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Dispensing: Cash-handling in dispensaries

Surgeries must ensure they keep on top of the reconciliation process, writes Annette Arthur.

The only cash that most English dispensaries take on a daily basis is payments for the NHS items they dispense - prescriptions in Wales and Scotland are free.

Every surgery chooses to deal with this income differently but there must be a transparent audit trail for each transaction so mistakes can be kept to a minimum.

The Prescription Pricing Division requires that any charge is noted on the back of a prescription form which must be signed and dated by the patient.

Daily reconciliation
At the end of each working day, the total amount from the back of the prescription forms should tally with the amount held in the dispensary. Whether a receipt is given for each charge is the choice of the surgery but the total amount must be reconciled at the end of each working day so that mistakes can be corrected immediately.

It is more difficult to manage this if you do it once a week, or even worse, once a month.

Cash receptacles can be varied - some small dispensaries still use a cardboard box hidden under the counter, others use a lockable metal cash box and many use a proper cash register.

Large amounts of money should never be kept in the dispensary and there should be a facility elsewhere in the surgery for this money to be locked in a safe until it is banked.

Ideally, prescription levies should be held in a separate bank account because the money paid in should then balance the payment deducted from the overall reimbursement to the GPs.

Whether funds are banked daily or weekly is up to the surgery to decide, but standard operating procedures should be in place to cover all financial operations in the dispensary.

Private prescriptions
Other income in the dispensary is generated by the dispensing of private prescriptions. These may be from regular patients who are not eligible to receive certain medication on the NHS or from overseas visitors.

Pricing a private prescription varies widely but the recommendation is always that the amount per item should not be less than an NHS levy would be (£7.65).

A formula that is used widely is: the cost of the drug plus VAT plus 50 per cent. Some practices also add on an amount for the prescription form and, if the patient is a visitor, a consultation fee should certainly be added.

Whether this latter amount is taken by reception or whether the total charge is paid in the dispensary is a matter of choice, but the transaction must be documented by both reception and dispensary.

Foreign visitors
In the case of foreign visitors, a copy of the charge and the prescription should be given to the patient on headed notepaper for their insurance company's records. All patients tendering private prescriptions should be offered a receipt for the money and this should show the VAT element of the transaction.

Small modern cash registers will show the VAT element separately and will provide a tear off receipt for the patient, and it is recommended that all dispensaries have a proper till.

Protocols within the surgery should exist to direct 'private' money to a designated bank account, but some surgeries prefer to put all dispensary income into one account, highlighting the NHS levy portion in the paying in book.

Travel medicines
Lastly, an increasing amount of money is being generated by travel clinics held in the surgery. Since many vaccinations are quite expensive and many patients will also need anti-malarials, first aid requirements and so on, many surgeries have produced a price list for their travel clinic.

If you are using an electronic till, a separate coding can be used to identify this income on the audit roll.

At most practices, dispensaries will deal with requests for travel medication rather than the nurses in the clinics. Patients should always be given a receipt for this money.

Whatever protocol is in place at the surgery, it is important to keep on top of the reconciliation process to avoid potential loss of money. Only by doing this can you achieve an efficient and accurate audit trail of all dispensary income.

  • Annette Arthur is a consultant for dispensing practices
Key points to remember
  • A small electronic till will ensure an accurate audit trail.
  • Standard operating procedures should be in place for all financial dealings in the dispensary.
  • Provide a safe place to store dispensing income if it is not banked daily.
  • Provide receipts where necessary, either from the till or on headed notepaper.

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