Real Time Exemption Checking (RTEC)
Real Time Exemption Checking (RTEC)
Real Time Exemption Checking (RTEC) is a technical solution enabling the PMR system to automatically find out whether a patient has a known exemption that can auto-apply to their EPS prescription. If the PMR system confirms an exemption, the EPS prescription is auto-flagged as exempt so that the patient won’t need to make a written exemption status declaration. If the system cannot identify an exemption the pharmacy team and the patient will use the usual process.
RTEC is being rolled out firstly amongst pharmacy contractors that use the Positive Solutions (PSL) Analyst, Invatech Titan, Cegedim and EMIS PMR systems. Other PMR suppliers are also working with NHS Digital and many are progress with testing or rolling out.
How RTEC works
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.
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.
Phasing and pilots
Phasing of RTEC categories rolling out
The RTEC system is being rolled out in phases:
- Phase One comprises maternity, medical, pre-payment, low income scheme and HMRC exemptions (Phase One RTEC is rolling out now amongst contractors with PMR systems that have introduced the RTEC feature);
- Phase Two will include Department for Work and Pensions (DWP) exemptions (excepting Universal Credit) (five pharmacy contractors using PSL have been testing this Phase since December 2019); and
- Phase Three will include Department for Work and Pensions (DWP) Universal Credit exemption.
Once the first three phases are complete, NHSBSA and 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. There is a lower volume of prescriptions which fall into these categories.
Piloting of Department for Work and Pensions (DWP) RTEC
Five pharmacy contractors using PSL have been testing this Phase since December 2019. NHSBSA are working with DWP to further expand the piloting to more pharmacies. PSNC and Community Pharmacy IT Group support the expansion of this to additional pharmacies.
The 2019 RTEC Phase One piloting: PSL
Four community pharmacy contractors piloted Real Time Exemption Checking (RTEC) from February 2019 and acros 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. Following the completion of this pilot PSL progressed to further roll-out of RTEC Phase One to more of their customers (see Rollouts section below).
Rollout progress (updated July 2020)
PSL contractors initially began using RTEC Phase One (see the section above for information about RTEC phasing) in 2019 and other EPS R2 PMR suppliers have also started to test and rollout during 2020 – including Cegedim, EMIS and Invatech Titan. The table below will be updated further as developments continue.
Other pharmacy system suppliers are also working with NHSBSA and NHS Digital for scheduling of testing and then if the later testing is successful a move towards rollout.
|RTEC Phase One exemptions (NHSBSA exemption categories)
||RTEC Phase Two (DWP exemptions first stage)
||RTEC Phase Three (DWP exemptions second stage)|
|Analyst PMR (Positive Solutions (PSL))||Rolling out across 2020 following completion of 2019 pilots.
||Piloting amongst a small number of PSL-using pharmacies||To be confirmed (tbc)|
|Pharmacy Manager/Nexphase (Cegedim Rx)||Rolling out||tbc||tbc|
|ProScript via AAH (AAH)||Limited testing conducted||tbc||tbc|
|ProScript Connect (EMIS Health)||Piloting||tbc||tbc|
|Titan (Invatechhealth)||Phase 1 is now generally available for all Titan PMR customers||tbc||tbc|
PMR suppliers will work with NHS Digtial specification and settings. If pharmacy teams have more detailed questions about when PMR suppliers’ plans you may also refer to the Supplier contact information webpage. The Community Pharmacy IT Group (CP ITG) has encouraged PMR suppliers to pursue the opportunity to progress with RTEC at the earliest opportunity.
Volunteer to be early user
System suppliers are seeking community pharmacy contractor volunteers to take part in Real Time Exemption Checking (RTEC) piloting. This follows the announcement that RTEC is due to be piloted and rolled out across more pharmacy patient medication record (PMR) systems.
Participation in the pilot or earlier roll-out will provide you with an opportunity to provide feedback directly to your PMR supplier and other stakeholders (which could include the NHS Business Services Authority, PSNC and NHS Digital) about how the RTEC feature might best work for your pharmacy team.
Contractors that wish to take part or find out more can email email@example.com with ‘RTEC’ in the subject*. Note, volunteers may be chosen on a ‘first-come-first-served’ basis.
If you are interested in sharing your views on wider digital, IT and EPS developments with PSNC, please consider joining the Community Pharmacy Digital mailing group.
