pharmacy and gms number

Aziraphale

When you take a prescription into a pharmacy, what checks do they do? Do they check the GMS number (and how)? If it's a pharmacy you haven't been to before do they usually ask for your name and address to register you?

Victor

I imagine they are familiar with all the GMS numbers of local doctors.

Address is a normal and useful cross check, so as to make sure they don't confuse you with other people. they keep a record of all the drugs you use, which makes it harder for mistakes to be made, e.g. if someone had a past reaction to a drug or is using other drugs at the moment, it would be important for them not to get the wrong drug.

Address also means that if there is a serious problem with what you have been given, e.g. a contaminated drug or a faulty medical device, then at least they know where to contact you.

They seem to two computer systems. One standalone with your details and another one for billing the HSE.

locum-motion

It is the Doctor's responsibility to write the prescription correctly; for a Medical Card holder, this includes writing the patient's name, address and medical card number on it.
As far as the pharmacist is concerned, this is the only proof of entitlement that is required; if the patient isn't entitled to free meds, then the Dr shouldn't have written the prescription on a green Medical Card Prescription form.

That's the theory, anyway.
In practice - and with apologies to any conscientious prescribers that may be reading this - very many doctors don't bother writing the number on, or use a green form for a private patient, or use a green form and write the number on for a patient who has only got a Dr Visit Medical Card etc etc.

So, what actually happens when a patient who's new to the pharmacy presents a Medical Card prescription is that the pharmacist will often ask to see the card. If the patient doesn't have the card, there's a website that we can access to check if the number on the prescription is a valid one. If there's no number and the patient doesn't have the card, then we'll usually ring the GP's surgery to check the number. Once we have confirmation that the number is valid, we usually record it on the patient's file on the computer, so that we don't have to do the same next time.
None of this, by the way, is actually the pharmacists job, it's the doctor's. However, the pharmacist will know from prior experience that an apparently correctly filled in prescription is no guarantee that the patient is entitled (and therefore that the pharmacy will be paid).
{It's always seemed very unfair to me; if the Dr. doesn't do their job right, the pharmacist is the one that gets punished by not being paid for their work!}

As Victor said, the pharmacist will record the patient's name and address and other details so that they can keep records of what has been dispensed. Address is needed to differentiate between people of the same name; I once worked in a pharmacy that had over 200 Mary Murphys on file!

Victor, what's your source for saying the pharmacy has two separate systems for records and claims? That's completely wrong.

Quiet Lurker

locum-motion wrote: »

It is the Doctor's responsibility to write the prescription correctly; for a Medical Card holder, this includes writing the patient's name, address and medical card number on it.
As far as the pharmacist is concerned, this is the only proof of entitlement that is required; if the patient isn't entitled to free meds, then the Dr shouldn't have written the prescription on a green Medical Card Prescription form.

That's the theory, anyway.
In practice - and with apologies to any conscientious prescribers that may be reading this - very many doctors don't bother writing the number on, or use a green form for a private patient, or use a green form and write the number on for a patient who has only got a Dr Visit Medical Card etc etc.

So, what actually happens when a patient who's new to the pharmacy presents a Medical Card prescription is that the pharmacist will often ask to see the card. If the patient doesn't have the card, there's a website that we can access to check if the number on the prescription is a valid one. If there's no number and the patient doesn't have the card, then we'll usually ring the GP's surgery to check the number. Once we have confirmation that the number is valid, we usually record it on the patient's file on the computer, so that we don't have to do the same next time.
None of this, by the way, is actually the pharmacists job, it's the doctor's. However, the pharmacist will know from prior experience that an apparently correctly filled in prescription is no guarantee that the patient is entitled (and therefore that the pharmacy will be paid).
{It's always seemed very unfair to me; if the Dr. doesn't do their job right, the pharmacist is the one that gets punished by not being paid for their work!}

As Victor said, the pharmacist will record the patient's name and address and other details so that they can keep records of what has been dispensed. Address is needed to differentiate between people of the same name; I once worked in a pharmacy that had over 200 Mary Murphys on file!

Victor, what's your source for saying the pharmacy has two separate systems for records and claims? That's completely wrong.

I accept your comment that the GP should get the details correct first time. In well computerised practices there should not be a problem getting the medical card or private script correct.

