BRIEFING: WHAT TO DO WHEN PRESCRIBERS JOIN OR LEAVE YOUR PRACTICE
When prescribers (including both GPs and non-medical prescribers) join or leave GP surgeries there is a risk that prescribing information and costs will not be correctly attributed unless the correct notifications occur. Wrongly attributed prescribing costs cannot be retrospectively corrected.
This document links in with other guidance adopted fromthe NHS Business Services Authority (NHSBSA). For relevant contact details please see appendix 1.
Background information about prescribing budgets and prescription forms
The NHS BSA maintains a central database of all GP practices, and the prescribers within them. When a prescriber leaves or joins the practice, the NHS BSA must be notified so that the central database can be kept up to date. If it becomes out of date, then costs of prescribing cannot be charged to the correct budget.
In South Sefton CCG and Southport and Formby CCG the arrangement is that the Primary Care Support team at the NHS England Liverpool office notify the NHS BSA for all GP related changes and the Medicines Management Team notifies the NHS BSA for changes relating to practice employed nurse prescribers, and pharmacist prescribers including those employed by the Practice directly and those working within the CCG Medicines Management team.
Please note that the NHS BSA central database is only for prescribers involved with the practice on a permanent basis – locum or bank prescribers are not included. Please refer to appendix 2 for more information about processes for temporary staff.
About unique identifiers for prescribers
All prescribers are identified in the central database by a unique code.
For non-medical prescribers, this code is simply their registration number for their professional body (the NMC number for registered nurses or GPhC number for pharmacists). NMPs who work in more than one location at the same time should ensure that the correct practice’s N-code or Y-code is also printed on the prescription in each role, alongside the prescriber’s registration number, therefore ensuring that the cost of the prescribing is charged to the correct practice.
For GPs, the unique code is their doctor index number (DIN). This code, unlike the NMC code, cannot be used in multiple practices, so if a GP is working in more than one practice at any one time, they must use a separate identifier code for each practice. The additional code is known as a spurious code. If a spurious code is not used, and the doctor’s DIN is registered to more than one practice, errors occur and can result in incorrect charging running into tens of thousands of pounds. Please refer to appendix 3 for more information about requesting spurious codes.
The tables on the next pages show the actions required for prescriber changes, to ensure that the central database is kept up to date and prescribing costs are charged correctly.
Approved by xxxxxx JMOG xxxxx 2015 Review xxxx 20181
GP CHANGES – ACTIONS REQUIRED BY PRACTICE
Actions /If a new GP prescriber joins your practice
(not including locums)
/If an existing GP prescriber leaves or your practice
(not including locums)1 / Please notify Primary Care Support of the change in writing as early as you can, ideally 2-3 months in advance. Primary Care Support will send the required notifications to the NHA BSA to update the central database. Primary Care Support will contact the practice when these actions have been carried out.
Comments / If the GP is joining having previously worked in another practice/CCG please include this information when you contact Primary Care Support.
If you are aware that the GP will be working at another practice or in another area at the same time as working in your practice, then it is vital that you inform Primary Care Support AND the Medicines Management team of this, as it will be necessary to request a spurious code for the purposes of the doctor’s prescribing costs in your practice. / If you are aware that the GP will be taking up a post with another practice (either locally, or in another CCG), please include this information when you contact Primary Care Support.
2 / Contact the prescriber’s former practice and ask them to confirm that the prescriber’s name has been removed from their clinical system. If this does not happen, your practice may be incorrectly charged the cost of any prescriptions issued in his/her name by the former practice. It is also strongly advised that the practice seeks assurances that any hand-held personalised prescriptions that may have been held by the new GP or at the former practice have been destroyed. / Please ensure that your practice computer system is amended so that no further prescriptions are issued bearing the details of the prescriber who is leaving. This can involve reassigning patients from one patient to another to avoid, for example, the generation of prescriptions by locums or practice nurses bearing the details of a prescriber who no longer works in the practice.Please contact the iMerseyside training team for further advice / support0151 247 7167 IM&vice is also available within EMISweb about reallocating patients
3 / If the GP will be generating prescriptions using practice computers ensure that the clinical system is updated to print the correct details on the prescription. Refer to the NHS BSA specifications for overprinting prescriptions. / Please ensure that any hand-held prescriptions that may have been held by the GP or stored in the practice are securely destroyed to prevent inadvertent use of them. Record the serial numbers to be destroyed and shred them/cut them up in the presence of a witness. Keep the record of the scripts destroyed in case of future query.
NMP CHANGES – ACTIONS REQUIREDBY PRACTICE
Actions /If a new Non-Medical Prescriber joins your practice
(not including locums/bank staff)
/If an existing Non-MedicalPrescriber leaves or your practice
(not including locums/bank staff)1 / Please notify the CCG of the change as early as you can, ideally 2-3 months in advance. Please contact the Authorised Signatory at the CCH Medicines Management team who will send the form for return to the CCG. Refer to appendix 1. The authorised signatory within the CCG will send the required notifications to the NHA BSA to update the central database, and then contact the practice and prescriber when these actions have been carried out.
Comments / If the non-medical prescriber is joining having previously worked in another practice/CCG please include this information on the proforma to assist the Medicines Management Team. / If you are aware that the NMP will be taking up a post with another practice (either locally, or in another CCG), please include this information on the proforma to assist Medicines Management Team.
