The Pharmaceutical Journal
Vol 270 No 7239 p341
8 March 2003

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Local Pharmaceutical Committees

PSNC rapped over "badly taken" period-of-treatment fee decision

The decision taken by the Pharmaceutical Services Negotiating Committee to accept the suspension of the period-of-treatment and threshold quantity fee was "a bad decision, taken badly", according to STEVE BRILL (Hertfordshire).

Mr Brill was seconding a motion jointly proposed by Hertfordshire and Bedfordshire local pharmaceutical committees lamenting the "total absence of consultation" over the decision and deploring the PSNC's action.

GRAHAM PHILLIPS (Hertfordshire), proposing the motion, said that the PSNC had made its decision without carrying out any kind of assessment of the impact it might have on contractors.

SUE SHARPE, chief executive of the PSNC, explained to the conference that the decision to accept suspension of the fee had its roots in flawed proposals from the Department of Health to make changes to the way in which pharmacists would supply patient information leaflets (PJ, 10 August 2002, p180). The PSNC rejected a £4m payment towards this as part of rejecting the proposals.

After the PSNC's November 2002 meeting, the Department told the PSNC that the projected prescription volume increase for the year was 6.5 per cent and that it believed that the period-of-treatment fee was unnecessary.

The PSNC was faced with a potential overpayment of £4m and was seeking to avoid the "horrific clawback" which happened in previous years, Mrs Sharpe said. Since the Department has undertaken to increase the global sum with new money to match any increase in prescription volume caused by introducing repeat dispensing pilots, so maintaining the level of the dispensing fee, the PSNC did not want to take any action that would cause that fee to fall.

"Neither the PSNC nor the Department had any information about which contractors would be affected by ending the period-of-treatment fee," she said. "We were not willing to propose any cut, so the Department proposed abolishing the 'arcane and unnecessary' period-of-treatment fee (as has already happened in Scotland and Northern Ireland)."

Members of the PSNC were contacted by e-mail and telephone and agreed by a majority of one vote to accept suspension of the fee. Subsequently, the PSNC has requested that the fee be reinstated from 1 April (PJ, 22 February, p255). The motion was carried.

A second motion, from Brent and Harrow LPC, deplored the withdrawal of the fee and urged the PSNC not to accept the extension of its withdrawal until "a properly remunerated repeat dispensing service is universally available through all pharmacies that wish to participate".

Proposing the motion, MARION GARNER-PATEL (Brent and Harrow) said that many pharmacies suffered because local prescribers would not issue 28- or 30-day prescriptions, instead giving out much larger quantities. "Hopefully, medicines management and structured medicines reviews will slow down the issuing of 'shipping orders', but until then the period-of-treatment fee should be reinstated," Mrs Garner-Patel said. She noted that national service frameworks, such as those for coronary heart disease and diabetes, are driving up prescription volumes in a way over which community pharmacists have no control. The motion was carried.

A third motion, from Berkshire LPC, calling for the immediate reinstatement of the fee, was carried without debate.

Monitored dosage systems

The conference approved a motion from Wirral LPC calling on the PSNC to negotiate a system of additional fees for the provision of monitored dosage systems (MDS) to patients in the community.

TONY WELSH (Wirral), proposing the motion, said that decisions to request use of an MDS for a patient are being taken by social services care workers in order to comply with risk management protocols, rather than by health care professionals based on patient need.

The cost of MDS is being funded in effect from the global sum through the use of seven-day prescriptions, distorting the fee structure. General practitioners and their staff are concerned about the additional workload imposed by issuing these prescriptions in order to shore up "a problem that is not of their making". Allowing GPs to order an MDS on FP10 prescription forms would bring the area back under the control of health care professionals.

MIKE HOLDEN (Hampshire and Isle of Wight) described a pilot project on the Isle of Wight in which pharmacists are paid a fee for undertaking patient assessments and a monthly dispensing fee.

For the PSNC, GODFREY HORRIDGE, financial executive, said that the committee would be seeking payment for MDS from the Department of Health. This was being supported by the British Medical Association and by work on the impact of disability discrimination legislation.

Following an amendment, proposed by GRAHAM PHILLIPS (Hertfordshire), that prescribing of MDS should follow "a robust pharmaceutical care needs assessment", the motion was carried.