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	The Pharmaceutical Journal Vol 269 No 7229 p884-885 21/28 December 2002	This page Reprint Photocopy
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Period-of-treatment fee

Small groups could not do worse than the PSNC

GPs should restrict their prescribing to 28 days

This ludicrous decision must be reversed

Robin Hood in reverse

A worrying decision by the PSNC

Small groups could not do worse than the PSNC

From Mr A. D. Castell, MRPharmS

The proposal to abolish the period-of-treatment threshold fee is disgracefully discriminatory, illogical and unprincipled. Having been proposed by the Department of Health and accepted by the Pharmaceutical Services Negotiating Committee, it serves, in its sheer iniquity, to obscure a situation that may be embarrassing to our "negotiators".

The £4m "overpayment" is due to us doing 6.75 per cent more work instead of the 6.25 per cent required for us to receive the same remuneration as last year. That is, we have dispensed too many prescriptions. So instead of sharing out the misery by cutting the fees (which would be highly noticeable), it proposes to axe a subsidiary item in the hope that few people will notice. The fact that the load will fall heaviest on those who, by dint of the long period prescribed, have contributed least to the "discrepancy", is apparently of no consequence.

This fee was introduced to ameliorate a perceived unjust discrimination within the global sum. Its abolition is therefore discriminatory and could be actionable. What is more to the point is that the total is only 0.5 per cent of the global sum. Why should this sum precipitate such apparently urgent action and why should the PSNC have felt the need to act without debate or consideration of the consequences? Both the Department and the PSNC have some explaining to do.

If we are dispensing 0.5 per cent too many prescriptions perhaps a more equitable solution would be to close our dispensaries for the last Friday and Saturday in April explaining to the public that we have completed our year's quota and will be penalised if we continue to work.

Bearing in mind the impetus towards a new contract, contractors and their local pharmaceutical committees should be asking the question: "Are you happy with these bodies negotiating your future?" I certainly have no confidence whatsoever. I urge all LPCs to consider the concept of a group local pharmaceutical services scheme to be offered to their PCTs. I have never previously believed that small local groups could better negotiate than our well-resourced national body, but I am now convinced that they cannot do worse.

Alan Castell
Vice-Chairman
North East London Local Pharmaceutical Committee

GPs should restrict their prescribing to 28 days

From Mr J. R. Patel, MRPharmS

How can the Pharmaceutical Services Negotiating Committee accept proposals from the Department of Health to remove the threshold-quantity fee for the remainder of the financial year (PJ, 14 December, p835) without getting the Department to agree to limit prescribing to 28 days? Why should contractors be penalised for prescribing policies set up by local primary care trusts and general practices?

Due to a lack of insight by our professional negotiating body are we the only profession to be battered for improvement in patient care and outcomes?

Are we to provide rapid access to medication, improve convenience to patients and provide additional patient centred services like free deliveries, free compliance aids, free advice to patients and prescribers and clean up or rectify any mess a prescriber makes for year-on-year pay cuts?

Which other profession has an annual downward pay review? If the PSNC honestly believes that it works in the interest of the profession and the contractors it represents, why does it not regularly manage an upward only review in the dispensing fee with the Department of Health, by agreeing ways of off setting any overspends? The overspends relate to prescribing, which is out of pharmacy control.

The PSNC must make the Department of Health recognise the true professional cost of dispensing and the quality of services delivered through pharmacies.

Come on, PSNC! Pull out all your guns and start fighting for us and not against us.

Jignesh Patel
Vice-Chairman
North East London Local Pharmaceutical Committee

This ludicrous decision must be reversed

From Mr C. K. Nathwani, MRPharmS

In the item "Period-of-treatment fee to go?" (PJ, 14 December, p835), it is stated that "some members of the committee feel strongly that this is not the best course of action". Well, it certainly is not, and those members must realise that they are in the committee to make, and be seen to make, fair and accurate representations of all contractors.

How can an overpayment of £4m made to all contractors because of a higher than forecast number of prescriptions dispensed be clawed back from only some who rightly receive period-of-treatment fees? I hope that this ludicrous decision is reversed in order for it not to set a precedent to alter fees other than dispensing fees without a policy decision.

C. K. Nathwani
Southall, Middlesex

Robin Hood in reverse

From Mr P. Walton, MRPharmS

When a pharmacy receives a prescription that asks for medicines with a treatment period well in excess of a month, the receiving pharmacy is grossly disadvantaged because it will not get as many dispensing fees as a pharmacy that receives monthly prescriptions. The pharmacy is unlikely to keep stock required to service requests for expensive items much in excess of a month's supply on cost grounds, and thus it is likely that the pharmacy will have to owe medicines, requiring two dispensing processes for one dispensing fee. Even to keep run of the mill items required to service everyday prescriptions where general practitioners regularly write prescriptions for large quantities costs dear. If a phar-macy operates a collection and delivery service, large quantity prescriptions would likely require two deliveries.

