Business Services Organisation Roadshow 2018 Agenda Prescription journey

Business Services Organisation Roadshow 2018

Agenda • Prescription journey – Submissions – Coding – Validation – Current issues • Concessionary prices • Future developments • Update from the FPS Information Unit

How to Batch and Submit Your Prescriptions

What Should Be Placed In Amended Batches? • Computer generated forms with prescriber amended item • Quantity, Drug or Presentation • • Prescriber has handwritten additional item Dispensing quantity other than prescribed Item not dispensed Intervention claim

Where should I bundle fully coded hand written forms? • Appropriate fully coded batch

General Batching Issues • Don’t use sellotape, staples or sticky labels • Use current HS 30 forms and don’t swap • Actual number of counted forms endorsed on HS 30 • HS 30’s and address labels can be ordered by email – pharmacystationeryorders@hscni. net

General Batching Issues • Batch all your invoices together and do not attach to prescription forms – Ensure that all invoices submitted relate to the prescription forms in that month. – Endorse the relevant 11 digit prescription form number on each invoice used for claiming payment. – Submit prescription forms in boxes for their security.

The use of Auto-endorsing printers • Ensure the print is at least as dark as the print on the prescription. • Ensure the ribbons are regularly changed. • Faded codes could result in keying errors. • Submissions may be returned where the printing quality is so poor. • Impact on the 30 Day Payment Cycle.

Poor Quality Auto-endorsed Codes

Poor Quality Auto-endorsed Codes

How to Code and Endorse Effectively

Good Coding • Always Code Using Up To Date Codes • Code Or Diamond Every Item • No code or diamond may result in the form being returned to contractor • All Supporting Endorsements Must Be Made On Main Body Of Prescription Form • Always Code In Same Order As Items Appear On Prescription Form

PARTIALLY AUTOCODED • Form was partially autocoded • Manual Data Entry will punch top code

Good Coding • Do Not Code Over Or Deface The 2 D Barcode – Contains Vital Prescribing Information – Enables Auto-Coding – Improves payment accuracy • Code In Black • Code Clearly

Code. Book • Doesn’t Have Codes For All Items • Several Sections – Also provided as separate documents Code Book – – – – Drugs Dressings (including Wound Management) Ostomy / incontinence appliances Catheters Lymphoedema Other Appliances Substitute prescribing supervision codes Minor Ailment Codes (Not included in full codebook)

Coding A code number is a complete endorsement. • It includes • Zero Discount Status • Controlled Drug Fee NB. You must always diamond any items when making a Broken Bulk or OOP claim

dm+d Unit Of Measure Pack Alignment

What is the dm+d & Unit of Measure? • Dictionary of medicines and devices is the UK wide reference source for all products. – dm+d have defined the unit by which volume of products are measured. – Tablets, capsules, grams, ml, doses • Health and care organisations, system suppliers and pharmaceutical companies have complied with these standards since 30 th June 2017. • dm+d populates all the clinical systems • Currently we have inconsistent application of unit of measure and need to align these within the payment system to ensure our packs match GP generated packs/quantities e. g inhalers

dm+d Challenges • Prescribing by dm+d unit of measure/pack size – not in BSO control • Inconsistency due to limitations of previous system • Part packs coded • Started with borderline substances in April 2017 • Moving towards full alignment October 2018

Current methods of validation This validation falls into 4 categories, is carried out on every prescription item. • Has been present in various systems for 20 years 1. Invalid drug code 2. Item over maximum quantity * 3. Targeted checks over £ 200 4. Invalid prescriber

Currents methods of validation • Principal validation was enhanced to include: • Specific drug codes where payment issues were identified • Specific quantities where payment issues were identified • This is carried out manually before the payment is made

Validation moving forwards • Increase autocoding • Full pack alignment to the dm+d pack – October 2018 • Automated Advanced Validation (AVS) – Prescribing / dispensing comparison – Quantity checked against pack size and special container status

What will AVS mean for me? • Increase confidence of our contractors in the BSO payment systems • Putting in place electronic processes to ensure consistent and accurate payment based on BSO payment rules. – Factoring – Rounding – Pack swapping

Inconsistent pack alignment: Examples from April 2018 codebook • Current codebook description Future codebook description • Will code over the number of gauze swabs i. e. multiples of 100 BSO have been working towards implementing AVS for all prescribed items ; products such as gauze swabs will become virtual “special containers” and the AVS will protect against payment of part packs.

