Home Endorsing and Submission
Release 2 will support the electronic submission of prescriptions to NHS Prescription Services for reimbursement. Only electronic prescriptions can be sent to NHS Prescription Services for reimbursement therefore until the regulations change, initially it will only be those prescriptions that have been sent to a patient's nominated pharmacy that should be forwarded to the NHS Prescription Services electronically for reimbursement.
To support the electronic submission of prescriptions for reimbursement, there will be a number of subtle changes to the arrangements for endorsing and submitting prescriptions for pricing.
Quick Links:
Endorsement Information Required by NHS RxS
Including Prescription Charge Exemption Information in the e-Reimbursement Claim
Common Problem: Supplementary Product Information in Dosage Instructions
Payment Window for e-Prescriptions
When to send e-Prescriptions for Reimbursement
Completing FP34 and the Submission Process
Accuracy of Prescription Pricing
Information Required by NHS Prescription Services to Price Prescriptions
The information required to be sent to the NHS Prescription Services electronically is, as now, only the essential information required to price prescriptions. Information on the dispensed product, where required, will be provided to NHS Prescription Services using the dm+d code for the product.
Other endorsements will also be required, in the same way as now, for example endorsements to claim broken bulk or out of pocket expenses or the NCSO concession. Pharmacy systems will support pharmacy staff in making these endorsements electronically.
Useful resources:
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EPS R2 Endorsement Guide (this is due to be updated shortly to reflect recent Drug Tariff simplification changes)
Some pharmacy contractors currently make endorsements manually by hand without any support from their pharmacy systems. In these cases, pharmacy staff will in future be required to use their pharmacy system to make endorsements electronically.
| Product Type Prescribed | Information Required by NHS Prescription Services |
| Generic Product listed in Part VIII of the Drug Tariff |
VMPP or 'nothing'* |
| Generic Product which is not listed in Part VIII of the Drug Tariff | AMPP or AMP |
| Branded product | AMPP or 'nothing'* |
| Appliance prescribed generically and only listed generically in the Tariff (e.g. Absorbent Lint BPC) |
VMPP or 'nothing'* |
| Appliance prescribed generically but listed by Brand name in the Tariff |
AMPP, AMP or 'nothing'* |
| Appliance prescribed by Brand Name(but listed generically in Tariff) | AMPP or VMPP of the dispensed item, or AMP or 'nothing'* |
*When the dispenser submits 'nothing' in the reimbursement claim message, the pharmacy system will default to the dm+d code for the prescribed item.
Prescription Charge Status
In addition to the current endorsing information, pharmacy staff will also have to mark whether a prescription charge was levied for a prescription, and where relevant the prescription charge exemption category and whether evidence of exemption was seen. The exception to this is where the patient is age exempt and the patient's date of birth is included in the electronic prescription message.
Pharmacy system suppliers have flexibility in the way they support pharmacists in entering this information, for example if pharmacy staff have already recorded the details of a valid exemption certificate, for example a pre-payment certificate, the system could be set to pre-populate this information on the system - the pharmacy would still be required to collect the patients exemption declaration on the prescription or dispensing token where required.
Common Problem: Supplementary Product Information included in Dosage Instructions
Occasionally, prescribers include supplementary product information, for example a brand or manufacturers name or an indication that a sugar free or preservative free prescription is required as part of the dosage instructions rather than as part of the name of the prescribed product, for example:
10ml Hypromellose 0.3% Eye Drops
Insert one drop into both eyes
four Times a day Preservative-Free
Reimbursement of electronic prescriptions will be based on the product code of the prescribed product, therefore, supplementary product information included in the prescriber's dosage instructions will not be considered when calculating payment. If electronic prescriptions are received with supplementary product information in the dosage instructions, the prescriber should be contacted so that the item can be cancelled and a new electronic prescription generated using the correct product code.
Payment Window
For paper prescriptions, NHS Prescription Services consider for payment all items included in the physical bundle submitted in a given month.
For electronic prescriptions, for a given month, NHS Prescription services consider for payment, all electronic prescriptions where items have a dispensing notification date up to and including the month concerned and where the claim message was received by NHS Prescription Services up to midnight on the 5th of the following month. For example:
A form and item sent to NHS Prescription Services on the 5th September but dispensed in August (e.g. dispensing notification date = 29th August) would be included with August prescriptions.
A form and item sent to NHS Prescription Services on the 5th September and dispensed in September (e.g. dispensing notification date = 2nd September) would be included with September prescriptions.
Note, a claim message cannot be sent to NHS Prescription Services until a dispense notification message has been sent for every item on the form. If the product is not going to be dispensed or is only going to be part dispensed, the dispense notification message can be sent carrying this information.
