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by Alexander Humphries*

My recent dealings with the NHS Business Services Authority have made it patently clear that it doesn't know the meaning of the words fair and transparent

We recently queried one month's payments at both our branches, with very different results. I was so wound up by one response that it would be fair to say that I'm furious about the way the NHS BSA operates. First, the background. When we received January's NHS schedule of payments, it felt like something was wrong: a number of the indicators that we routinely check were off the mark.

We noticed a huge increase in prescription switches at one branch, which would have been worrying enough on its own, but we also had a large unexplained drop in average item value at both branches. We all know about the accuracy problems that have plagued the BSA. Compensation has been paid on more than one occasion, numerous contractors have had large amounts of money returned to them, targets have been tightened and it has committed to being 'more transparent'.

But has the situation really improved? The only right of recourse that we have is to query our submissions and to ask the BSA to re-price the batch. A warning is made that overpayments can and will be corrected, as well as those in the favour of the contractor, which is fair enough.

All we are asking for is a fair system that we can trust to deliver what we are owed. Our query at our first branch yielded a net underpayment of around £150 (a quarter of 1 per cent on the £60,000 value of the batch). If this underpayment was repeated consistently over a year, we would be about £2,000 out of pocket.

But it is what happened with the second branch that has got me spitting pips. This branch had 23 switches (more than the other branch had had in the last two years combined), which couldn't possibly be right. When the letter came back from the BSA, we found a net underpayment of £250 for medicines supplied, plus other adjustments, amounting to a total value of +£454.76. Great, I thought; it was worth querying this batch €“ but then my heart sank.

There were 56 additional prescription charges (more than £400) to deduct. The BSA had helpfully included copies of these prescriptions stamped €For Information Only€. When I looked through them, I was even more annoyed.

Fifteen handwritten prescriptions for patients who were age exempt had been transferred to 'paid' because the person collecting had not signed the box in part 3 of the declaration. We were charged £8.20 for supplying amoxicillin worth 20p to a patient over 60 years of age. The other switches were along similar lines.

Punitive

The BSA could check the exemption status for these patients quite easily with a few additional keystrokes, but instead the rules have been written to punish contractors. Yes, it is the responsibility of the contractor to ensure that the levy declarations are appropriately made, but it is difficult to see the BSA's approach as being anything other than punitive.

When I checked this month's batch for submission last week, I counted approximately 15,000 separate checks on the bundle: a minimum of three on the levy declaration (part 1, part 3 signature and pt/pt rep box), plus one for endorsing each item. When I finished checking the bundle three-and-a-quarter hours later (at 11pm), I worked out that I had made 1.3 checks on the bundle per second.

Inevitable

There are bound to be errors within any contractor's submission every month but what we have is an unfair system where the pharmacy has no right to correct those errors. If you are 'lucky' like us, you can just kiss goodbye to £400 in fees. If you are less lucky, you could find yourself talking to NHS Protect about fraud.

This is neither fair, nor proportionate. The BSA seems to be looking for any and every excuse to penalise contractors for actually checking their bundles, to put them off checking at all. It must, after all, cost a fortune to process these requests.

The true result of the repricing exercise should have been more than £400 returned to us. The reality is that, across both branches, not a penny will be returned because of the approach to switching taken by the BSA.

With mistakes at one branch costing £454, and around £150 at the other, we could be losing more than £7,000 a year because of the BSA's processes. We have repricing requests for one year's worth of prescriptions at each branch filled out and ready to go. The question is, should we bother to send them?

 I finished checking the bundle three-and-a-quarter hours later

* Pen name of a practising community pharmacist. Alexander Humphries' views are not necessarily those of Pharmacy Magazine. What has your experience been of the BSA? Email pm@1530.com