April 2018 Code Book Gauze swabs type 13 light BP 1988 8 ply non -sterile x 80 swabs 1181 1 Code over BSO pack =1 Won’t split a pack of 100 swabs D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 26/03/18 1234

Post Pack Alignment October 2018 Gauze swabs type 13 light BP 1988 8 ply non -sterile x 80 swabs D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 1181 80 26/03/18 1234 BSO will treat gauze swabs as a special container. This means that AVS will prevent the payment of a part pack in this case and round up the quantity from 80 to 100 automatically - no need for manual intervention The AVS rules built to assure correct payment

Post pack alignment Gauze swabs type 13 light BP 1988 8 ply non -sterile x 90 swabs D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 1181 1 BSO will treat gauze swabs as a special container. This means that AVS will prevent the payment of a part pack in this case and factor up the quantity from 1 to 100 automatically - no need for manual intervention 26/03/18 1234 The AVS rules built to assure correct payment

Sodium cromoglycate 2% eye drops 13. 5 ml D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 787 14 26/03/18 1234 This is a Part 1 generic item which has a single pack of 14 mls listed on the NI Drug Tariff and it is a special container

Sodium cromoglycate 2% eye drops 5 mls D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 787 14 26/03/18 1234 You should code for the full Drug Tariff pack You must dispense what is on the prescription i. e. 5 mls You will be paid for the full Drug Tariff pack of 14 mls

Sodium cromoglycate 2% eye drops 10 mls D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 787 14 26/03/18 1234 You should code for the full Drug Tariff pack You must dispense what is on the prescription i. e. 10 mls You will be paid for the full Drug Tariff pack of 14 mls

Commonly prescribed items which will be affected by pack alignment

Inconsistent pack alignment: Examples from April 2018 codebook • Current codebook description Future codebook description • Both inhalers above will have codes to be coded over the number of doses Validation will be in place to protect against payment of part packs for items in special containers.

April 2018 BSO code book Salbutamol 100 micrograms/dose breath actuated inhaler CFC free 200 dose Salbutamol 100 micrograms/dose dry powder inhaler 200 dose D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 14564 200 13003 1 26/03/18 1234 Coded over number of doses Coded over number of packs

Following move to pack size alignment Salbutamol 100 micrograms/dose breath actuated inhaler CFC free 200 dose Salbutamol 100 micrograms/dose dry powder inhaler 200 dose D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA xxxxx 200 26/03/18 1234 All inhalers will be coded over number of doses

INHALERS Clenil modulite 100 micrograms/dose inhaler 200 dose 1126 1 Symbicort 100/6 Turbohaler 120 dose 8686 1 Ventolin 100 micrograms/dose evohaler 200 dose 8255 1 D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 26/03/18 1234 April 2018 BSO code book These inhalers are currently coded over then BSO pack of 1

Following move to pack size alignment Clenil modulite 100 micrograms/dose inhaler 200 dose xxxx 200 Symbicort 100/6 Turbohaler 120 dose xxxx 120 Ventolin 100 micrograms/dose evohaler 200 dose xxxx 200 D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 26/03/18 1234 All inhalers will be coded over number of doses

Nasal Sprays Beclometasone 50 micrograms/dose nasal spray 200 doses Mometasone 50 micrograms/dose nasal spray 140 doses Fluticasone furoate 27. 5 micrograms/dose nasal spary 120 dose D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA April 2018 BSO code book 7747 1 12821 1 13332 1 26/03/18 1234 These nasal sprays are coded over BSO pack of 1

Nasal Sprays Following move to pack size alignment Beclometasone 50 micrograms/dose nasal spray 200 doses Mometasone 50 micrograms/dose nasal spray 140 doses Fluticasone furoate 27. 5 micrograms/dose nasal spary 120 dose D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA xxxx 200 xxxx 140 xxx 120 26/03/18 1234 All nasal sprays will be coded over number of doses or mls depending on their UOM

Ear/Nose sprays April 2018 BSO code book Otomize ear spray 5 mls Xylometazoline 0. 1% nasal spray 10 mls Sodium chloride 0. 9% nasal drops 10 mls D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 6505 1 157 1 6369 1 26/03/18 1234 All these preparations are coded over BSO packs =1