When to Send e-Prescriptions for Reimbursement
The definition of 'dispense' used in discussions on the EPS is 'both the preparation and issue of medication items on a prescription'.
When a prescription is dispensed and the prescription is being submitted for pricing electronically, there are two messages that should be sent to the Spine, 'a dispensed notification' message and a 'reimbursement claim' message which includes endorsement information and information on the prescription charge status of the prescription. At present, pharmacy staff have the option of putting a prescription to one side on the dispensing bench, for example if pharmacy staff are waiting for an invoice to endorse the price paid for a product on the prescription or if a product is in short supply but the NCSO Concession has not yet been granted. In the same way, pharmacy staff will be able to choose to delay submission of the 'claim' message until the required additional information is available.
Some pharmacy contractors may prefer that staff, for example locums, do not submit the 'claim' message at the same time as the 'dispensed notification' message to allow the contractor time to check that a prescription has been endorsed fully and appropriately before submission. Pharmacy systems will provide pharmacy staff with a list of electronic prescriptions which have not been submitted for reimbursement so that these can be completed and submitted when appropriate. Once a claim message has been submitted, it cannot be amended, if a problem is identified, contractors should, as now, contact NHS Prescription Services as soon as possible to report the problem.
Pharmacies will have to continue submitting paper prescriptions (and tokens where required) to NHS Prescription Services on a monthly basis.
Submission Process
The FP34 Submission Document will continue to be the official means of claiming payment and contractors should complete the document as follows:
At the end of the month, pharmacy contractors must use this form to declare the combined total of paper and electronic prescriptions, for both messages and items, being submitted to the NHSRxS for reimbursement.
For paper prescriptions, the numbers declared should relate to the prescription forms and items that are physically included in the bundle (including returns). The number of items declared should be adjusted to take into consideration any additional fees due (for example if an HRT product normally attracts 3 fees, it should be counted as 3 items).
For electronic prescriptions, the numbers declared should relate to the submission of electronic forms and items with a dispensing notification date up to and including the month concerned and where the claim message was received by NHS Prescription Services up to midnight on the 5th of the following month. The number of items declared should be adjusted to take into consideration any additional fees due (for example if an HRT product normally attracts 3 fees, it should be counted as 3 items).
Using this basis to calculate the number of items will ensure correct advance payment, however if contractors do not calculate the number of items correctly, it is a self-correcting process and the contractor will be paid correctly via the final payment.
Paper prescriptions and prescribing/dispensing tokens, should continue to be submitted to NHS Prescription Services on a monthly basis where necessary. Tokens must be submitted to NHS Prescription Services in the same month that the corresponding electronic prescription has been submitted electronically. When tokens are submitted, the 'ETP Token for non-payment' box on the FP34C Submission document should be ticked. Guidance on sorting prescriptions and tokens for submissions can be found on the FP34C Submission document.
Although different members of the pharmacy team may submit the 'reimbursement claim' messages for electronic prescriptions, in the same way that different members of staff may support the endorsement of paper prescription forms, the paper FP34C submission document will continue to be the form on which the official claim for payment is made. By signing and dating section 3 of the submission document and including the pharmacy stamp, a contractor or the person authorised to sign on his behalf is declaring that all of the endorsement information provided in the 'reimbursement claim' messages and on the paper prescription forms submitted is correct and accurate and that the contractor is entitled to claim payment in accordance with the relevant provisions of the Terms of Service contained in the NHS (Pharmaceutical Services) Regulations 2005.
Resolving Issues
In some scenarios, NHS Prescription Services return prescriptions or copies of prescriptions to pharmacy contractors where there is insufficient information on the prescription form to process the prescription. Initially, it will not be possible for NHS Prescription Services to electronically return prescriptions submitted electronically. As an interim measure, NHS Prescription Services staff will contact pharmacies by telephone to try and resolve issues that arise. If required, NHS Prescription Services will send a paper representation of the claim to the pharmacy so that amendments can be made and the paperwork sent back to NHS Prescription Services. The return of electronically submitted prescriptions for clarification where required is an anticipated future enhancement of the service.
Schedule of payments
Changes have been made to the Schedule of Payments to support the implementation of EPS Release 2. In future, the Schedule will provide information on the number of prescription forms and items received electronically. This information will appear in the 'Prescription Data' section which is normally on page 2 of the Schedule. These fields are only visible on the Schedule where some electronic prescriptions have been received by NHS Prescription Services electronically.
The numbers provided will relate to the physical receipt of electronic forms and items identified with a dispensing notification date up to and including the month concerned and where the claim message was received by NHS Prescription Services up to midnight on the 5th of the following month. These figures have not been adjusted to take into consideration any additional fees due, for example if an HRT product normally attracts 3 fees, it will be counted as 1 item on the Schedule of Payments for this purpose. Also, this figure will exclude any paper tokens for non-payment received by NHS Prescription Services for audit purposes.
