CCG and CSU access to FP10 prescription forms
and dispensing data
1. Background
Prior to 1st April 2013 PCTs were responsible for the commissioning of
pharmaceutical services. From 1st April 2013 the responsibility for these contracts
now sits with NHS England.
The regulations; “The Pharmaceutical and Local Pharmaceutical Services
(Prescriptions, Payments and Listings) Directions 2013” section 7 -Examination of
prescription forms and payment data by representative bodies came into force on 1st
April 2013 and specifies who has the authority to request copies of NHS prescription
forms.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/19321
3/2013-03-27__Prescriptions__Payments_and_Listings_Directions_2013_e_signature.pdf
This document sets out the current position based on these regulations and explains
the process for requesting dispensing data and access to NHS prescription forms
that have been dispensed and submitted for payment to NHSBSA by Pharmacy
Contractors, Appliance Contractors, Dispensing Doctors and those personally
administered.
2. Current Situation
There appears confusion regarding the legal position of who can access prescription
forms/images and dispensing data which has resulted in many queries being raised.
Authorisation to this information has always centred on the legal entity that
commissions pharmaceutical services. Prior to April 2013 that was the former PCTs
and since that date it is the NHS Commissioning Board (legal entity of NHS
England). Whilst PCTs employed medicines management teams NHS England does
not and so it is the division of the architecture of the NHS that has changed the
dynamics, and hence access to data and prescription forms, for medicines
management teams.
The NHSBSA acts under the instruction of NHS England in regard to accepting and
fulfilling requests for access to prescription forms/images and dispensing data.
Information governance expert advice has been sought to resolve these matters.
This advice can be summarised as:
Recall of prescriptions by CCGs/CSUs should only be allowed in situations 'where
the public interest in the disclosure outweighs the public interest in protecting public
trust in the confidentiality of services and the confidentiality owed to the particular
individual'.
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In essence this means that there will only be a very small number of situations where
CCGs/CSUs could legally request access to dispensed prescription forms or
dispensing data. Examples might be in situations of crime taking place or patient
safety concerns. However, as the commissioner of the services NHS England will
also need to be directly involved.
The Health and Social Care Act 2012 does not allow NHS England to delegate its
responsibilities for pharmaceuticals services to any other body. Therefore, NHS
England are not able to delegate responsibility to CCGs/CSUs for the access to
Prescription forms or dispensing data.
3. NHSBSA systems and processes
NHSBSA systems and processes will remain unchanged.
Where CCGs/CSUs have concerns and require information which NHSBSA hold, in
addition to what they routinely have access to, NHSBSA will support these
investigations within the legal frameworks that exist. The steps to follow are outlined
in Appendix 1.
4. Frequently Asked Questions
The specific concerns and questions that have been raised by CCGs and CSUs
regarding access to prescription forms/images and dispensing data are recorded
below with the response based on current regulations.
Questions and Answers
Question 1 - Commissioner Rights
The CCG is the bill payer and as a matter of principle must be sighted on community
pharmacy/dispensing doctor dispensing activity which can, and does, impact on
prescribing costs. This includes drug costs, out of pocket expense claims and
container charges. If the CCGs cannot see the data, e.g. for out of pocket expenses
and where they are incurred, then the accountability must transfer to those that have
access, NHS England or DH.
Response 1:
CCGs are not the commissioner of pharmaceutical services and so do not have
commissioner rights. CCGs pay for drug re-imbursement via a re-charging method.
Question 2 - Transparency agenda
The NHS has been moving to greater transparency and as a result GP prescribing
information is now in the public domain. There is no reason to stop this trend and
removing CCG access to “dispensed by” data suggests a need for secrecy which is
unfounded. In fact we would urge even greater transparency and full publication of
all available prescribing and dispensing data into the public domain.
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Response 2
Prior to transition PCTs had responsibility for both commissioning the services and
for providing the medicines management support. CCG are not the commissioner of
pharmaceutical services, this is the responsibility of NHS England.
The Information Commissioners Office (ICO) recently determined that it was in the
public interest to release details of dispensing information for identified dispensers.
Following this decision more dispensing data than before will become available in
the public domain and the first of these releases is now available on the NHSBSA
website.
This information and the details of the ICO decision and the rationale for publishing
more pharmacy data is available at
http://www.nhsbsa.nhs.uk/PrescriptionServices/4818.aspx
Based on this, NHSBSA will be able to support CCG and CSU queries through the
provision of data without the need to supply copies of NHS prescription forms,
however, where concerns are raised regarding pharmaceutical services NHS
England should be involved.
Question 3 - Safety and quality concerns
The CCGs, whilst not commissioners of services provided by community pharmacy
and dispensing doctors under their national contract, must be able to address safety
and quality concerns regarding dispensing of prescriptions written by their member
practices. Easy access to the digital images in these circumstances often aids rapid
resolution.
Response 3
In certain circumstances this may be appropriate where patient safety concerns are
raised. Where there are potential concerns regarding the dispensing activity these
should be raised with NHS England. Where there is a need for a copy of the
prescription form NHS England should be contacted. This authority cannot be
delegated to CCGs/CSUs.
Question 4 - Professional obligation
CCGs have a professional obligation to follow up prescribing, for example, when a
special is dispensed for which there is a suitably licensed alternative, especially
where the provision of the special makes the GP unknowingly liable for medico-legal
issues
Response 4
Through routine information or additional information on request provided by
NHSBSA this issue can be addressed, without a copy of the FP10 prescription form.
