Pharmacists given discretion to dispense urgent items on mixed prescriptions in ‘confusing’ HRT prepayment certificate guidance  

The Pharmaceutical Services Negotiating Committee says it is “totally unacceptable” to expect stretched community pharmacies to deal with the government's rules over mixed prescriptions and the new HRT prepayment certificate.
Boots prescription counter

The UK government is pressing ahead with plans to launch the prepayment certificate (PPC) for HRT, despite criticism that there is no IT infrastructure to support it.

However, the Pharmaceutical Services Negotiating Committee (PSNC) has warned that introducing the PPC without supportive IT systems in place will risk “causing confusion” for some patients, “adding to the burden” for pharmacy teams.

There has also been confusion over how to handle combined prescriptions for patients who held a PPC, but in final guidance published on 22 March 2023, the Department of Health and Social Care (DHSC) said pharmacists may dispense urgent items “at their discretion” on a mixed prescription — which includes both HRT and non-HRT medicines — where a patient holds a HRT PPC.

The 12-month certificate, which will be available in England from 1 April 2023, is priced at £18.70 (the cost of two single prescription charges).

If a patient holds a valid PPC and presents a mixed prescription, the DHSC guidance says the prescription should normally be returned to the prescriber so that separate prescriptions can be issued.

“HRT and chargeable items cannot be dispensed from a single prescription where the patient is claiming exemption from charges because they hold a valid HRT PPC,” it says.

However, it gives pharmacists discretion to dispense just part of the prescription if needed.

The DHSC guidance advises: “If the non-HRT items are urgent, the appropriate charge should be levied. If the HRT items are urgent, these can be dispensed free of charge against a valid HRT PPC.

“Items not supplied should be marked ‘not dispensed’ or ‘ND’. The patient should then request new prescriptions for any items not dispensed and complete the exemption page of the prescription form/token accordingly,” it adds.

However, in a statement published on 24 March 2023, following the guidance’s publication, the PSNC said it had warned the DHSC “at the earliest opportunity” that suppliers needed advance notice to update their IT — for example automating the issuing of listed HRT medicines as single-item prescriptions — but that the DHSC had yet to confirm when this would happen.

Janet Morrison, chief executive of the PSNC, commented: “The HRT PPC being introduced by the government [in April 2023] is a positive development for patients — indeed, we argued that these medicines should have been made available for free — but NHS systems have not kept pace with policy, meaning the certificate is launching without the IT in place to support it.

“This is totally unacceptable: community pharmacies cannot on the one hand be subjected to funding cuts, but on the other hand be expected to keep picking up the pieces when the DHSC and NHS launch policies without having the infrastructure in place to effectively implement them.”

The HRT PPC will be able to be used against any DHSC-listed HRT medicine licensed for the treatment of menopause and will be available to purchase through the NHS Business Services Authority website or from selected pharmacies.

Last updated
The Pharmaceutical Journal, PJ, March 2023, Vol 310, No 7971;310(7971)::DOI:10.1211/PJ.2023.1.179799

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