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Letters to the Editor
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New contract
I will be out of a job
From Mr L. S. Curie, MRPharmS
Despite the support for the new contract, do not ignore the fact that
over a quarter of contractors did not vote. Moreover, I suspect the majority
of that 25 per cent were independents who knew they would stand no chance
anyway — whichever way they voted. Since 54 per cent of all pharmacies
are multiples there was only ever going to be one result, and I guarantee
you that every multiple voted!
I also suspect that all the other pharmacies that voted “yes” will
be doing well above 2,000 items per month.
Those below 2,000 like myself have everything to lose … our livelihoods
for a start!
Lionel Curie
East Molesey,
Surrey
Has the penny dropped yet?
From Mr H. R. Patel, FRPharmS
There are two significant changes to the payment system under the new
contract which have not been made in a transparent way. More than that,
it appears that there is not much discussion about the specific changes
and the decimation of the “front-loading” element of the
contract. The vote in favour of the contract does not negate the need
for greater transparency and understanding.
A significant amount of money has been moved from the front-loading element
of the contract and spread to the rest. If it is accepted that every
pharmacy has fixed costs, which must be met before the marginal costs
have to be met, then giving the top 25 per cent of contractors 50 per
cent of the global sum (PJ, 1 February 1997, p174) is unfair because
the cost of providing each prescription decreases as the volume increases.
The new contract flies against this and generates a significant increase
to the bottom line profits of the top 25 per cent of the contractors
at the expense of the bottom 50 per cent.
Under the old contract, the maximum professional allowance is paid to
all those dispensing 1,600 items a month. The allowance starts at 1,100
items per month and is graduated before reaching the maximum allowance.
It represents about 25 per cent of the global sum and the majority of
contractors get the full allowance.
Under the new contract pharmacies have to dispense 2,500 items a month
before getting the full amount of front-loading. Also, according to Noel
Baumber (PJ, 20 November, p743), the amount of front-loading is now only
16 per cent of the total amount available (which is £1.766m).
To draw attention away from this situation the amount of front-loading
has been split into two pots. First is the practice payment, which starts
at 1,100 items a month (£2,000 per annum) and increases, at 1,600
items per month, to £3,000. Instead of flattening out at a given
point it increases per item by 24.2p, with the result that it spreads
out to the busiest contractors. Next is the additional establishment
payment, which starts at 2,000 (£20,000 per annum) and increases
to £21,821 per annum at 2,500 items per month. This flattens out
at 2,500 items per month. So, instead of a gradually increasing, professional
allowance we now have clear bands.
In summary, the total figure for remuneration has risen from around £850m
to £1.766bn (207.8 per cent) but smaller contractors (say, those
dispensing fewer than 2,500 items per month) are not going to get the
same percentage increase as larger contractors. It would be interesting
to see at what point people get the full percentage increase and how
it increases beyond that point. It would be even more interesting to
see how it translates to bottom line profits. Those who do more work
should be paid more but the relationship cannot be linear because the
need for front-loading to cover the fixed costs cannot be ignored or
minimised, and decreases in unit costs must be properly recognised.
The key question that needs to be answered is this: has the gap in income
between the bottom 25 per cent of contractors and the top 25 per cent
of the contractors increased and if so by how much? Also, what are the
intentions behind such a change and reasons for the change?
Hemant Patel
Secretary
North East London Local Pharmaceutical Committee
What did the electorate vote for?
From Mr A. R. Korsner, MRPharmS
Contractors have overwhelmingly voted for the new contract. But what did
they vote for?
Were they voting for the distribution? Did they know what it was to be?
Do we know the figures now? How many had already voted before problems
were identified? Or did they just vote for the £1.7bn, which seemed
a lot?
It is all about information. I am convinced that a contract based on quantity
(which this is) flies totally against the new services. For example, if
you are chasing a threshold, will you review patient medications, which
may result in a reduction of a number of items? Will you give a patient
a cough linctus under a minor ailments scheme when a recommendation for
a visit to a GP could result in another prescription towards the threshold?
Medication reviews (leading to reductions in items dispensed, leading to
reduced drug costs and enhanced patient outcomes with respect to interactions
and side effects, and the all important reduction of hospital admissions)
just cannot happen when pharmacists are chasing numbers.
Primary care trusts are now having to fund payment by results to hospitals.
City and Hackney PCT has already identified that increased payments to
hospitals under this scheme may take 7 per cent out of its budget, which
could have been available for payments to pharmacists. Pessimistically,
it could be a bottomless financial pit. Pharmacists in the City and Hackney
area are being asked by the PCT to do everything in their power to keep
patients out of hospital, by monitoring patients with chronic obstructive
airways disease, diabetes, hypertension and other conditions which, when
not checked, often result in admission to hospital.
The new contract and extra services cannot be fully successful under these
conditions.
The profession is treading a fine line and its credibility within an integrated
health service is being gravely tested. Payments for the new contract must
be structured according to the stated principles of quality and “fair
return”.
Adrian Korsner
London N20 |
The
Pharmaceutical Journal