Real-time Exemption Checking – how will it work?

Real-time Exemption Checking – how will it work?

October 27, 2018

Earlier this month, the Department of Health and Social Care made an announcement on action which would be taken to reduce fraud against the NHS; this would include digitising information on exemption from prescription charges, via a project being undertaken by NHS Digital and the NHS Business Services Authority (NHS BSA), in collaboration with pharmacy PMR system suppliers. This project – known as Real-time Exemption Checking (RTEC) – has attracted a lot of media attention and comment, but the full detail of how RTEC will work has not been explained in the coverage of the announcement, leading to some misunderstanding of what will start to be implemented in 2019.

PSNC believes there will be clear benefits to pharmacy teams and patients when RTEC is rolled out, reducing the burden of the current prescription charge exemption system which pharmacy contractors are required to operate. This article explains how RTEC will operate and how the benefits it will bring to pharmacy teams and patients will be delivered.

How will RTEC work?

The system uses data on people’s prescription charge exemption status, held by the NHS BSA. The check of the NHS BSA 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 NHS BSA 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 NHS BSA 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 NHS BSA 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 NHS BSA;
  • 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 NHS BSA;
  • 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.

Roll-out plans

The system will be rolled out in phases:

  • Phase One will comprise 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 when they become available; 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.

Testing

NHS Digital and NHS BSA are working with several PMR suppliers to test this functionality; a pilot with one supplier is scheduled for late 2018. It is expected that all PMR system suppliers will work to update their systems to incorporate RTEC during 2019.

PSNC will provide further information on progress with the testing and rollout of RTEC as it becomes available.

 



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