The Pharmaceutical Journal
Vol 277 No 7428 p651
25 November 2006

Society summary

An occasional feature, prepared in the Royal Pharmaceutical Society’s Professional Standards Directorate, to highlight problems and inquiries currently being handled

Law and Ethics Bulletin, 2001 to present

• Preventing NHS fraud
• Homoeopathy and malaria prophylaxis
• Methadone oral solution

Preventing NHS fraud

Pharmacists are reminded of the need to ensure that any payment claims for NHS services are truthful and accurate. Making a false claim for payment may constitute a criminal offence or professional misconduct or both.

Prescription endorsements Pharmacists are advised to ensure that all prescription endorsements are accurate so that the pack size and quantities endorsed correctly reflect the supply made. Particular caution should be exercised when using an automatic endorsing system that may default to the smallest pack size available. The Society is aware of a number of incidences in which endorsements for small packs of a product were inaccurately and/or dishonestly made and large pack sizes dispensed.

Medicines use review (MUR) Pharmacists must ensure that they do not claim payment for more than the maximum number of MURs that they are entitled to undertake and that claims are not being made for consultations that would not be classed as an MUR. If pharmacists are in any doubt as to what claims they are entitled to make they should contact their local primary care organisation.

Other professional services Pharmacists should ensure that when providing locally agreed NHS services, eg, smoking cessation, payment claims accurately reflect the type and level of service provided.

Patient declaration Pharmacists are reminded to check that the declaration on the back of the prescription form has been filled in correctly. When a patient (or his or her representative) declares an exemption from prescription charges, the pharmacist is required to check for evidence of this, except where a patient is exempt due to age and the date of birth is computer-generated on the prescription.

The Society does not encourage pharmacists to sign the declaration on behalf of a patient unless fully satisfied as to the patient’s identity and exemption status. A false declaration made by the pharmacist, whether knowingly or as a result of failure to check a patient’s exemption, may constitute a criminal offence or professional misconduct or both. In addition incorrect declarations made by a pharmacist may result in the patient being subject to a criminal investigation.

Counterfeit and stolen prescriptions Finally, pharmacists are reminded of the pharmaceutical reward scheme, whereby a pharmacist who identifies and reports a fraudulent or stolen NHS prescription will receive a monetary reward. In detecting such prescriptions, pharmacists are helping to reduce and deter patient prescription fraud. Any pharmacist who believes that he or she is eligible for this reward in England should contact the NHS Counter Fraud Service on freephone 0800 068 6161. In Wales, please contact Health Solutions Wales on 029 2050 0500.

Both the Royal Pharmaceutical Society and the NHS Counter Fraud Service are committed to developing counter fraud techniques and sharing information to crack down on those defrauding the NHS. To highlight this commitment, the Society and the NHS Counter Fraud Service have agreed a memorandum of understanding formalising the working relationship between the two organisations.

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Homoeopathy and malaria prophylaxis

Following the recent media coverage regarding the use of homoeopathic remedies for malaria prophylaxis, pharmacists must ensure that patients who request homoeopathic or herbal remedies to prevent malaria are aware of the risks of not taking recognised antimalarial medicines.

The Faculty of Homeopathy and the Health Protection Agency’s advisory committee on malaria prevention do not recommend patients to rely on any homoeopathic or herbal remedies for the prevention of malaria as there is no scientific proof that these are effective in preventing malaria.

Although it is for individual patients to make decisions about their health care, pharmacists have an important role in ensuring that these decisions are informed, and that patients have access to necessary information to assist their decisions.

Pharmacists are well placed to discuss fears that patients may have about taking their medicines and should encourage patients to use appropriate preventive measures. Advice on preventing or avoiding bites should also be provided to patients who are travelling to regions where they may be susceptible to malaria. This advice should include wearing long sleeved clothing and long trousers if outdoors after sunset and using mosquito repellents and nets.

Further comments on the issue of homoeopathy and immunisation can be obtained from the Faculty of Homeopathy, Hahnemann House, 29 Park Street West, Luton LU1 3BE (tel 0870 444 3950; fax 0870 444 3960).

Also provided for further assistance are the link to the Health Protection Agency website, which contains guidance on prophylaxis, and the link to the advisory committee on malaria prevention homeopathic statement.

The guidance issued above has been endorsed by the Health Protection Agency and the Faculty of Homeopathy.

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Methadone oral solution

Pharmacists are advised to exercise caution when dispensing methadone oral solution. There is the potential for confusion to occur between different strengths. Methadone oral solution is available in various strengths: 0.4mg/ml; 1mg/ml; 10mg/ml; 20mg/ml.

The Royal Pharmaceutical Society is aware of occasions where the wrong strength of methadone has erroneously been supplied to a patient.

Pharmacists should have in place procedures for recording dispensing errors and near misses.

The Society guidance on dealing with dispensing errors (PDF 120K) also gives a link to the Pharmaceutical Services Negotiating Committee website, which has an error log template that was devised in conjunction with the National Patient Safety Agency.

The Society has also produced a near miss error log (PDF 80K). The advisory service of the Society’s Fitness to Practise and Legal Affairs Directorate has also produced a fact sheet entitled “Dealing with dispensing errors” (PDF 70K).