To support pharmacy's in reconciling the schedule of payments with their submission form, NHS Prescription Services are giving consideration to whether information can be added to the Schedule on the number of items received electronically for which a fee has been received (i.e. the number adjusted to include additional fees that have been paid).
Payment Timescales
At present, one month after the FP34C Form is submitted; pharmacy contractors receive an 80% advance payment for prescriptions sent to NHS Prescription Services with a deduction for prescription charges collected. One month later, once the prescriptions have been priced, pharmacy contractors receive the remainder due for the prescriptions in question.
There will be no change to this payment timescale with the introduction of EPS Release 2. PSNC continues to hold the view that the Government should pay community pharmacies more quickly and hopes that in the long term, the efficiencies offered by the EPS to NHS Prescription Services will translate into quicker payments for pharmacy contractors.
Accuracy of Prescription Pricing
When prescriptions are received electronically by NHS Prescription Services they will be routed to a 'rules engine' which will support the automatic processing of prescriptions for pricing. It is hoped that this will improve the accuracy levels of prescription pricing as there will be less scope for human error which is a particular problem with current paper based processes.
PSNC has a key role in conducting external audits of the accuracy of NHS Prescription Services' prescription pricing. PSNC is in discussion with NHS Prescription Services on the audits that will be conducted in future on the automated pricing of prescriptions submitted electronically.
- Dispensing sites will have 65 days to submit an electronic reimbursement claim message after the final dispense notification for an item. After this time, an electronic claim will be rejected and a manual claim must be sent to NHS Prescription Services.
- A prescription which has been left marked as partially-dispensed or owing will have its status changed to 'expired' 6 months after the last dispensing event. After this time an electronic reimbursement claim will be rejected and a manual claim must be sent to NHS Prescription Services. If further dispensing events are required, the patient should be referred to the prescriber so that a new prescription can be issued. (NB: The RPSGB has issued guidance on the legal validity period for owing slips which depends on whether the prescription is for a Controlled Drug or not. Guidance on the legal validity period for owings differs from the Spine's housekeeping rules.)
- A prescription which is held on the Spine with no items dispensed will be changed to 'expired' after the expiry date of the prescription and the prescription will not be available to be dispensed. If dispensing is required, the patient should be referred back to the prescriber for a new prescription. Expired prescriptions will be held on the Spine for three months after expiry with no processing allowed on these items. If an attempt is made to 'pull down' the item for dispensing, the pharmacy will be sent a rejection message informing the pharmacy staff that the prescription has expired.
Frequently Asked Questions
Q: I have recently upgraded to EPS Release 2, do I need to record a patient’s exemption status in the electronic prescription claim message returned to NHS Prescription Services?
A: Yes. In EPS Release 2, pharmacy staff must mark every electronic prescription to indicate whether a prescription charge was levied, and where relevant indicate the prescription charge exemption category and whether evidence of exemption was seen. Where the patient is not age exempt, the patient’s exemption declaration also needs to be collected on either a prescription or dispensing token and submitted to NHS Prescription Services along with the monthly paper prescription submission.
NHS Prescription Services base payment solely on information contained in the electronic prescription message, therefore it is essential that prescription charge exemption information is recorded accurately in the electronic message to ensure correct payment.
Pharmacy system suppliers have flexibility in the way that they develop systems to support pharmacy staff in entering this information. Different systems provide different levels of support to pharmacies. This is a key area for pharmacy contractors to engage with suppliers to ensure that systems meet user needs, for example:
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If exemption information hasn’t been recorded in the local system, does your system automatically default to recording electronic prescriptions as ‘paid’ or before allowing a message to be sent for payment, does your system always prompt staff to confirm the prescription’s exemption status to ensure that this is entered correctly?
- If pharmacy staff have already recorded details of a valid exemption certificate in the PMR system, for example a pre-payment certificate, the system could be set to pre-populate this information in the electronic reimbursement claim message, reducing workload. Note, the pharmacy would still be required to collect the patient’s exemption declaration on the prescription or dispensing token, where required.
- Where a system supports auto-population of exemption information, are there controls to ensure that when an exemption certificate expires, pharmacy staff are prompted to check whether the patient remains exempt and input up-to-date information, as appropriate?
- Is there a management screen or system report that allows, at a glance, a sense check that exemption information has been input by staff where required?
Guidance on other areas where pharmacy contractors have reported differences between PMR systems in the usability of the EPS R2 functionality can be found in the PMR Suppliers section of this website.
