
While the aim is to ensure overall compliance with the expected standards, the visiting team is aware of the possibility of fraud.
Although some written evidence is submitted by every claiming practice, this may have to be augmented for the review visit. This is to ensure that dispensary arrangements exist at the level claimed.
The practice should receive adequate notice of the extra information required to allow for full preparation. Where a practice feels the process is in some way disadvantaging them, it may seek guidance from the Dispensing Doctor's Association or its LMC.
PCT assessors will speak to the senior dispenser, the practice manager and the dispensing partner
The visit often only takes a few hours and is timed to minimise disruption to the practice. Usually the PCT will provide a team of two to three assessors, one of whom is likely to be one of the prescribing advisers.
The practice should have the senior dispenser, the practice manager and the dispensing partner (the so-called accountable doctor) available to meet them. There is no reimbursement for the staff time required as the DSQS is a voluntary process.
To ensure compliance, various details may be requested by the PCT but details of staffing levels and staff training are often required. The staffing levels are dependent on the number of items dispensed per month, excluding personally-administered items. Surprisingly, this is information that PCTs do not always have available routinely.
Adequate training is one of the main concerns of DSQS and a list of competency certificates held by trained dispensing staff and the courses being undertaken by those in training will usually be asked for. Similarly, evidence that there is ongoing updating of skills may be discussed.
Dispensary opening times and the method by which patients are informed of these times may be considered, along with advice to patients on access to medicines required out of hours. Usually, displaying the number for NHS Direct is sufficient. Checks may be undertaken by looking at notices displayed in the surgery or on a practice website, or by interviewing dispensary staff.
These staff, especially junior members, may be questioned on their role to ensure the overall competency of the dispensary. Issues such as adherence to standard operating procedures (SOPs), data management and confidentiality may also be confirmed with staff. SOPs should be updated yearly and those in operation during the preceding year may also be discussed.
Mechanisms of recording adverse incidents in the dispensary are often discussed, along with how lessons learnt are acted upon. The PCT staff may wish to discuss one or two incidents in depth to look at how practices respond to these challenges and are able to use them to improve patient services.
Staff contracts may be brought up, particularly in relation to patient confidentiality. A clause relating to this should be in every dispenser's contract, as it should be for every member of staff.
Dispensing Review of Medication (DRUM)
Perhaps the area in which doctors often have the most direct input is the patient Dispensing Reviews of Medication. In the usual DSQS review visit, PCT staff do not have direct access to confidential medical information and so may not check practice computer systems to monitor compliance. They may, however, discuss the selection of patients for review and how the process is undertaken.
It is worth noting that although the PCT cannot directly check on patient records to ensure DRUMs have been undertaken, if fraud is suspected, the NHS counter fraud investigative team is allowed full access to medical records.
The overall meeting is relatively informal with immediate feedback. Any difficulties in complying with DSQS standards will be discussed and suggestions made to aid the practice. The DSQS visit is part of the ongoing check that dispensing practices undergo and should not be cause for alarm.
Dr Phipps is a dispensing GP in Lincolnshire
- Contact Sarah Wild at email@example.com or tel 020 8267 4532.
Quality Review Visits
- For 5 to 10 per cent of practices per annum.
- Non-threatening, co-operative, 'low touch, high trust'.
- Visiting team usually includes a prescribing advisor.
- Involves checks of dispensary opening hours and staff hours.
- Also discussions about ongoing staff training and current competency certificates.
- May check process of Dispensing Reviews of Medication but not patient records.
- May discuss adverse incidents and standard operating procedures.
The DDA is the only organisation that ensures the views of dispensing practices are heard by the government and key negotiating bodies. We also provide telephone advice to members and essential updated information via our website, and email alerts. To find out more call Jeff Lee on (01751) 430835 or visit www.dispensingdoctor.org
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