2 / Where appropriate, contact the prescriber’s former practice and ask them to confirm that the prescriber’s name has been removed from their clinical system. If this does not happen, your practice may be incorrectly charged the cost of any prescriptions issued his his/her name by the former practice. It is also strongly advised that the practice seeks assurances that any hand-held personalised prescriptions that may have been held by the new non-medical prescriber or at the former practice have been destroyed. / Please ensure that your practice computer system is amended so that no further prescriptions are issued bearing the details of the prescriber who is leaving to avoid generation of prescriptions bearing the details of a prescriber who no longer works in the practice.
3 / If the non-medical prescriber will be generating prescriptions using practice computers ensure that the clinical system is updated to print the correct details on the prescription. Refer to the NHS BSA specifications for overprinting prescriptions. / Please ensure that any hand-held prescriptions that may have been held by the NMP or stored in the practice are securely destroyed to prevent inadvertent use of them. Record the serial numbers to be destroyed and shred them/cut them up in the presence of a witness. Keep the record of the scripts destroyed in case of future query
Approved by xxxxxx JMOG xxxxx 2015 Review xxxx 20181
APPENDIX 1: CONTACT DETAILS FOR NOTIFICATIONS ABOUT PERMANENT STAFF
Organisation/contact / Contact for… / Email / TelephonePrimary Care Support, NHS England (Liverpool ) / GPs leaving or joining the practice / Clare.O’ / 0151 296-7093 Tel
0151 296-7096 Fax
Primary Care Support, NHS England (Liverpool) / GPs change of details notification / Clare.O’ / 0151 296-7093 Tel
0151 296-7096 Fax
South Sefton / Southport & Formby CCG Authorised signatory / Non-medical prescribers (NMPs) leaving or joining the practice
NB: only for practice employed prescribers in South Sefton or Southport & Formby CCGs / / 0151 247 7107
Please email completed forms to email account
South Sefton / Southport & Formby CCG Authorised signatory / Non-medical prescribers (NMP) change of details notification / / 0151 247 7107
Please email completed forms to email account
OTHER CONTACT DETAILS
Organisation/contact / Telephone / Relevant guidanceSefton Local Medical Committee (LMC) /
Approved by xxxxxx JMOG xxxxx 2015 Review xxxx 20181
APPENDIX 2: LOCUM PRESCRIBERS AND BANK STAFF
Actions /Locum GP
/Locum or bank NMP
1 / Locum GP prescribers should use prescriptions of another GP in the practice. It is good practice for the locum to print their name next to their signature on the prescription, so that if there is any query about the items prescribed, the dispenser/pharmacist will be able to get in touch with the correctprescriber in the practice to obtain clarification. / Locum/bank non-medical prescribers should ideally use prescriptions of another prescriber in the practice with the same prescribing qualification (e.g. lilac prescription forms of another nurse independent prescriber or community practitioner prescriber).Nurse independent prescribers may also sign a green form bearing details of a GP, but this should be avoided if possible.
It is good practice for the locum/bank nurse to print their name next to their signature on the prescription, so that if there is any query about the items prescribed, the dispenser/pharmacist will be able to get in touch with the right prescriber in the practice to obtain clarification.
Comments / Locum or bank staff MUST NOT generate prescriptions bearing their details (name and prescribing code) together with the practice code because these prescribers will not be listed in the NHS BSA organisational database as being linked to the practice. This means that the cost of their prescribing cannot be accurately recorded against the practice code.
2 / If a locum GP were to print prescriptions showing their own name and the practice code, as well as the prescription not being processed properly at the NHS BSA, if the GP has a current permanent position in another practice or CCG, the cost of the items prescribed by them in your practice may be charged to that other practice/CCG. When this comes to light the practice budget is likely to have to be adjusted to take account of this cost. / If a locum/bank nurse prescriber were to print prescriptions showing their own name and your practice code, as well as the prescription not being processed properly at the NHS BSA, the cost of the items prescribed would be added to “unidentified” prescriber, which is a bill that the CCG has to pay each year for prescribers who are using incorrectly correctly coded prescriptions.
3 / When locum and bank staff cease work with the practice, please ensure that any details added to your clinical system are amended or deleted so that no-one may inadvertently use their details, particularly to generate a prescription.
APPENDIX 3 – SPURIOUS CODE HANDLING
Actions /Locum GP
/Locum or bank NMP
1 / A spurious code will only be issued to GPs whoseDINcode is already in use at another practice/cost centre, or for hospital doctors who are not issued with aDINcode. Locum doctors should use the prescribing code of the doctor for whom they are providing locum services (unless there are no GPs left in the practice/cost centre). GP prescribers working for practices, other than their main one should have a spurious code assigned. / Locum/bank non-medical prescribers do not require spurious codes to be assigned.Comments / Spurious GP codes are used for a variety of reasons, including:
- A locum doctor working in a practice where the GP has resigned (normally single-handed practices)
- Special exercises, projects or initiatives running in theCCGand funded from theCCGprescribing budget. i.e. Dermatology Centres, Hospices etc where prescribing data is not required at individual prescriber level
- As an additional prescribing code for a GP working in more than one practice/cost centre (in order to monitor prescribing in each practice/cost centre)
2 / Practices / Services should notify the PCS team / Medicines Management team of prescribers that are working in sites other than their main site. This will allow for the cost of their prescribing to be accurately recorded against the spurious code. Changes in prescribers assigned a spurious code and prescribers leaving a practice having had a spurious code assigned to them, are required to complete the relevant form signed by an authorised signatory. Please refer to appendix 1. / Not applicable
3 / Where a spurious code has been requested, the authorised signatory will be notified of the new code(s) by email. If theCCGdoes not supply information to NHS Prescription Services in a timely manner, prescription costs may be attributed to an incorrect organisation
Approved by xxxxxx JMOG xxxxx 2015 Review xxxx 20181