However, and i have checked this with several pharmacists in the past, if an incorrect number is entered e.g. 1234567A as a GMS number that the pharmacist WILL be paid and the only exception to this is with high tech drugs. So the pharmacist is not penalised if a card is incorrect. Most pharmacists do their utmost to have the correct number on the system

locum-motion

Quiet Lurker wrote: »

However, and i have checked this with several pharmacists in the past, if an incorrect number is entered e.g. 1234567A as a GMS number that the pharmacist WILL be paid and the only exception to this is with high tech drugs. So the pharmacist is not penalised if a card is incorrect. Most pharmacists do their utmost to have the correct number on the system

The pharmacist is supposed to be paid if the Dr has put any 7-digit-and-one-letter number on the script. That was always supposed to be the case, and it is only logical for it to be so because - as I said - it's the prescriber's job to check the number.
However, it doesn't happen like that. If the number on the claim is an invalid one, the claim will be rejected by the PCRS. Believe me, I've seen it happen. I've even seen it happen when the PCRS's computer system hasn't been updated, and the number is valid but the PCRS think it's invalid.

Victor

locum-motion wrote: »

Victor, what's your source for saying the pharmacy has two separate systems for records and claims? That's completely wrong.

Sorry, that was my understanding based on a conversation with a pharmacist. A foreign friend died (epilepsy) here without family and I knew he had been on medication, but didn't know the precise condition - he had mentioned an accident as a child. I ran this by the local pharmacist who said the computer system wasn't centralised and he could only check his own system. and even at that he couldn't confirm the deceased had been a customer, but that if there was a likely name match he would suggest a court order to the coroner.

But I knew that the GMS has some sort of live computer system , so I concluded there were two systems.

nesf

locum-motion wrote: »

The pharmacist is supposed to be paid if the Dr has put any 7-digit-and-one-letter number on the script. That was always supposed to be the case, and it is only logical for it to be so because - as I said - it's the prescriber's job to check the number.
However, it doesn't happen like that. If the number on the claim is an invalid one, the claim will be rejected by the PCRS. Believe me, I've seen it happen. I've even seen it happen when the PCRS's computer system hasn't been updated, and the number is valid but the PCRS think it's invalid.

Well paying the pharmacist for invalid numbers would just encourage medical card fraud no? Not that pharmacists would aid fraudsters but if they weren't "punished" for invalid numbers they'd have no reason to be (healthily) sceptical of a new person arriving presenting a GMS number.

RobFowl

Just regarding the GMS numbers, it's not always posssible to verify if a patient has a valid medical card. Often the card is stopped early so the patient has a card saying tit will expire say Nov 2010 but in reality it has already expired. Also there is a website that allows you to check GMS numbers but it only tells you if the number is valid and which doctor it is registered with. It does not tell you who the card is issued to.

locum-motion

nesf wrote: »

Well paying the pharmacist for invalid numbers would just encourage medical card fraud no?

Not that pharmacists would aid fraudsters but if they weren't "punished" for invalid numbers they'd have no reason to be (healthily) sceptical of a new person arriving presenting a GMS number.

No, it wouldn't encourage fraud. It would just mean that the pharmacists were getting paid for doing their job in good faith.

It is NOT the pharmacists job to check if a person is entitled to recieve free treatment. In fact, a pharmacy is contractually obliged to dispense for free any correctly completed GMS prescription. In this context, 'correctly completed' means that all the details required are present, including a medical card number written in the appropriate space on the form. A medical card number consists of seven digits and a letter, or in some cases six digits and a letter at each end.
So, if a person hands in a GMS form that says Joe Bloggs X123456X, we are obliged to dispense it for free. If the doctor has made a mistake, and Joe's number is actually X213456X, it's not the pharmacist's fault. By dispensing the prescription the pharmacist has done their job in good faith, and deserves to be paid for it. The system was set up so that this was the case.
Somewhere along the line, the GMS (Payments) Board* stopped paying in this situation. That's what I meant about pharmacists being punished. It's like they're saying to us "Well you gave the medicine to someone who wasn't entitled to it, so tough 5hit, we're not gonna pay you for it", despite the fact that the pharmacist could've been taken up for breach of contract if they hadn't dispensed it.

*now called the HSE(SS)PCRS. It stands for Health Service Executive (Shared Services) Primary Care Reimbursement Services. I kid you not.They took a body whose name described what it did perfectly, and in the name of efficiency changed it to a name that's 9 words long and has the same word in it three times!