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Letters to the Editor
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Prescription fraud
Will pharmacists pay price of reduction in prescription fraud?
From Mr H. R. Patel, MRPharmS
I was, as a pharmacist and a taxpayer, pleased to learn about the “significant
achievements the NHS has seen in tackling prescription fraud” (PJ,
20 March, p348). It was also reported that over a four-year period ending
in 2003 there was a 60 per cent drop in fraud, which freed £70m
per year for patient care.
Bill Darling, chairman of the NHS Counter Fraud and Security Management
Service, went on to say that with the continued support of the profession “we
will reduce prescription fraud to the absolute minimum”. That is
excellent news for all those seeking to reduce fraud. I know that at
one stage, every pound that the NHS invested in pharmacy to reduce fraud
saw a four-fold return on investment for the NHS. It would be interesting
to know where the rate of return stands at present.
However, there are a number of points to note and questions to be answered:
1. There is a law of diminishing returns and, at some stage, the cost
of the measures taken will be greater than the reduction in fraud. This
will mean frustration in some quarters if the expectations are not properly
managed.
2. Many pharmacists will remember that there was a promise of monies
released from anti-fraud activity in pharmacy to help improve premises,
for example, by installing private areas. What has happened to that promise?
3. There is no doubt that there has been an increase in low level abuse
and, in some cases, violence in pharmacies as a result of the “policing” activity
of pharmacy staff in order to reduce fraud. What is the counter fraud
service going to do to train pharmacy staff to better handle the difficult
situations in which they may find themselves? Will the service support
making available training programmes on dealing with aggressive and potentially
violent patients?
4. Does the service support a possible and much needed extension of “zero
tolerance” campaigns, which have already been introduced in hospitals
and GP surgeries, to community pharmacies?
5. Does the service realise that with open access to pharmacies, shifting
crime from high streets (where there are better security measures) to
secondary parades, and the increasing feminisation of the profession,
means there is a need to invest in improving security measures in community
pharmacies? Is the service willing to enable access capital funds or
premises money that has been saved to help provide necessary and urgent
improvements in pharmacy security?
6. There is a need to consider relaunching the scheme because after some
time all schemes become dated.
The chief executive of the NHS CFSMS, Jim Gee, said recently: “We
take the problem of violence and aggression seriously and are determined
to deliver an environment for those who use or work in the NHS which
is properly secure, so that the highest possible standard of clinical
care can be made available.”
I am sure Mr Darling, as a community pharmacy owner and a former member
of the Royal Pharmaceutical Society’s Council, will know that the
hardest part of re-engineering is living through change. It is at this
time that help is needed to keep people motivated and rewarded. Community
pharmacists will be wondering if the counter fraud service will reciprocate
their support by supporting community pharmacy with resources — or
will there be more lip service this time next year? Time will tell, but
I am concerned that, with around 15 per cent more prescriptions than
last year, pharmacy staff will once again be overloaded with work.
The question that remains unanswered is: “Will the price for reducing ‘prescription
fraud to the absolute minimum’ be paid by community pharmacy or
by the NHS, which has already benefited so much from the diligent hard
work of community pharmacists?”
Hemant Patel
Secretary
North-East London LPC
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DERMID McCAUSLAND, director of corporate affairs, NHS Counter Fraud
and Security Management Service, replies:
In response to the letter
from Hemant Patel, I would like to begin by pointing out that between
1999 and 2003 counter fraud work has financially benefited the NHS
by £320m — a
16:1 return on the budgetary investment. This means less money being
lost to the fraudsters and more being spent on patient care. Shortly
we shall be announcing the latest figures up to the end of the 2003–04
financial year. However, it is clear that these figures show that we
are not anywhere near the point where the cost of the measures taken
are greater than the reduction in fraud losses.
Since April 2003 the NHS CFSMS has been responsible for both countering
fraud and managing security in the NHS, including tackling violence
against staff.
The expertise of NHS CFSMS staff is in protecting the NHS and the services
it delivers. Where savings are identified or losses recovered, we seek to
ensure that the monies concerned are reallocated according to three principles:
· First, if necessary, a portion of the recovered
resources should be used to prevent any repeated or further loss
· Second, the budgetary area from which the
losses occurred should benefit from the resources being restored
· Third, areas of particular financial need
(other than that from which the loss occurred) may also benefit These are not in order of importance and the second principle very
much reflects the commitments which have been made to pharmacists.
Resources made available through civil recoveries in smaller cases, are directly
reinvested into local NHS services via local NHS organisations. Where savings
are identified nationally, for example, by reducing pharmaceutical patient
fraud and ensuring that there is an extra £70m a year available to spend
in the NHS budget, we discuss how the above principles (and particularly the
second principle) can best be implemented. A range of options is being considered
as to how such monies could be invested.
Violence against pharmacists and their staff is just as unacceptable as fraud.
We are determined to do all we can within our remit to ensure that pharmacies
and those who work in them are safe and secure.
In recent discussions with the Pharmaceutical Services Negotiating Committee,
we agreed that conflict resolution training should be made available at cost
to pharmacists. The one-day course will enable pharmacists to recognise potentially
violent situations and defuse them before they escalate. Details will be available
shortly on how pharmacists can book a place on the course. Further information
is available at www.cfsms.nhs.uk
It was also agreed with the PSNC that the new national reporting systems for
violent incidents will be opened up to pharmacists through their primary care
trusts. The systems will allow cases to be followed from report to conclusion
and will provide feedback to the person assaulted.
Training for the new local security management specialists will also begin
shortly. They will work with the police in investigating assaults against NHS
staff and professionals and, along with the new NHS legal protection unit,
will focus on increasing the prosecution rate in these cases. Until then members
of the CFSMS operational teams will investigate such incidents. Publicity about
these initiatives will also be increased considerably to raise awareness.
To repeat the statement made by our chairman Bill Darling, I would like to
thank pharmacists for their support in the fight against prescription fraud.
CFSMS does not pay lip service to anything — our record shows that if
we say something we mean it. We are completely serious both about continuing
to reduce all types of fraud in the NHS and to
freeing resources for better patient care. |
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The
Pharmaceutical Journal