PSNC has been working with NHS Business Services Authority (NHSBSA) to understand if claims for Serious Shortage Protocols (SSPs) are being submitted correctly. PSNC understands that a large number SSP claims continue to be deemed invalid by the NHSBSA due to incorrect endorsements applied by PMR systems and/or pharmacy staff.
Common reasons for these incorrect/invalid SSP claims
Incorrect dispensed item endorsed – for SSPs that require substitution to an alternative product, the item endorsed was very often the same as original prescribed item.
Claims made against items without an active SSP – SSP endorsement applied against items for which a valid SSP does not exist.
Reduced quantity not endorsed– for SSPs that require a reduced quantity to be endorsed, often the endorsed quantity matched the prescribed quantity.
Claims for supplies made in accordance with an expired SSP:
No active SSP in place at the time of supply – i.e., SSP claimed for items after expiry of SSP.
Alternative item correctly supplied during the period of SSP validity, but Dispense Notification message submitted after the period of SSP validity.
Alternative item correctly supplied during the period of SSP validity and the Dispense Notification message submitted during the period of SSP validity but the EREM or Claim Notification message submitted after the 3-month claiming window (where multiple items are ordered on the same prescription).
Invalid or incorrect SSP reference number endorsed – The endorsed SSP number does not match the actual SSP number. For example, SSP470 (this SSP number does not exist); SSP(blank) (missing reference number); and SSP47 (two instead of three digits).
Top tips to endorse SSP claims correctly
To ensure correct payment for SSP claims, contractors should ensure that endorsements reflect the requirements outlined in the corresponding SSP endorsing guidance available on NHSBSA’s website.
For SSPs that allow for an alternative product or quantity to be supplied, endorse the details of the alternative product(s) or quantity supplied in accordance with the SSP – not the details of the product or quantity that was originally prescribed.
Only endorse strength(s)/formulation(s) of products that are covered by the SSP.
Contractors are strongly advised to check if their PMR system supports correct and complete SSP endorsements. If there is any doubt on the correct use of the SSP endorsement functionality available on PMR systems, contractors should contact their system supplier for further guidance. Any suggestions about how system usability and functionality could be improved should also be fed back to the system supplier.
EPS tokens should not be used to make SSP claims. The electronic claim message created by the PMR system, including the electronic endorsements within it, is used to determine payment. Ensure your endorsement is accurate and clear – NHSBSA processing staff must be able to determine what has been supplied.
If patient is exempt from prescription charges, the correct exemption reason should be selected.
For patient’s that normally pay for their prescriptions, usual charges apply except for supplies in accordance with SSPs for a reduced quantity.
No prescription charge is payable if a patient receives a smaller quantity of the medicine than the quantity originally ordered on the prescription if it was supplied in accordance with a SSP for a reduced quantity. If a patient normally pays for their prescriptions, the paid status should be selected on the EPS claim message.
Once submitted for payment, the NHSBSA will recognise the SSP endorsement and process the prescription as a no-charge item i.e. no prescription charges will be deducted by the NHSBSA.
Where applicable, check that the correct number of patient charges are collected and declared on the end of month FP34C submission form.
If an electronic prescription has been endorsed incorrectly and before the claim is submitted for payment, where PMR systems allow, contractors may be able to retrieve any submitted EPS dispense notification messages by using the claim amend facility.
SSPs cannot be supplied after the period of SSP validity. Any other items on the prescription (such as an owing) can continue to be dispensed as usual but must be submitted for payment within three months of expiry of the SSP.
To claim for an SSPs using the Electronic Prescription Service (EPS):
Select the SSP endorsement.
Input the appropriate 3-digit reference number of the SSP.
Follow the specific supporting endorsement guidance for the applicable SSP – often this will require contractors to select and endorse the SSP product and quantity supplied to the patient.
Contractors should check with their system supplier on the correct use of the SSP endorsement functionality particularly where the dispensed item is different to the prescribed item. Contractors should note that only the correct endorsements contained in the electronic message are used to price electronic prescriptions (i.e. handwritten endorsements on the corresponding EPS Tokens are not referred to by the NHSBSA when pricing SSP claims).
To claim for an SSPs using FP10 paper prescriptions:
Endorse SSP and the appropriate 3-digit reference number
Follow the specific supporting endorsement guidance for the applicable SSP – often this will require contractors to endorse the relevant SSP product dispensed including strength, pharmaceutical form, and quantity supplied to the patient.
Place the prescription in the red separator.
Declaration of monthly SSP claims using MYS
There is a separate declaration of monthly SSP claims on the digital FP34C submission form via the Manage Your Service (MYS) portal for contractors to declare the correct number of SSP claims made each month.
Separately, contractors should also include the number of items supplied in accordance with SSPs with the usual item totals.
Please note that the NHSBSA will not be using the SSP declaration made on the FP34Cs for reimbursement purposes. Instead, the SSP declaration is to provide the NHSBSA with an indication that SSP claim(s) are expected in that month.
Reconciliation of SSP claims
The SSP declaration is to support contractors when reconciling the value of SSP fees on their payment schedules against the expected fees based on the number of SSP claims declared on the FP34C. SSP payments can be found on the second page of the monthly Schedule of Payments under the section ‘Details of Other Amounts Authorised’.
The SSP payments will appear as:
SSP Remuneration – this is monthly total value of all SSP fees (currently £5.35 per item). In addition to the SSP fee, contractors also receive a Single Activity Fee (currently £1.27) for every SSP claim processed by the NHSBSA.
SSP Reimbursement – this is the monthly total VAT element of SSPs. Note: the total SSP drug reimbursement value (excluding VAT) is incorporated into the ‘Total of drug and appliance costs’ and is not itemised separately in the Schedules.
For any invalid SSP claims, contractors will continue to receive the usual Single Activity Fee but will not receive any SSP fee (£5.35). Reimbursement for invalid SSP claims will also be in accordance with the prescribed product rather than the alternative product or quantity supplied in accordance with an SSP.
For any unpaid SSP claims (where payments for SSPs on the Schedule of Payments do not align with the number of SSP claims declared on MYS), contractors should query any payment discrepancies directly with the NHSBSA, and, if required, request a recheck of affected prescriptions.
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