The Pharmaceutical Services Negotiating Committee's bid for £1.8m to pay for a two-year national pilot of medicines management by pharmacists puts the Government's attitude to community pharmacy to the test, the Pharmaceutical Services Negotiating Committee chairman (Mr Wally Dove) told the conference.
|
Wally Dove: Government response to medicines management bid will answer important questions |
"Perhaps the Department does not think it is important, Mr Dove suggested. "Whatever it thinks, we are fed up with waiting. If the Government will not bring the strategy to us, then it is time for us to take it to them."
The PSNC chairman then outlined some components of a strategy, including reducing medicines waste and introducing pharmacist prescribing.
Official figures suggested that wastage of medicines amounted to over £30m a year. That was probably the tip of an iceberg and the real amount was probably hundreds of millions of pounds, Mr Dove told the meeting.
"The solution is quite simple. You can sum it up as one-month's prescribing," he said. It should be a requirement, with a few exceptions, for general medical practitioners to prescribe no more than one month's supply at a time.
"That would bring an instant reduction in waste, saving the NHS and the taxpayer millions," Mr Dove explained. "And, in future, when medicines management services are being provided by community pharmacists, we will have even greater ability to control and reduce inappropriate or excessive prescribing by GPs."
Any coherent strategy for the future development of community pharmacy needed to include proposals on pharmacy prescribing, Mr Dove went on. Last week, Ministers had announced an extension to nurse prescribing. Their commitment on pharmacist prescribing had been less concrete. They would introduce legislation when they had time, and then only to allow repeat prescribing (PJ, March 18, p424).
It had taken a long time to make this announcement two years after discussion had started with Ministers and a year after the Crown report had been published. It was progress in the right direction, but pharmacists wanted more progress, more quickly.
Taken together, medicines management, one-month prescribing, with a possible link to repeat dispensing, and the concept of pharmacy prescribing went some way towards representing a strategy for the future, Mr Dove stated. He added that other ideas were under consideration, but he did not elucidate on them.
What all this proved, was that it was possible to come up with practical and deliverable proposals that benefited patients, the NHS, pharmacists and other health professionals. The Department had promised that it would do that, but it had failed to do so.
The PSNC and other pharmacy organisations did not have a monopoly on ideas, Mr Dove went on. Many LPCs were developing innovative solutions to local health needs and problems. They should not forget to tell the PSNC what they were doing. Local initiatives might be deliverable on a national scale with central funding.
"By telling us, you can help shape our strategy and make sure that it fits your aspirations," Mr Dove told his audience.
Turning to joint working between the national pharmacy organisations, Mr Dove said that there were now shining examples of collaborative work. One was the joint promotion of pharmacy at last year's Labour Party conference by the PSNC, the National Pharmaceutical Association, the Royal Pharmaceutical Society and the Company Chemists Association. This had proved well worthwhile. All were committed to repeating the exercise this year, with a presence at the Conservative and Liberal Democrat conferences, too.
Another successful initiative had been the formation of the All-Party Pharmacy Group. This group, inaugurated in December, 1999, had around 100 Parliamentary members, and had already published a report calling for emergency contraception to be available from pharmacies (PJ, March 4, p354). A Ministerial response was awaited, but the signs were that Ministers would agree.
Commenting on pharmacy remuneration, Mr Dove said that a claim for a significant increase had been submitted for 2000-01. The claim had highlighted the work of contractors in reducing the impact of the "influenza season" on hospital and GP services.
"We have said that this important work requires adequate reward and that the serious recruitment and retention problems in our profession will only be tackled by improvements in funding," the conference was told by Mr Dove. "But we have reserved our position in the event that the new pharmacy strategy document is released, since new or expanded services could require additional funding in the coming year."
Outlining current events impacting on reimbursement, Mr Dove said that there would be a new discount inquiry in April. Now that an outstanding discount liability from November, 1998, had been paid off, the Department had agreed to a 1.06 per cent cut in the discount clawback from next month. In addition, the container allowance would rise from 5.6p per prescription to 6.5p.
Considering the issue of generic medicines and Drug Tariff Category D, Mr Dove said that he had given evidence to a House of Commons Health Select Committee inquiry in order to ensure that community pharmacy would not be blamed for generic price rises.
The committee had pressed for changes to the Category D system, including reducing the criterion for inclusion from four week's stock in the supply chain to two weeks. At the time the Department had been pressing for one week and the PSNC had agreed to two weeks shortly before the committee had published its report.
Ministers had told the select committee that they had asked the Office of Fair Trading to examine competition aspects of the supply of generics and had asked an economic analyst - Oxford Economic Research Associates (OXERA) - to review all aspects of the supply of generics to the NHS and to recommend changes. OXERA was expected to report in the summer and it was highly likely that changes it suggested would affect contractors.
Turning to prescription "switching" - the transfer of prescriptions from charge exempt bundles to charge paid bundles by the Prescription Pricing Authority because patient exemption declarations were incomplete - Mr Dove said that it was outrageous and unjustifiable. Proposals had been made to the Department concerning age-related exemptions which could reduce the problem by 70 per cent. In the meantime, contractors should make sure that all forms were correctly signed by patients.
On rural matters, Mr Dove said that an agreement had been reached with the medical profession which, if implemented, would mean that doctor dispensing was no longer such a threat to pharmacies in market towns and suburbs. The proposals were now being modified by the PSNC and the British Medical Association's General Practice Committee in order to deal with questions raised by Ministers and their officials. Mr Dove hoped to report a successful conclusion at next year's conference.
Turning to primary care groups and primary care trusts, Mr Dove said that PCTs could change the landscape in primary care.
"It is extremely important that LPCs exercise their right to have a say on PCT applications," Mr Dove told the conference. "They are going to shape the future for everyone in primary care."
PCTs should not be seen as a threat, or that was what they would become, Mr Dove went on. They offered an opportunity to develop and to progress pharmacy locally, to work more closely with other health professionals, to do more for patients and to get more money for pharmacy. But there were potential problems. Although Ministers had said that they did not intend PCTs to open their own pharmacies, they had stopped short of issuing directions to prevent them from doing so. The PSNC should be informed immediately anyone saw any moves by a PCT to open a pharmacy.
Other topics discussed |