The necessary updates for prescribers’ IT systems to automatically issue HRT prescriptions separately will not be in place in time for the introduction of the HRT pre-payment certificate (PPC) on 1 April, the Pharmaceutical Services Negotiating Committee (PSNC) has warned.

PSNC raised concerns that ‘mixed’ prescriptions, where HRT items are issued on the same prescription as other items, may continue ‘for some time’.

In order for patients to use a HRT PPC to exempt them from charges for HRT items, prescribers must issue HRT prescriptions separately to those for other items.

The government previously said that a digital solution will be introduced to prescribing systems to automate the issuing of listed HRT medicines as single-item prescriptions – but it won’t be in place before 1 April, and the Department of Health and Social Care (DHSC) has not said when it will be ready.

Instead, prescribers will have to manually issue a separate prescription for items on the DHSC’s list of eligible HRT, and another prescription for any other items, including non-listed HRT products.

If a patient does present a mixed prescription alongside a valid HRT PPC, the pharmacist may refuse to dispense the mixed prescription or may agree to dispense just the HRT or non-HRT items.

PSNC reiterated its concerns that this would create extra work and incur additional costs for pharmacies.

Chief executive Janet Morrison said that community pharmacies could not be expected to ‘keep picking up the pieces when DHSC and the NHS launch policies without having the infrastructure in place to effectively implement them’, whilst also being subject to funding cuts.

She said that PSNC had warned the government that the HRT PPC rollout would ‘add to the burden on pharmacies’ as well as risk ‘causing confusion for some patients’.

She added that while ‘government recognises the challenges’ – stating in its guidance that there will be a need for ‘workarounds’ as well as ‘associated costs’ until solutions are in place – it was ‘determined to move forwards with the policy’.

PSNC was ‘pressing for appropriate financial compensation for pharmacy owners’, she said.

She added that it had also sought guidance for GPs, and published its own guidance for pharmacy teams.

A Department of Health and Social Care spokesperson said that the department was working to introduce a digital solution to automate the issuing of listed HRT items as single-item prescriptions at the point of prescribing 'as soon as possible'.

'We’ve also published guidance on the options available for pharmacy contractors, and will continue to work with the sector seeking to minimise the impact on pharmacy teams until the digital solution is in place.

'This should not prevent people from accessing the HRT PPC,' they added.

Community pharmacist and contractor Vikesh Patel told The Pharmacist that the time associated with understanding and implementing the changes was already costing his team, as it was not covered by protected learning time.

And he was doubtful that GPs would consistently issue HRT as a separate prescription manually, which would mean additional work for pharmacy teams to ask the practice to amend the prescription.

He said: ‘It’s unpaid work. Why should I be picking up the phone to the doctor? I don’t get paid for that. The only payment we get is when we carry out the activity for dispensing. That is the contract. The pharmacy contract does not have any other payment.

‘They took away the establishment payment and they’ve taken away the transitional payment now, so how is there this expectation that pharmacy should do work which is not paid for?’