Ear/Nose sprays Otomize ear spray 5 mls Xylometazoline 0. 1% nasal spray 10 mls Sodium chloride 0. 9% nasal drops 10 mls D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA xxxx 5 xxxx 10 26/03/18 1234 Unit of measure following move to pack size alignment All these preparations will be coded over the number of mls in the pack

Gaviscon infant sachets April 2018 code book Gaviscon infant oral powder sachets 15 dual dose sachets {BSO pack is 30) 1992 30 Sodium alginate 225 mg/dose/magnesium alginate 87. 5 mg /dose oral powder sachets sugar free 15 dual dose 18811 15 D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 26/03/18 1234 Branded and generic products are coded over different units of measure

Gaviscon infant sachets Gaviscon infant oral powder sachets 15 dual dose sachets {BSO pack is 30) xxxx 15 Sodium alginate 225 mg/dose/magnesium alginate 87. 5 mg /dose oral powder sachets sugar free 15 dual dose 18811 15 D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 26/03/18 1234 Unit of measure following move to pack size alignment Branded and generic products will both be coded over the number of dual sachets

Appliances April 2018 code book Cavilon Durable barrier cream 92 g Tubifast 2 -way stretch stockinette 7. 5 cm 5 m D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 7910 1 9258 1 26/03/18 1234 These appliance products are all coded over BSO unit of measure pack size =1

Appliances Cavilon Durable barrier cream 92 g Tubifast 2 -way stretch stockinette 7. 5 cm 5 m D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA xxxx 92 xxxx 5 26/03/18 1234 Unit of measure following move to pack size alignment These appliance products are all coded over the dm+d pack size

Appliances April 2018 code book Instillagel (Clini. Med Ltd) 60 mls 10 x 6 mls D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA xxxx 10 26/03/18 1234 This appliance is currently coded over BSO pack =10

Appliances Unit of measure following move to pack size alignment Instillagel (Clini. Med Ltd) 60 mls 10 x 6 mls D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA xxxx 60 26/03/18 1234 This appliance will be coded over 60 (mls) and the “special container” status assigned to the sub-pack of 6 mls

When is this happening? • October 2018 • Lots of communication prior to this – Information packs – Frequently asked questions – Highlight the most commonly dispensed items which will be affected

What does this mean to you? • You must: 1. Update BSO codes in your dispensing system each month 2. Always refer to the updated codebook.

What Can You Do? • Keep forms in the amended batches to a minimum • Communicate with the prescriber to correct amendments on repeat items • Don’t automatically substitute items without getting prescribing amended • Apply your system supplier updates as soon as you receive them. • Check the code book to ensure you code the correct quantity/unit of measure

How to Code and Endorse Effectively Part 2

Endorsements • • ZD / CD Only need to endorse if item has no code Endorse on main body of form, not in coding column Only endorse ZD on items listed on ZD list in NI Drug Tariff Do not endorse ZD on items not listed on ZD list.

CODING ASSORTED FLAVOURS • Code 98765 over the number of additional fees being claimed • Always code 98765 as last item in coding area • Contractors must endorse on main body of form: • Number of flavours dispensed • Assorted flavours must be requested by prescriber • Place in appropriate multiple dispensing batch

Place in Multiple Dispensing Batch Place in Multiple Dispensing Fortisip Compact Protein liquid (mixed flavours) Bottle 125 ml 2 Daily mitte 56 4 flavours dispensed Fortisip Yogurt Style liquid (mixed flavours) Bottle 200 ml 1 Daily mitte 28 4 flavours dispensed D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 18581 7000 EACH ITEM CODED AS NORMAL 6473 5600 98765 6 ADDITIONAL FULL DISPENSING FEE CLAIM (8* – 2** = 6) 23/06/18 1234 * Total Number of flavours dispensed on prescription ** You receive 1 full dispensing fee by coding each type of food

Place in Multiple Dispensing Ensure Plus (mixed flavours) Yoghurt Style liquid mitte 56 x 220 ml 2 Daily Dispense weekly DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 54321 9 98765 2 13/06/18 12 Fees 3 flavours dispensed D O Getwell 4393 12320 ITEM CODED AS NORMAL ADDITIONAL MULTIPLE DISPENSING FEE CLAIM ( 12 – 3 = 9 ) ADDITIONAL DISPENSING FEE CLAIM (3* – 1** = 2) 13/06/18 1234 * Number of flavours dispensed on prescription ** You receive 1 full dispensing fee by coding the food

