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The process of prescription switching

Ensure the backs of the prescription forms are correctly completed, writes Annette Arthur.

Prescription switching is the process whereby the NHS Business Services Authority Prescription Pricing Division (PPD) moves prescription items between the chargeable and exempt groups.

The majority of dispensers will be aware of the importance of endorsing items correctly to receive appropriate remuneration but many do not realise the importance of ensuring that the back of the prescription form is completed correctly.

Switches are occasionally made from the paid group to the exempt group, but most switches are from the exempt group to the paid. The remuneration then owed to the NHS is taken off the final remittance total and appears on the financial statement received by the practice.

Unproven exemptions
Patients who fall into the 'under 16' or 'over 60' categories do not need to sign the back of the prescription form when collecting medication so long as the computer-generated details on the front of the form are legible. If the prescription is hand-written there should be a signature on the back.

Any other category of patient needs a signature to claim exemption. Patients claiming any exemption must fill in both Part 1 and Part 3 on the reverse of the prescription.

The main reasons for switching prescriptions from the exempt group to the paid is when the prescription back has not been signed by the patient or their representative or where there is a signature, but no category has been ticked. Unless the medication is obviously covered under a medical exemption certificate (for instance, diabetes or thyroidism), the prescription will be moved to the paid category.

'Category B' on the back of a prescription causes confusion as it states that the patient: 'is 16,17 or 18 and in full-time education.' Many first year university students feel this should apply to them but this is not the case.

University students should apply for an HC2 charges certificate if they need regular medication and should provide evidence of this when they collect their prescription.

For every category of exemption, if the patient cannot produce evidence of exemption the dispenser should put a cross in the box 'evidence not seen'.

Categories H, K, M and S are the four sections listed for people who receive monetary help from the government. If any of these sections are ticked, the extra line beneath them should be filled in, in addition to the signature in Part 3.

Patients falling into these categories are also asked for their National Insurance number. Dispensers should politely remind them of this when they collect the prescription. These sections may alter when changes to benefits from this year's budget are implemented, but the protocols will remain the same.

Wrong classifications
Sometimes a prescription will be submitted in the wrong group in error and, if the back of the form states clearly that the patient has paid for the medication, this form will be switched to the paid group.

Exempt forms that have been completed properly and submitted with the paid group in error will also be switched.

Young women prescribed the contraceptive pill for reasons other than contraception should have a prescription charge levied unless the prescriber has marked the form with the female symbol and the back of the form has been marked accordingly.

If a dispensary undertakes remote deliveries to secure sites, the prescription forms will stay in the dispensary once the drugs have been despatched. In this case, the dispenser can sign on behalf of the patient where necessary but should also stamp the back of the prescription with the surgery stamp.

Patients who take part in delivery schemes, but who are exempt from payment for reasons other than age, can give permission for their exemption card details to be held on their file in the surgery. Confidentiality rules still apply to these details.

It is also important to remember to note expiry dates, particularly for pre-paid certificates.

Taking more care in ensuring that patients fill in the back of the prescription forms correctly will ultimately mean that GPs do not lose money through prescriptions being switched from the exempt to the paid group.

  • Annette Arthur is a consultant for dispensing practices
Key points
  • Patients who are not under 16 or over 60 should fill in Parts 1 and 3 if exempt.
  • Patients who are not under 16 or over 60 should fill in Parts 2 and 3 if they need to pay for medication.
  • Patients claiming exemption in categories H, K, M and S need to fill in the extra line with their National Insurance number and sign Part 3.


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