Real-time exemption checking (RTEC)
Real-time exemption checking (RTEC)
To date, there has not been a ‘live’ technical solution for a pharmacy team to check a patient’s active prescription exemption status. Soon, real-time exemption checking (RTEC) will enable pharmacy PMR systems to automatically check a patient’s exemption status in the background while the prescription is being processed in the PMR system.
Where RTEC identifies the patient as being exempt from prescription charges, the patient will not need to complete a declaration on an EPS token.
How will RTEC work?
The system uses data on people’s prescription charge exemption status, held by the NHS Business Services Authority (NHSBSA). The check of the NHSBSA data will usually occur automatically at the time the prescription is being processed in the PMR system to produce dispensing labels, but PMR suppliers have some flexibility about the point that the data will be requested from the NHSBSA using an Application Programming Interface (API) built into the PMR system.
Pharmacy staff will not normally need to check the patient’s exemption status more than once, but a second check will be possible, if the patient queries the initial status returned by the NHSBSA system. If the patient believes they are exempt from prescription charges, but RTEC returns no exemption information, the patient will complete a declaration on an EPS token in the normal way.
If a prescription is confirmed by RTEC as exempt, it will be treated as such by the NHSBSA and no further prescription exemption checks will be applied and the patient will not need to complete a declaration on an EPS token.
The benefits of RTEC
Through the operation of the system described in the above diagram, it is expected that RTEC will:
- reduce the risks of contractor loss caused by pharmacy staff inadvertently submitting EPS prescriptions with a paid status when the category should have been exempt;
- enable a reduction in the number of EPS tokens which have to be printed, completed by patients and then be sent from pharmacies to the NHSBSA;
- provide a more efficient digital process for pharmacy staff, reducing the time spent helping patients complete declarations, checking physical evidence of exemption status and sorting tokens for submission to the NHSBSA;
- reduce the risk to the NHS of prescription fraud due to a decrease in false prescription exemption claims; and
- increase convenience for patients, as there will be less need for them to provide physical proof of exemption from prescription charges
RTEC roll-out process (updated October 2019)
Four community pharmacy contractors piloted Real-time Exemption Checking (RTEC) from February 2019. Those teams can now digitally check whether patients are eligible for free prescriptions (because they hold specific exemptions) using the new RTEC system. NHS Digital worked with the NHS Business Services Authority (NHSBSA) and Positive Solutions (PSL) Analyst system to develop the RTEC system.
A small number of additional contractors using PSL have also started to use RTEC.
More than 3,700 patients were confirmed as exempt during the opening stage of the pilot, meaning those patients did not have to be asked whether they pay for prescriptions or to sign a declaration.
PSNC believes there will be clear benefits to pharmacy teams and patients when RTEC is more widely rolled out, reducing the burden of the current prescription charge exemption system which pharmacy contractors are required to operate.
Initially, those pharmacy teams that use the Positive Solutions pharmacy system will be able to use RTEC. Other pharmacy system suppliers are working with NHS Digital to introduce the RTEC feature in their software.
The RTEC system is being rolled out in phases:
- Phase One comprises maternity, medical, pre-payment, low income scheme and HMRC exemptions;
- Phase Two will include all Department for Work and Pensions (DWP) exemptions, including Universal Credit; and
- Once the first two phases are complete, NHS Digital plans to conduct a prioritisation and costing exercise to explore the possibility of including the Education and Ministry of Defence exemptions in the system.
Further roll-out is anticipated in the coming months, initially amongst those contractors which use the Positive Solutions system.
RTEC and maternity exemption information
Community Pharmacy Patient Safety Group (CPPSG) have highlighted that RTEC will not provide the specific exemption status to the pharmacy, as explained earlier, a check will provide either ‘unknown’ or ‘exempt’. In the past, some pharmacy teams may have used patients’ maternity declaration to help identify some of those patient which were pregnant or breastfeeding. While this was not the only or a guaranteed source of information, it may have sometimes assisted in clinical decision making relating to this group of patients.
CPPSG have produced a Real time exemption checking and maternity resource: poster and factsheet for pharmacy teams. The resource:
- Reminds pharmacy teams to encourage patients to notify healthcare professionals if they are pregnant or breast feeding.
- Includes a patient-facing poster to promote this amongst patients.
- Reminds pharmacy teams that: women who miscarry or have a stillborn child are eligible for free NHS prescriptions until their maternity exemption certificate expires; and pharmacy teams should use expert clinical judgement and compassion when having difficult conversations.
- Includes links to additional resources relating to dispensing for this group of patients.
PSNC is supportive of future standards and systems seeking opportunities to better enable a more seamless transfer of the information that patients expect should be transferred (e.g. that where pregnant women update their health record with their status, that the staff caring for them have sight of information where it is needed).
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