From Mr P. Walton, MRPharmS
SIR,—I fear that the situation regarding the National Health Service and medicine supply is far far worse than stated by Mr G. W. Walker in the letter entitled "A crazy world" or Mr R. G. Lee in the letter entitled "A scandal" (PJ, October 2, p520).
I have seen an unprecedented jump in my overdraft and have done a little research into a few commonly prescribed generics and I am aghast at the findings.
Category D ferrous sulphate from at least one major wholesaler became unavailable in July, when its price went up 600 per cent or thereabouts. Unfortunately, the price increase was not notified to the Prescription Pricing Authority by this wholesaler until August 14. As the cut off point for inclusion in September's Drug Tariff would have been August 8, this means that pharmacists will not be paid this increased price until October.
We have no control of the date of submission of price lists, but suffer when the wholesalers do not make efforts to be prompt. It is no use a pharmacist submitting a price to the Prescription Pricing Authority. Unless it matches their price, it is simply ignored when prescriptions are checked.
A different wholesaler is sending Marevan brand warfarin for generic warfarin (again Category D). Marevan, the brand, is priced at £12.49. The price of the generic is approximately £22. We lose considerably when we endorse honestly and on prescriptions written as Marevan. Endorsing the wholesaler and brand may help - if the wholesaler price list is used and the PPA computer is up to date. Of course, the 100 per cent estimated advance is a problem when we have ultra rapid increases in prices, unless the factor for inflation is accurate.
The 4 per cent reduction in the price of "ethical" drugs over the board seems to have concentrated on those that pharmacists can get deals on as parallel imports but has not that discount already been clawed back? Should I have reduced my stockholding to almost zero at the end of September (ignoring patient needs) and re-stocked on October 1?
I also looked at the costs incurred in dispensing high value drugs. Thirty-seven items cost me £6,000, approximately 10 per cent of my monthly turnover. Because of the high value, I get a 2 per cent dispensing fee. Unfortunately, the maximum discount on "ethicals" I can negotiate with my wholesalers, taking into account thresholds, from first and second wholesalers, is 2 per cent less than clawback, cancelling the fee. The £6,000 ups the clawback by 0.2 per cent on £60,000, which equals £120. The £6,000 also ups my overdraft, costing £50 per month. The outcome is that I am paying approximately £170 for the privilege of dispensing 37 items for maybe 20 patients. It is my gut feeling that if I could look at prescriptions valued at say £50 to £99 where there is no expensive prescription fee, I would lose out on a gross scale. Perhaps I should learn to be rude to the patients that in effect cost me money to keep supplied? Up to now I have not refused or been unhelpful to any patient, regular customers or not. To maintain a financially viable position, this situation may well have to change short term.
There are well over 100 category D drugs and lots of expensive prescriptions - I might have to be extremely rude to half of Swinton to stave off bankruptcy.
P. Walton
Swinton, Manchester