Pharmacies disadvantaged by large quantity prescriptions have to some extent been protected by a threshold payment of 40p, which is more than 40 per cent of the standard dispensing fee. This protection has always been inadequate because of the large number of owing prescriptions requiring two dispensings for one fee plus 40p.

With these facts it beggars belief that the Pharmaceutical Services Negotiating Committee can agree to allow the Department of Health to scrap payment to those pharmacies that do receive them to prevent overpayments to contractors in general who may not (PJ, 14 December, p835). My pharmacy services a surgery whose GPs always write in three-monthly quantities, and is shortly to move into a new health centre with these GPs. The PSNC has effectively agreed that I will receive 40 per cent less than our budgeted remuneration and has given us 20 days notice of this.

This move is totally unjust. It affects only a small number of pharmacies — some of them may suffer almost a 40 per cent reduction in fees. Multiples will hardly be affected because on average they will gain in some areas and lose in others.

I have no way of knowing who on the PSNC voted for the potentially crippling reduction in the remuneration I will receive to protect the income of others. I do suggest that this information is made public by the PSNC so that the democratic process becomes transparent. I would also like to hear from others who are going to be severely affected by this injustice in order to formulate an action plan.

It is almost certain that this action will cause some patients on high-cost, high-volume prescriptions to become "pariah" patients whom pharmacists will not want to deal with, especially for additional services such as collection and delivery.

I no longer have any confidence that the PSNC will act fairly on behalf of all contractors. It needs to have its powers curtailed so that it is never again in a position to change the contracted payment in such a devastating manner to some contractors with such short notice and without any consultation.

Philip Walton
Manchester
(e-mail philip.walton2@ntlworld. com)

A worrying decision by the PSNC

From Mr D. N. Maxwell, MRPharmS

I read with considerable dismay of the decision by the Pharmaceutical Services Negotiating Committee to accept the Department of Health's proposal to discontinue the period-of-treatment fee for the remainder of 2002–03 (PJ, 14 December, p835). Despite the criticism of this fee by Tessa Jenns (PJ, 23 November, p743) this goes in a small way to compensate those contractors faced with a reduction in item numbers outside their control. Many of these contractors will probably already be suffering from a less than average increase in prescription numbers thereby reducing their proportion of any increase in the global sum. To further their disadvantage by removing this fee is grossly unfair and certainly does not spread the load evenly among contractors. Surely the correct way to avoid the overpayment (assuming no further funding) would be to reduce the standard dispensing fee appropriately, thereby reducing all contractors' incomes in proportion to their overall turnover more accurately.

The decision to accept this proposal by the PSNC (officers?) without a proper debate by the full committee is extremely worrying. Is this the first step towards the single flat dispensing fee that the DoH has been looking for since the demise of on-cost? I find these developments extremely worrying and hope to see a reasoned (political as well as financial) explanation of this decision.

Neil Maxwell
Past Chairman of PSNC Technical Subcommittee
Bolton, Lancashire

SUE SHARPE, chief executive, Pharmaceutical Services Negotiating Committee, states:

Your correspondents Neil Maxwell and Philip Walton sent me copies of their letters to The Journal. Both have been misinformed as to the process by which the PSNC decided to agree to the Department of Health's proposal to abolish the period-of-treatment fee and, in Mr Walton's case, the decision itself.

In its letter making a final offer of an increase of 3.6 per cent on the global sum, the Department stated that it wished to avoid reducing the basic dispensing fee, and indicated that it would wish to avoid an overpayment by making changes to the expensive prescription allowance or the period-of-treatment fee. At its meeting in November, the contract planning subcommittee debated at great length the options. It did not reach a firm conclusion but the discussion was reported to the full committee meeting, when there was a further debate and views were expressed, with reasons, on both sides. At that time there was no specific proposal from the Department, which appeared to be in no hurry to press for a decision on the options, and for that reason the committee did not press the issue to a conclusion at its meeting.

Towards the end of November a proposal was received from the Department to abolish the period-of-treatment fee. This was accompanied by a request for a speedy decision, and on that basis committee members were e-mailed and their views were sought. A narrow majority favoured removal of the period-of-treatment fee. In reaching their decision, PSNC members were able to reflect on the discussions at the contract planning subcommittee and the full committee meeting.

Mr Walton asserts that the PSNC has allowed the Department of Health to "scrap" the fee. It has not. That was the proposal from the Department, but the PSNC has agreed only to suspension of payment for the remainder of the current financial year, that is until April 2003. If Mr Walton does indeed find that loss of the fee reduces his NHS dispensing income by 40 per cent, or if any other contractors can establish significant reductions in their fees, it would be helpful if they could send relevant information to Godfrey Horridge at the PSNC, because this will assist the committee in considering the issue for future years.

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