Q. MY RTEC system does not display the specific exemption type. Is that right?
Yes, this is how RTEC is expected to work. When you use RTEC, your PMR system should confirm an RTEC exemption is present (or ‘RTEC yes’) or determine ‘RTEC status unknown’ so that your team can use the usual process. You won’t be able to determine which specific exemption category is present. The last FAQ on this webpage addresses queries relating to maternity and RTEC.
Q. Do I need to submit EPS tokens for prescriptions with an RTEC exemption?
No. The PMR system can apply the RTEC information onto the EPS prescription and therefore those tokens won’t need to be sent to NHSBSA.
Q. Our system performs the RTEC check earlier during the dispensing process and ‘RTEC’ real time exempt was already confirmed on the prescription? Is there a need to check again later if there is a slight gap between dispensing and supply.
No. There is no requirement to check a prescription twice if RTEC already applied to the prescription. See also the question below.
You may inform the patient that an RTEC check has already been performed earlier during the dispensing process which has stamped the prescription RTEC and therefore a penalty notice cannot apply.
Q. Might a patient receive a penalty notice charge if their prescription was real time exempted by the RTEC system at the original time of the RTEC check?
No. Those prescriptions if stamped as real-time exempt by the RTEC system do not require investigation.
Q. My system performs the RTEC check during the dispensing process and originally the RTEC system found ‘unknown’, but the patient now explains they have a new exempt status since (e.g. have just purchased a relevant certificate or they have reached 60 years old)?
There is an ability to re-perform the RTEC check with an override so that the patient can re-confirm their status in a rare scenario such as this, although performing two checks for each prescription is not required, a patient can ask for a second check.
The override option is intended for infrequent scenarios such as when patients may have originally been confirmed ‘unknown’ and have since become exempt.
Q. The patient says that RTEC system should be identifying an NHSBSA exemption but the RTEC system is not finding an exemption?
This can occur if the exemption may no longer be in place or if there is a mismatch between databases e.g. if the patient’s address at the GP practice and their address within NHSBSA records is different or if there is a name mismatch (see question below which explains how patients can update the NHSBSA with their new or correct address/name information).
The NHSBSA’s RTEC patient-facing and pharmacy materials explain for patients to make use of RTEC for NHSBSA exemption categories, patients need to ensure that their address at the GP practice and held by the NHSBSA is aligned. To benefit from using the RTEC system, patients who move address must:
- contact their GP practice to correct their address information; and
- contact NHSBSA to correct their address information.
The prescription charge refund (FP57 form) procedure can apply in scenarios such as where:
- the patient (or representative) requests a refund form;
- the patient (or representative) is unsure whether they are entitled to free prescriptions; or
- the patient (or representative) has applied or will be applying for a prescription charge exemption certificate or prepayment certificate.
Q. What is the process for patients to update their new or correct address/name records held by the NHSBSA?
If patients arrive at your pharmacy expecting RTEC to confirm their BSA exemption but ‘RTEC unknown’ is returned on the PMR system (see also, question above), you may ask patients whether they have moved address and if so, whether both the GP practice and NHSBSA have updated their records following the patient’s request. Additionally you may check whether their name is correct in both places and matching. A mismatch of names could also prevent a positive RTEC confirmation.
Process for patient who need to request NHSBSA update their address: NHSBSA’s contact webpage includes a link to a patient contact NHSBSA webform which patients can use to request their address informaton is updated.
The small print under the ‘Query’ box had explained how patients can update NHSBSA address information, by including the new address in the relevant ‘address’ fields and “including your previous address, including postcode in the query box” (as of early 2020).
Given that the process for the patient and the NHSBSA updating of the NHSBSA address records may take a bit of time, the pharmacy team might need to use the non-RTEC route of capturing exemption (e.g. EPS token declaration etc).
The webform can also be used to request that a name is corrected/adjusted.
Patients can also use the NHSBSA patient checker tool (see question below) to access information about their exemption status. Additional contact information for NHSBSA is set out on the NHSBSA’s contact webpage.
Q. Can patients also check information relating to their own exemption?
Patients may refer to NHSBSA patient checker tool to view some information about their exemption category. Whilst using the tool, patients will enter the postcode held by the NHSBSA into the tool to access their information.
Q. Before RTEC, visibility of maternity exemption status had assisted clinical decision making, but maternity exemption is not visible with RTEC. How is this addressed?
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).
If you have queries on this webpage or you require more information please contact firstname.lastname@example.org. To share and hear views about digital developments with like-minded pharmacy team members, join the CP Digital email group today.
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