Currently, where prescription items have been reported in systems as “unspecified”
NHSBSA provide CCGs with the drug prescribed for items where their value is
greater than £250. NHSBSA are working towards supplying CCGs with a record of
what was prescribed for all prescriptions recorded as “unspecified”.
Items classified as “unspecified” are where products prescribed cannot be identified
from the NHSBSA drug database.
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Question 5 - CD monitoring
CCGs are expected to support NHS England in this and without prescription data
recall, and also sometimes knowing where prescriptions are dispensed, will
undermine governance of many services not just GP prescribing e.g. out of hours,
hospice, various ex PCT prescription accounts that will have transferred to
secondary care, so it’s an issue for secondary care trusts also.
Response 5
The Controlled Drugs (Supervision of Management and Use) Regulations 2013
NHS England Single Operating Model explains the role of CDAOs and CCGs. This
can be found at
http://www.england.nhs.uk/wp-content/uploads/2013/11/som-cont-drugs.pdf
The overall responsibility for CDs lies with NHS England and that organisation has
access to data to allow CD monitoring. In addition, CCGs have access to prescribing
data.
Regulation 13(4) of the Controlled Drugs (Safe Management and Use) Regulations
2013 (SI 2013/373) states that “A CCG….. must assist the relevant CDAO of the
NHSCB (now NHS England) in the carrying out of the CDAO’s functions. The single
operating model acknowledges the important role CCGs can play in regard to CD
monitoring, “NHS England considers it good practice for CCGs to assist its CDAOs
which includes the analysis of the CD prescribing data available”.
However, in the event of needing to look at a prescription form, the CCG should ask
NHS England to request this as part of the investigation process.
Question 6 - Local CCG commissioned services monitoring
Some community pharmacy services involving dispensed by data, e.g. Not
Dispensed schemes are being retained by CCGs and for monitoring purposes
dispensing data must be made available to the commissioner.
Response 6
If the CCG is the commissioner these services are not considered pharmaceutical
services and in this instance it may be appropriate for them to have access to the
data. However, where the service is linked to the dispensing of an NHS prescription
form, which is part of Pharmaceutical Services, NHS England will need to be
involved. For example, a “Not dispensed” scheme that encourages Pharmacies to
intervene where medications may not be needed by the patient is very beneficial, but
where dispensing data that is not routinely available is needed to monitor this
scheme NHS England should be made aware.
Question 7 - Local intelligence
With the demise of the police drugs liaison officers, in some areas, and changes
taking place in the NHS since April 2013 there is a reduction in local intelligence from
visiting community pharmacies, dentists and GPs that can identify strange CD
prescribing. Losing access to ePACT “dispensed by” information and prescription
copies will exacerbate this.
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Response 7
While the ePACT system is under review due to the technical platform it is built on
currently there are no plans to make changes to the system. However, requests for
copies of FP10 prescription forms will need to be made via NHS England.
All CCGs in England are designated as responsible bodies under Regulation 6 of the
Controlled Drugs (Supervision of Management and Use) Regulations 2013. CDAOs
should ensure that the Local Intelligence Networks actively engages with all CCGs.
Some geographical locations of NHS England and CCGs have already established
good working arrangements underpinned by a Memorandum of Understanding.
Question 8 – Miscoding
Spotting miscoding by identifying out-dated assignment of prescriber following a
change of practice by tracing prescribing through the dispenser would be made
impossible and could lead to significant overcharges to individual CCGs which would
go unnoticed.
Response 8
Where concerns regarding miscoding of prescribing activity are raised these should
be addressed in collaboration with NHSBSA who will supply the necessary data and
support the investigation to resolve the matter. Please contact NHSBSA on
nhsbsa.prescribingqueries@nhs.net
Question 9 - Dispensing practices
Monitoring dispensing practice prescribing has required use of where prescriptions
are dispensed to ensure that they are complying with pharmaceutical services and
not diverting expensive prescriptions to community pharmacies.
Response 9
It is the role of NHS England to monitor and performance manage pharmaceutical
services. Where there are concerns these should be raised with NHS England.
Question 10 – NHS England capacity
NHS England from experience locally to date may not have the capacity, or
potentially the knowledge, and may not be best placed to carry out these activities.
There is a danger as a result of this significant fraud issues going unrecognised.
Response 10
It is correct NHS England resource is limited. However, while CCGs are willing to
support this activity we must operate within the law. Currently there is no legal basis
for NHS England responsibilities to be delegated to CCGs or CSUs. NHS Protect
and local counter fraud specialists will also play a key role but as the commissioner
of pharmaceutical services NHS England must be made aware of potential issues.
5. Contact Details
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Useful contact details for queries relating to information contained on a prescription
form.
Topic
Concerns regarding miscoding of
prescribing activity
Requests for copies or images of
prescription forms or specific
information from a prescription form
Contact Details
nhsbsa.prescribingqueries@nhs.net
nhsbsa.prescriptionsearchrequest@nhs.net
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Appendix 1 - Process to request Prescription forms/images or Pharmacy
dispensing data
CCG/CSU require
information to support
an investigation
Contact NHSBSA for
information
NHSBSA has processed
incorrectly during
payment process?
No
Yes
NHSBSA to provide
correct information
and resolve as
appropriate
Investigation can be
resolved without a
copy/image of the
prescription form
Yes
NHSBSA provide
information to
CCG/CSU to support
investigation
CCG/CSU able to
resolve issue
No
CCG/CSU to approach
NHS England for their
involvement
NHS England request
copy/image of
prescription form as
appropriate
NHSBSA provide
information to NHS
England
NHS England and
CCG/CSU able to
resolve issue
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