Place in Multiple Dispensing ITEM CODED AS NORMAL Clarithromycin 125 mg/5 ml oral suspension Take 5 mls twice a day mitte 280 ml 27 280 98765 1 ADDITIONAL DISPENSING FEE CLAIM 1* * Number of additional dispensing required due to shelf life of product D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 10/07/18 1234 In this case reconstituted product lasts 14 days and prescribed quantity is for 28 days

Broken Bulk can be claimed in respect of: 1. Drugs and preparations not listed in part 2 (Chemical Reagents) of NI Drug Tariff 2. Incontinence & Ostomy appliances Endorsing prescription: 1. Always diamond the item 2. Endorse BBC, Pack size & date 3. Endorse remaining pack BBC & date 4. Always refer back to open claims

Accupro Tabs 20 mg 1 Daily mitte 28 ALWAYS DIAMOND BBC 4/8/18 PACK 60 ENDORSE BBC DATE OF DISPENSING PACK SIZE D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 4/08/18 1234

Out of Pocket Expenses Can be claimed in respect of: 1. Drug Tariff Part 1 category “C” drugs 2. Drugs not listed in Part 1 3. Reagents and appliances with no Tariff price 4. Oxygen

Out of Pocket Expenses Endorsing the prescription: • Always diamond the item • Endorse OOP, admin charge, postage & VAT • Endorse ingredient cost (excluding VAT), if item has no code • Must provide supporting invoice for OOP costs • Endorse prescription serial number on invoice • Oxygen rental claimed on PO 1 form

HOW TO ENDORSE AN OUT OF POCKET CLAIM Always Diamond The Item Accupro Tabs 20 mg Mitte 60 Endorse on main body of prescription the following: One to be taken daily • OOP • Cost if item has no code • Admin Cost • Post Cost • VAT OOP ADMIN £ 10 POSTAGE £ 12 VAT D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 9/01/17 1234

Current Issues ZD ENDORSEMENTS • Endorsing ZD on all diamonded items. • Endorsing ZD on all items where you didn’t receive discount. • Pricing staff will just start to ignore all your ZD endorsements. • Only items on ZD list allowed.

Current Issues Trimovate Cream • Only unlicensed product currently available. • Contractor must ensure prescriber is aware that unlicensed product being dispensed. • Diamond item • Endorse price • Claim OOP if required • Provide supporting invoice for ingredient and OOP claim.

Current Issues Auto-endorsing Good Practice 1. Ensure That Printer Is Properly Aligned 2. Replace Printer Ribbon When Auto-Endorsement Becomes Faint. 3. Auto-endorsed Codes Should Be At Least As Dark As The Print On The Prescription

Current Issues Part 1 Generics Prescribed By Manufacturer 1. Contractors must still code using appropriate Part 1 generic code 2. The addition of a specific manufacturer to the generic drug description does not change the items status from being a Part 1 item. 3. This is in line with how the BSA would reimburse same prescription in England

PART 1 GENERIC PRESCRIBED BY MANUFACTURER Losartan 50 mg tablets (Accord Healthcare Ltd) 1 Daily mitte 28 D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 591 28 4/08/18 1234 ALWAYS CODE USING APPROPRIATE PART 1 CODE

Current Issues Endorsing Specials 1. Diamond item 2. Endorse on main body of prescription: 1. Ingredient cost excluding VAT & any OOP claim 2. ZD 3. OOP if applicable 3. Do not use labels from suppliers 4. Ensure invoice supplied relates to prescription

HOW TO ENDORSE A SPECIAL Always Diamond The Item Melatonin Oral Soln 1 mg/ml 10 mls at Night mitte 2 x 200 ml £ 443. 02 OOP ZD Claim Endorse on main body of prescription the following: ADMIN £ 20 POSTAGE £ 12 VAT D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA ZD 9/01/17 1234 • Ingredient cost of item excluding VAT • OOP • Admin Cost • Post Cost • VAT

COST EFFECTIVE CHOICE Kid. Mel or Neomel Always Diamond The Item Melatonin Oral Soln 1 mg/ml 10 mls at Night mitte 2 x 200 ml £ 63. 60 OOP ZD Claim Endorse on main body of prescription the following: ADMIN £ 20 POSTAGE £ 12 VAT D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA ZD 9/01/17 1234 • Ingredient cost of item excluding VAT • OOP • Admin Cost • Post Cost • VAT

