Pricing Accuracy

Monitoring Accuracy

PSNC are independently auditing the CIP system. Where errors were discovered during the checking process, the individual accounts are corrected by NHS Prescription Services and the contractor concerned is notified. As processing issues are identified, PSNC raise these with NHS Prescription Services. These are fed into NHS Prescription Services' internal accuracy working group to ensure that the root cause of problems is investigated and solutions found.

The first statistically significant sample audited by the PSNC was taken from prescriptions dispensed at the Newcastle site in May 2007 – the first month of live implementation. This showed overall accuracy within NHS Prescription Services’ target levels of 0.2% net cash variance; however there was significant variation in some contractor accounts, both under and over-payments.

In October 2007, NHS Prescription Services significantly increased the number of accounts that were processed via CIP and implemented the second release of the CIP System. The second statistically significant sample audited by NPRC was drawn from prescriptions dispensed in October 2007 and provided a direct comparison of the pricing of prescriptions via legacy systems and the CIP system.

The results showed that the overall accuracy level for contractors priced using the legacy processes was within the NHS Prescription Services’ target levels. For CIP, the majority of CIP processing sites were within target levels but one processing site was outside the NHS Prescription Services’ targets due to high value errors in some accounts. Again, there was variance in accuracy at individual account level.

NHS Prescription Services implemented a range of solutions earlier this year seeking to resolve processing issues that had been identified. The effectiveness of these solutions is currently being evaluated by NPRC, through an audit of prescriptions dispensed in June 2008. More information will be available in due course.

Improving Accuracy

NHS Prescription Services has agreed to commit significant additional resource of over £1 million to identify and implement sustainable improvements to accuracy and measures to monitor and improve accuracy will account for over 5% of NHS Prescription Services prescription processing budget over the next year. A wide range of accuracy improvement initiatives are being implemented including:

Improving the information resources available to pricing operators including reference material and help desk support and making changes to on-screen navigation to reduce the risk of errors
Increasing targeted checking to improve the level of feedback to staff on accuracy and to support the performance management of individual staff members
Increasing the frequency of accuracy briefings to staff and targeted re-training where checks indicate variable accuracy levels
NHS Prescription Services' staff bonus is being reviewed to put a greater emphasis on accuracy
Particular parts in the process are being reviewed with best practice procedures adopted to minimise errors, for example changes have already been made to the batch preparation stage in the process with NHS Prescription Services internal evaluation showing that changes made have led to improvements.
Introducing additional validation checks to deal with error ‘hot spots' for example at the point of scanning, checks against the Submission document (FP34C) to help ensure the operator places the forms in the correct group (exempt or chargeable).
NHS Prescription Services have engaged the supplier of the Intelligent Character Recognition (ICR) software in a continuous programme of improvement to the performance of the ICR software.

PSNC is working closely with NHS Prescription Services on an ongoing basis to identify problem areas and to find solutions.

Identifying Contractors who may have been affected by Significant Errors to date

The Industrial Statistics Research Unit (ISRU) at the University of Newcastle were contracted by NHS Prescription Services earlier in the year to support them in creating a tool that can be used to analyse contractor accounts to identify those accounts that may have been affected by significant errors linked to implementation problems. The tool assesses accounts against a range of variables, for example changes in average item value, differences in the number of items declared as submitted and NHS Prescription Services count and differences in the number of chargeable items declared versus priced by the system.

The tool has already been used to review all accounts that have been transferred to the CIP pricing system to date. Where the tool has identified an account as having a potential anomaly NHS Prescription Services have committed to reviewing the account. In some cases this may be looking in detail at a specific problem identified by the tool. In other cases, there may be a need to fully re-price an account.

PSNC is currently studying the tool and will be working with NHS Prescription Services to ensure that, subject to the tool being proved effective, account review is completed as soon as possible. In some cases, PSNC expects that the tool will identify that some contractors will have been owed large sums for prolonged periods before all of this work is completed. We will be discussing with the Department of Health arrangements to ensure that in these circumstances an interest component is added to the outstanding sums.

As well as using the tool retrospectively to review payments during the implementation of CIP, NHS Prescription Services are also working to implement the tool as an additional proactive check once an account has been priced. The proactive use of the tool will be implemented from October 2008 prescriptions.

Reviewing Schedules of Payments

It is important for contractors to review the Schedule of Payments received from NHS Prescription Services each month, for example to ensure that payment is as expected, for example the number of items that have been priced and that information on the Schedule of Payments matches declarations made on the submission document, for example the number of MURs conducted. Guidance on interpreting the Schedule of Payments can be found in the online Drug Tariff Resource Centre.

Back to the Main CIP Section

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