NPA says appliance contractors hold NHS to ransom
Appliance contractors should stop holding the National Health Service to ransom and receive the same payment for dispensing as community pharmacies rather than fund “free” services through excessive on-cost remuneration, the National Pharmaceutical Association says.
The Department of Health is currently consulting on possible changes
to the way in which appliance contractors are remunerated. At present,
appliance contractors receive an on-cost of up to 25 per cent (plus a
dispensing fee of 2p) on items they dispense. They are not subject to
a discount clawback. The NPA has made a strongly worded submission to
the consultation, even though it was not invited to do so.
The NPA says that for many years appliance contractors have “enjoyed
profits far higher than community pharmacies for providing what is, in
effect, the same service”. NPA director of practice Colette McCreedy
said: “Appliance contractors appear to have held the DoH to ransom
with their sponsored stoma care nurse positions and ‘additional
services’ such as home delivery, flange cutting and helplines.”
The NPA calls the additional services provided by appliance contractors
and their higher levels of remuneration a “chicken or egg” situation.
Appliance contractors fund up to 70 per cent of all stoma care nurse
positions in the NHS. They can afford to do this because of the higher
remuneration and because one of the main roles of the nurses is to ensure
that appliance prescriptions are routed to the sponsor’s dispensing
service, the NPA claims. The proportion of stoma appliances dispensed
by appliance contractors rose from 37 per cent in 1993 to 64 per cent
in 2001. “If the DoH did not reward appliance contractors so freely,
it would discover that it could afford its own independent stoma care
nurses,” the NPA says.
The NPA also expresses concern that the DoH consultation document makes
invidious comparisons between pharmacy and appliance contractors. The
NPA says that pharmacies can, and do, provide home delivery, flange cutting
and face-to-face advice on appliances and on medicine-related problems,
even without the funding that appliance contractors receive.
The DoH is proposing setting standards for appliance dispensing. These
include home delivery within two working days, measuring and fitting
at home, flange cutting, telephone helplines and supply of disposal bags
and wipes. Appliance contractors meeting these standards would be remunerated
at the current high level. If the standards are not met, or not required,
then remuneration “should be at the same rate as for pharmacies”.
The NPA suggests that instead there should be a tiered fee-based approach
to remuneration with additional services being commissioned locally as
required. This would remove current incentives towards prescribing large
quantities of expensive items. Any accessories required should be listed
in the Drug Tariff so that they can be prescribed in the normal way.
It adds that appliance contractors should be subject to discount clawback
and a global sum in the same way as pharmacies.
The Pharmaceutical Services Negotiating Committee has set up a working
group and will be making a formal submission to the consultation before
the closing date of 31 August.
Ray Hodgkinson, director general of the British Healthcare Trades Association,
which represents 90 per cent of dispensing appliance contractors, told
The Journal that much of the cost of looking after stoma patients in
the NHS, both pre- and post-operatively, is borne by appliance contractors. “It
can be shown that this cost exceeds the remuneration received by [them],” he
said. The needs of patients with stomas are different from the rest of
the population that might consult a pharmacist, he added. |