HOW TO ENDORSE A SPECIAL Invertase Oral Liquid 11, 600 units/ml 2 mls QID with meals mitte 720 ml Real example of obtaining the same product from two different suppliers ZD £ 9, 200 £ 720 OOP ADMIN £ 65 £ 20 ADMIN VAT D O Getwell DR DO GETWELL 1 A HEALTH ROAD BELFAST BT 17 1 DA 9/01/17 1234

Concessionary Prices

Concessionary prices • Northern Ireland pay concessionary prices as set by DH (England) • Over the last 12 months: – Increasing volume – Increasing number of “late” awards • BSO has introduced the following arrangements: – Late concessionary prices are paid by an exceptional monthly BACs payment (November 2017) – Temporary special advance of £ 2, 500 paid to all contractors with January 2018 prescription (payment made February 2018)

Individual Contractor Report Now includes month following feedback from contractors

Individual Contractor Letter

HSC Trust Medicines Adherence Pathway • Specialist Case-management Pharmacist per Trust • Accepting referrals from all HSC staff for patient’s >65 yrs living in their own homes • District Nursing/Reablement/social work/care package • Stroke Rehabilitation Team/ Care Management Team • Hospital (acute/intermediate care) staff etc • Completes comprehensive assessment with patient and family/carers in patient’s own home TRUST WHSCT SHSCT NHSCT BHSCT SEHSCT Adherence Pharmacist Pauline Mc. Caffrey medicinesadherence@westerntrust. hscni. net Joanne Mc Gennity medicinesadherence@southerntrust. hscni. net Áine Cunningham medicinesadherence@northerntrust. hscni. net Sharon Johnston medicinesadherence@belfasttrust. hscni. net Jean Patterson medicinesadherence@setrust. hscni. net Geographical Catchment Omagh, Strabane, Castlederg Craigavon, Banbridge, Lurgan and Portadown. East Antrim- Newtownabbey, Larne, Ballyclare, Carrickfergus and Whitehead South Belfast Bangor, Holywood

Future Developments Cryptocard rollout • Enables access to: – Secure email – Portal – ECR

E-pharmacy Business Case ELECTRONIC TRANSMISSION OF PRESCRIPTIONS (ETP) ENHANCED COMMUNICATIONS Email to facilitate secure communications to and from pharmacies, GPs and Department of Health. Prescriptions will be sent electronically from GP surgeries to nominated pharmacies where they are dispensed. Financial Claims sent from the system to the FPPS. ETP application integrates with PMRs. ENHANCED SERVICES INFRASTRUCTURE The delivery of additional applications, running on the same infrastructure platform as ETP. In scope: Minor Ailments and Medicines Adherence. An enduring infrastructure solution that enables and supports Community Pharmacy modernisation first and foremost; but is also scalable to accommodate modernisation. Copyright © 2018 Accenture. All rights reserved. 79

Changes within the BSO Information Unit Martin Mayock

FPS Information Unit – Pharmacy Data & Analysis • Staffed by BSO data specialists and NISRA statisticians • A range of financial and contractor statement information sent to customers following each payment • COMPASS Report • Notable statistics productions are open data format – GP Prescribing Data – most popular download on Open Data Northern Ireland – Annual Prescription Cost Analysis – provides cost and volume breakdown at item level of all primary care prescribing in Northern Ireland • Currently no Official Statistics publications

Future Statistical Plans • Compendium Report to be Released in June 2018 – High level information only • Future reports could be “focus on” format – looking at specific prescribing areas of interest, e. g. Antibiotic prescribing, diabetes prescribing, antidepressant prescribing • Potential to move to monthly Prescription Cost Analysis.

“Focus on” series • Occasional reports focusing on a range of different topic areas, similar to those produced by NHS Digital

Future Developments FPS Compendium Prescription Items 40 le p am y x E nl O 35 30 20 17 6/ 20 1 20 5/ 20 1 /1 20 14 Financial Year 16 5 4 /1 20 13 3 /1 20 12 2 /1 20 11 1 /1 20 10 /1 0 25 20 09 Number of Prescription Items (millions) 45 le p am y x E nl O

Summary and close