Practical know-how for a financially sustainable practice

The FP34 totals form — the count sheet non-dispensing practices have traditionally completed, sorting prescriptions into piles, counting them by doctor and writing the totals. When we asked NHS BSA what they use it for, the answer was that they don’t; it was only ever a tally for the practice. They scan your prescriptions and count both the forms and the items on them automatically, so you can stop sorting, counting and totalling. There’s no need to put them in alphabetical or per-doctor order either — one pile is fine.

No. Only the high-volume vaccines printed across the top of the FP34D — influenza, typhoid, hepatitis A, hepatitis B and meningococcal — go on the “numbers” form. Everything else, such as B12, Depo and coils, still needs its own FP10 green prescription.

Correct. Only the FP34D-listed vaccines are entered as numbers per prescriber. A coil — and anything else — goes on an FP10.

The totals form was never used by NHS BSA, so that count never drove your reimbursement in the first place. Items such as Prostap go on an FP10, and the dispensing fee and reimbursement are generated from the scanned prescription itself. If you like to keep a count to sense-check your own numbers that’s fine — just know it’s for you, not for them.

On the FP34D vaccine form you do need the brand or maker’s name and the presentation pack, because the tariff varies between them. On FP10s for other PA items, you don’t.

There are around 5,000 claimable items in total, but most practices use no more than about 20. We keep a list of the 100 most commonly claimed items and are happy to share it. To check any single item, look it up on the dm+d: the test is the PADM indicator, held at pack (AMPP) level under Prescribing information, which marks items that attract an administration fee when personally administered by the practice team. If the pack carries that PADM flag it’s a PA item you can claim; if it doesn’t, it isn’t.

For lidocaine you’ve bought in and used on your patients, issue an FP10 for the amount used and send it with your normal monthly claim. If lidocaine is the only thing you have that month, send the FP10s with your practice claim form so they know which practice it’s from. You don’t need anything else.

Not for ipratropium nebules. The test is the PADM indicator on the pack, and ipratropium nebules don’t carry one — they’re self-administered by the patient at home through their own nebuliser, so they sit outside the personal administration scheme. They’re dispensed on a normal FP10 through the pharmacy and reimbursed via the standard Drug Tariff, with no administration fee. The wider lesson: ‘used in the building’ doesn’t make something claimable — always check the pack for the PADM indicator first.

No. Oxygen is a drug, but it isn’t a PA item, so it can’t be claimed through this route.

No. If a local enhanced service already reimburses you for the stock, you can’t claim it again through the PA process. Always check whether your enhanced-service payment mechanism already covers an item before claiming it.

This one is genuinely complicated. Whether a travel vaccine is claimable depends on how it’s funded and the route it’s supplied through, and it differs item by item — some bought-in vaccines look identical to ones you can’t claim. It’s best checked individually rather than with a blanket rule, and we can provide clients with a crib sheet on which vaccines can and can’t be claimed, and under what circumstances.

You’d submit fewer FP10s, but you’d also forgo the small margin on each one, and sending B12 via the pharmacy brings its own friction: patient charges and getting the drug back to the practice in time for the appointment. It’s worth weighing the admin saving against the lost income and the disruption.

Claim the amount you’ve actually used and NHS BSA rounds it up to the nearest pack size — so if you used one, you’d still be reimbursed for the pack. The same applies to part-vials: half a vial of lidocaine rounds up to a whole vial. Always enter what was used and let them do the rounding.

You can only ever claim for stock you’ve paid for. If some of your stock arrives from the pharmacy because an FP10 was sent there, that isn’t yours to claim — but you don’t need to do it that way. If you buy the stock in, you can claim for what’s used on your patients in the practice. The one thing to watch is that no local enhanced service already pays you for that stock.

This is the reality of a process with a lot of people involved in it — it rarely runs perfectly every time. The most reliable fix is a quality-improvement approach that brings the team with you, which we cover in our training. Changes the team designs themselves tend to stick; ones imposed from above tend not to.

If you’re a non-dispensing practice, you don’t need to endorse PA items at all, and there’s no need to write the cost on the script. The one exception is pneumococcal, which is now centrally supplied: if you ever genuinely have to claim one, put it on an FP10 and write why. If you’re a dispensing practice, endorsement is a dispensing question — check with a dispensing specialist.

The presentation pack — for example, pre-filled syringe ×1 or ×10 — and the brand or maker’s name both come from the vaccine you actually used. They affect the tariff, so enter the ones that match the stock in front of you.

The good news is that this is a very reliable process. Once an FP10 is sent, NHS BSA scans it; if anything can’t be scanned, it comes back to you on a peach form, so you either get paid or get it returned. NHS BSA publish monthly scanning-reliability data of around 99.8%, and the actual value paid runs very slightly over 100%, so the money tends to sort itself out overall. The drugs statement is admittedly dense, and reading it is something we can walk you through.

The full dispensing fee currently applies up to around 479 items per prescriber per month, tapering slightly above that. NHS BSA reviews this figure periodically. Note that only GPs have a doctor index number and can hold the claim; other prescribers’ items roll up under the senior partner.

The dispensing-fee banding is per prescriber per month, so the lever is spreading items across as many prescribers as you have within the month to stay under the threshold — not holding claims back across months. Delaying a claim simply leaves your money sitting in NHS England’s account instead of yours. And only spread as widely as you need to: if you’ve items enough for one prescriber, leave them there rather than splitting across four.

Always the historic date the item was actually used — that’s your audit trail. NHS BSA allow claims back six years and capture that date when they scan, and dating it correctly keeps your clinical record accurate too.

Make sure each prescription is dated the date the item was used, get a GP signature on them, and send them with your normal monthly claim. Nothing special is needed; NHS BSA will pick up the historic dates.

There are searches that help with a monthly catch-up. Across six years, though, you’re dealing with tens or hundreds of thousands of data points, which is why most practices find a full historic sweep hard to do themselves. If you have the time, run the searches and chase the prints — you keep 100% of what you find. If you’d rather not, our historic reconciliation service does exactly this.

If you use a named-patient item — one that came from the pharmacy for a specific patient — on a different patient, that counts as medicines re-use, and you need a policy covering it and to follow it when the item is reallocated.

Your PA items can be claimed for all of your patients, dispensing or not. The VAT is reimbursed as part of the PA reimbursement, so account for that on your VAT return; and if you’re making a margin, run it through the business as you already do for dispensing.

This is one of the very few NHS processes that hasn’t changed in over 20 years. Wales has trialled an electronic FP34D vaccine submission and there has been a pilot in England, but neither has demonstrated meaningful time savings or progressed to roll-out, and there’s no sign of the wider process moving to EPS.