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From the front line: Pharmacy exemption checking

The Real Time Exemption Checking service automatically tells pharmacy systems when someone is exempt from paying for their prescriptions. Pharmacist Paul Rolfe looks at how it is improving dispensing for patients and pharmacy staff. 

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Pharmacist Paul Rolfe at work using the Real Time Exemption Checking system

Community pharmacy Birmingham’s is a busy independent pharmacy in Cleethorpes. We receive prescriptions from 14 local GP practices, and we deliver to patients at home in Cleethorpes, Grimsby and the surrounding area.

Our pharmacy counter is also extremely busy, serving patients from the GP practice we share the building with and customers who call in. Many people we serve are exempt from paying for their prescriptions and need to provide evidence and a signature if this is the case.

We are very enthusiastic about using any new advances in technology – we were one of the first community pharmacies to use the Electronic Prescription Service (EPS) – and we have a pharmacy robot as well as dispensing terminals.

The new system works effectively, saving time both in the pharmacy and out on the road

We want to serve our customers as efficiently as possible and help ease the workload for our staff. So the chance to work with NHS Digital and system supplier Positive Solutions to pilot the Real Time Exemption Checking was one that we jumped at.

The pilot scheme was restricted to five of the categories which currently entitle patients to free prescriptions:

  • maternity exemption

  • medical exemption

  • pre-payment certificate

  • HC2 (low income scheme)

  • NHS tax credit

We previously used our computer system to record exemptions and expiry dates, which had streamlined the checking process. Now, as we go through our normal dispensing procedure for EPS prescriptions, the dispensing terminal connects to the NHS Business Service Authority (NHSBSA).

The exemption check happens in the background, without interfering with the dispensing. If the patient has a valid exemption, the system simply tells the team in the pharmacy. And a handy addition is that the supplier has tweaked the software so that ‘Exempt’ is automatically printed on the bag label.

The new system works very effectively, and it does save time – both in the pharmacy and out on the road.

Our counter is often busy, but if a patient has an exemption confirmed by the system then we no longer need to capture their signature. Not having to attach the prescription to the bag with the medicine also helps. More importantly, time is saved at the counter because patients don’t need to look for their certificates, or even their glasses so they can read the back of the prescription.

Our counter staff say that Real Time Exemption Checking is helping them deal with patients quicker and is reducing queues. We used to have lots of conversations with exempt patients who were unsure over which box to tick, with staff explaining the consequences of an incorrect choice. These conversations don’t happen as much now.  I have also noticed that patients are pleasantly surprised that they don’t have to sign for their exemption anymore.

Real Time Exemption Checking  will also help reduce the number of patients who would be fined up to £100 for ticking the wrong exemption box. This was a major source of frustration with our patients.

It helps out on the doorstep as well. It has reduced tension during deliveries, as some patients get annoyed about having to show their exemptions to drivers – “but I showed it last time”. One of our delivery drivers has told me that 40% of his deliveries no longer need the patient to sign as they have had the electronic exemption confirmed.

Real Time Exemption Checking also helps pharmacy staff at month-end as we do not have to send tokens to the NHSBSA if an exemption has been confirmed by the system – they are safely destroyed instead.

Overall, we are having to do a lot less ‘policing’ of the process thanks to Real Time Exemption Checking. It is freeing up time for our staff, as well as reducing potential for confusion and upset for our patients. Even if someone’s status is unknown rather than exempt, the system will flag this up and we will follow our normal dispensing process and have the patient complete a declaration.

Nobody is refused medicine because the system does not know that they are exempt. The patients really do benefit from Real Time Exemption Checking. Any pharmacy should be using it if they can.

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Paul Rolfe

Pharmacist at Birmingham's community pharmacy in Cleethorpes.

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Last edited: 12 February 2020 10:26 am