HRT prescribing for PPCs – GP IT update

As announced in the NHS Primary Care bulletin (published 14 March 2024), over half of GP surgeries have digital solutions available to automate the issuing of listed HRT items as single-item prescriptions at the point of prescribing (separate prescriptions for each HRT item). This is something that NHS England and Department of Health and Social Care (DHSC) had committed to enabling when the HRT Pre-Payment Certificate (HRT PPC) was first introduced in April 2023. 

Community Pharmacy England has been pushing for this change and welcomes this important step in reducing burden placed on pharmacy teams processing mixed prescriptions that include both exempt (listed HRT medicines covered by the HRT PPC) and paid (non-HRT) items subject to a prescription charge. However, until the full roll-out of auto-separation is achieved, prescribers will still be required to manually issue all HRT items as single-item prescriptions. 

NHS England and DHSC are continuing to work together with IT suppliers to implement changes across all GP IT systems over the coming months. In the meantime, where a change hasn’t yet been automated, please remember that prescribers are required to issue all HRT items as single-item prescriptions.  

The NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 gives three options to pharmacy teams handling ‘mixed’ prescriptions presented by patients with an HRT PPC. Pharmacy teams may either: 

1. First, refuse to dispense a ‘mixed’ prescription issued to the patient – refuse to dispense both the listed HRT medicine and the other item – and ask the patient to return to the GP for two separate prescriptions. 
   
2. Second, either:
   • dispense the listed HRT medicine (the patient or the patient’s representative signing to claim the HRT prescription exemption), or
   • dispense the other non-HRT item(s) with the prescription charge(s) paid. (This may be appropriate if the patient has an urgent clinical need for the listed HRT medicine or non–HRT item(s), the patient will need to obtain another prescription for any items not dispensed)
     
3. Third, dispense both the listed HRT medicine and the non-HRT item(s) – and complete an FP57 refund form for the listed HRT medicine (there is a charge and refund for the HRT medicines, so no money changes hands) and a charge taken for the non-HRT item(s). 

For additional guidance see our Briefing 008/23: FAQs to support DHSC guidance on the new HRT prescription prepayment certificate (HRT PPC).