I have part-dispensed an item and I'm waiting for the patient to collect the remainder. Can I claim for this item?
Pharmacist contractors would be expected to apply their judgement as to when and how much reimbursement to claim, as they do now.
The local prescriber frequently issues prescriptions for 'Ensure Plus' with the instruction 'assorted flavours', will this remain possible in EPS Release 2?
Yes, for food supplement/food replacement products, prescribers will continue to be able to request that a variety of flavours are dispensed. The GP's prescribing system will support the prescriber in issuing a prescription using the products 'Virtual Medicinal Product' name and the prescriber endorsement to request that 'Assorted flavours' are dispensed. The pharmacy will continue to receive one professional fee for each flavour endorsed and dispensed, where assorted flavours are requested by the prescriber.
I have had to dispense a prescription from 2 different packs to make up the requested quantity. In the past, I would just endorse this on the form (e.g. 14 tablets from the 28 pack and 14 tablets from the 56 pack) and this would be taken into consideration when calculating reimbursement. Can I make an electronic reimbursement claim in this way?
Yes, 2 different SNOMED codes can be added to a dispensed "event" so for example if 50 tablets of Drug A were prescribed and the pharmacist has dispensed this quantity from 2 different available packs then the message would state:
Prescribed - Drug A snomed code with quantity of 50
Dispensed - Drug A pack size 1 snomed code with quantity
Dispensed - Drug A pack size 2 snomed code with quantity
I have received a prescription requesting "Levothyroxine Sodium 100mcg tablets (Actavis UK)". Do I have to dispense the Actavis brand and what will I be reimbursed for?
Levothyroxine sodium 100mcg tablets are listed in Part VIII of the Drug Tariff. When a prescription requesting generic "levothyroxine 100 mg tablets" is received the pharmacist can dispense any brand and will be reimbursed according to the Drug Tariff price for the product.
However, where a prescription for a generic product specifies the name of a manufacturer or supplier, legally and ethically that manufacturer's product must be dispensed, and the pharmacist would be reimbursed based on the manufacturer or suppliers list price rather. Out of pocket expenses in procuring the product may be claimed, where appropriate. Guidance on out of pocket expenses can be found in the PSNC Online Drug Tariff Resource Centre.
PSNC has received a number of reports of GPs inadvertently issuing prescriptions in this way because of the way products are listed in the picking-list of their prescribing system. This practice is not in the interests of patients, the NHS or community pharmacies. For example, this could lead to increased prescribing costs and delays in patients obtaining their medicine.
If contractors identify this as an issue in a locality, this is something that should be discussed directly with the prescriber and if necessary, with the PCT.
In EPS Release 2, will my system be able to tell if a particular prescription includes 'no charge' items, for example a paid prescription for different strengths of the same drug?
This is no different to now. The number of fees and charges payable is calculated by NHS Prescription Services – the same pricing processes will be used with paper prescriptions. Likewise, pharmacy system suppliers have flexibility, as now, in how they develop systems to support the process, for example to support the pharmacy for reconciliation purposes.
How will additional endorsements such as 'XP' be handled in EPS Release 2?
Information on the dispensed product, where required, will be provided to NHS Prescription Services using the NHS dm+d SNOMED code for the product.
Other endorsements will also be required, in the same way as now, for example endorsements to claim broken bulk or out of pocket expenses or the NCSO concession. Pharmacy systems will support pharmacy staff in making these endorsements electronically. The guidance that has gone to system suppliers is in line with existing endorsement guidance.
Some pharmacy contractors currently make endorsements manually by hand without any support from their pharmacy systems. In these cases, pharmacy staff will in future be required to use their pharmacy system to make endorsements electronically.
In EPS Release 2 can prescribers view whether an item has been dispensed to a patient?
Under normal circumstances, a prescriber would not be able to view whether an item has been dispensed however, if the prescriber attempted to cancel the prescription/item, they would receive an unsuccessful cancellation response which would indicate that the prescription could not be cancelled, the reason why e.g., "prescription/item was not cancelled - dispensed to patient ".
Can I endorse a prescription 'NCSO' in advance of the NCSO Concession being agreed by the Department of Health?
Yes, where a Part VIII product cannot be obtained at the Drug Tariff price because of a supply problem and a more expensive product has had to be dispensed, the prescription could be endorsed in anticipation of the NCSO Concession being granted. The full endorsement required is the initials, 'NCSO', full details of the product dispensed and the endorsement must be initialled and dated.
NHS Prescription Services will reimburse based on the standard Part VIII price where the product was not been granted the NCSO Concession in the month concerned. The Concession is only granted where there is a significant national shortage. Detailed guidance on the NCSO Concession can be found in the stock shortages section of the PSNC Website.