The NHS Business Services Authority (NHSBSA) report seeing a rise in items that are being referred back (RB) to contractors for the reason code RB2B: ‘The order/endorsement is incomplete. The presentation must be present.’ The NHSBSA note that this issue is most commonly seen with handwritten prescriptions. Where prescription does not specify the presentation of a drug that is available in multiple presentations (formulations), the prescription should be endorsed correctly with details of the presentation dispensed to avoid any delays in payment. 

The NHSBSA apply a coding system to identify up to 19 possible reasons for items being referred back (RB) to the pharmacy for further information. Each returned item is assigned an RB code to indicate the RB reason. A table of RB reason codes and what each code means can be found on our Prescription returns page or on the NHSBSA website. Contractors who receive a RB item with the code RB2B, should endorse the presentation (pharmaceutical form) that was dispensed.

The table below shows the presentation endorsement required for commonly dispensed drugs available in multiple presentations.

Item (as prescribed)
Presentations available 
Required endorsement of presentation dispensed
Fluoxetine 20mg – no presentation (pharmaceutical form)’ prescribed
Fluoxetine has four listed presentations (this is the unit of measure or pharmaceutical form):
capsules
dispersible tablet sugar free
oral solution
oral solution sugar free

Pharmacy contractors must endorse the presentation (pharmaceutical form) that was dispensed.

For example, if capsules are dispensed, this formulation must be endorsed.

Sertraline 50mg/5ml liquid
Sertraline has two liquid presentations (this is the unit of measure or pharmaceutical form):
oral suspension sugar free
oral solution

Pharmacy teams must endorse the presentation (pharmaceutical form) that was dispensed.

For example, if the oral solution is dispensed, this formulation must be endorsed.

Clarithromycin 500mg – no presentation (pharmaceutical form)’ prescribed
Clarithromycin has three presentations (this is the unit of measure or pharmaceutical form):
tablets
modified-release tablets
powder for solution for infusion vials

Pharmacy teams must endorse the presentation (pharmaceutical form) that was dispensed.

For example, if tablets are dispensed, this formulation must be endorsed.

Depending on the item ordered, other endorsements may also be required. For more information on the different prescription endorsements see our Endorsement guidance page.

Referred back and disallowed items going fully digital via MYS from July 2022

From July 2022 (for the dispensing month of June 2022), all RB and DA items will be received through the Manage Your Services (MYS) portal and submitted for payment using the same route. For those still using the paper-based route, the final paper referred back and disallowed items that will be sent through the post will relate to prescriptions dispensed in May 2022.

Contractors with paper RB items from previous months should aim to complete the required information and return these to the NHSBSA together with their monthly prescription bundle as soon as possible to avoid any delays to payment. NHSBSA will continue to process any paper RB items that are submitted for payment in line with the guidance for the original submission method.

At present, using the MYS portal to receive RB and DA items is optional, with nearly half of all contractors signed up to receive these digitally. Contractors already using MYS to process RB items should check if any returns are awaiting their attention. It is important to note that prescription returns via MYS are only held in the system for a period of 18 months from the date they are first sent to the pharmacy for action; if contractors have not completed and returned any outstanding RBs before this deadline has passed, the RB items will be deleted from the system and contractors will no longer be able to claim payment for these.

Pharmacy contractors wishing to sign up to receive digital RB and DA items earlier than the July 2022 switchover should contact the MYS team by emailing nhsbsa.mys@nhs.net or via telephone 0300 330 1368 to enable access to these features on the MYS portal. Once these features are enabled on MYS, paper referred back and disallowed items will no longer be posted to the pharmacy.

For more information on referred back items please refer to PSNC’s webpage on Prescription returns