|
· New contract (5)
· PPRS
· Registration exam (4)
· Prescription forms
· Community pharmacy
· Male health
· Competency
· Public health
· Alcohol
· Levithyroxine
· Complementary medicine
· The register (3)
· Retention fee
· The Journal (2)
Letters to the Editor
|
New contract
Is money really being devolved?
From Mr S. K. Bagga, MRPharmS
The new contractual framework for community pharmacy from the Department
of Health makes the following two statements:
· There are three tiers of services: nationally set essential and advanced
services (for which £1.766bn funding is available in 2005/06),
and enhanced services commissioned locally by PCTs.
· It is envisaged that there should be a periodic review of services
in the contractual framework to allow for updating or revision of service
requirement and standards of provision. As part of this, there may
be a shift in the categorisation of services, for example, a service
might move from being in the enhanced category to the essential category.
This is nonsense. The proposed arrangements show that “essential” and “advanced” services
are to be nationally negotiated and dispensing is to be paid from “the
new global sum”. The “enhanced services” are to be
paid from locally devolved sums of monies which are already considered
inadequate by most PCTs. In fact, in some PCTs, there are not enough
monies to make even floor payments to GPs for providing enhanced services
agreed in the new GP contract! Also, the Government, having devolved
85 per cent of NHS funds to PCTs, has said that they will devolve more
money and delegate power to PCTs in the future.
So, there appears to be a contradiction, which the Department of Health
must clarify. The impression is being created by the above two statements
that locally devolved monies would be pulled back to the centre and transferred
to the essential services. If this is correct then why are the monies
for minor ailments schemes not transferred to the central pot now? And
why are minor ailments schemes not an essential scheme from 1 April?
Other questions also arise. Under what circumstances will the enhanced
services be redefined and payments transferred to the central pot? What
schemes are they looking at to make the changes?
The second point I wish to make is that £866m of the £1.766m
funding for community pharmacy is labelled as the “new global sum” to
pay for dispensing services. This means that at any time the remaining £900m
can be devolved to the PCTs to commission local services. Are contractors
aware of this point?
Thirdly, where are the milestones for the future? How much of the average
community pharmacy’s income is going to be derived from the locally
negotiated services and how much from the centrally negotiated income?
This is extremely important as the majority of contractors are still
under the impression that monies being devolved to PCTs will not affect
their income in any way.
Shiv K. Bagga
London E6
| |
CHRIS TOWN, Chairman, NHS Confederation Negotiating Team, comments:
This letter makes a number of points about the new community
pharmacy contract and, although the funding of the contract is
entirely
a matter for the Department of Health, as chair of the negotiators
I will attempt to deal with as many of the issues it raises as
I
can.
First, it should be noted that the new contract will be introduced
in a phased approach and that it will evolve over time. This was
always the intention of
the DoH and is the reason for the statement in the contract that “it is
envisaged that there should be a periodic review of services in the contractual
framework to allow for updating or revision of service requirement and standards
of provision”.
Many of the points raised in the letter cannot be answered for the simple reason
that we do not yet know, and we need to wait to see, the outcome of the negotiations
over the next phases of the contract. Any development in the contract will
be the result of negotiation between the Department of Health, the NHS Confederation
and the Pharmaceutical Services Negotiating Committee and may, if necessary,
involve changes in primary legislation. These changes would be required, for
example, to introduce full local commissioning.
Certainly the detail such as funding for moving services between categories
is as yet unclear and will be subject to discussion in negotiation sessions
over
the coming months and to direction from the Department of Health. What is clear,
however, is that the trend is to continue to localise funding with the primary
care trusts as in “Shifting the balance of power” and this is not
likely to change.
It is important to appreciate that what we have now is the initial contractual
framework and that details in terms of the development of the contract will
become clearer over time as we discuss these issues in future negotiations. |
Contract rewards quantity not quality
From Mrs E. E. Hopkins, MRPharmS
The new contract was supposed to be about fair funding — quality
not volume — and an extended range of services.
At a recent London Pharmacy Forum it was highlighted from a Department
of Health document on the pharmacy contract that:
· All contractors, large and small, depend at present on profits from
purchase of medicines dispensed for the NHS to supplement the Global
Sum income. This income source is substantial, but was not recognised
under the present arrangements.
· Pharmacies’ reliance on purchase profits has been recognised
by the DoH and the Pharmaceutical Services Negotiating Committee. Thus,
money released from a reduction in reimbursement prices for generic medicines
will be used to contribute to funding the new contract.
This acknowledges the fact that all contractors, including smaller contractors
(who operate much nearer the break even point than the rest), are currently
benefiting from the available discounts. It has also been said that the
DoH objective is to reimburse pharmacies as closely as possible to the
price they pay for medicines for dispensing under the NHS. To avoid underpayment,
which would threaten the viability of the pharmacy network after considering
the costs of running the network, the DoH agreed to transfer the so-called
profit on purchasing to pay for various elements of the agreement. But
it excluded those dispensing less than 2,500 items a month from receiving
the full annual establishment payment (£21,821 per annum), which,
along with the variable volume-related practice payments, makes up the
front-loading necessary to ensure that fixed overheads are covered for
all pharmacies. At 2,000 items a month the annual establishment payment
is £20,000 a year. This means that a pharmacy dispensing 1,999
items a month will lose £20,000 a year for not dispensing 12 more
items; therefore each prescription is effectively worth £1,666.
The proposals put to a vote were unfair. Noel Baumber (PJ, 20 November,
p743) showed that monies have been transferred from front-loading to
back-loading the remuneration package without any disclosure to contractors.
I believe this should be challenged in law.
In my opinion the new contract will not extend the range of services
because the cost of providing the services will exceed the resultant
income and create more hassle.
Minister, rethink the proposals before you are forced to. Expect a challenge.
I would not accept this lying down. Someone should be accountable for
loss of service to my community.
Elisabeth Hopkins
Ealing, London
Points system for GPs’ new money
From Mr D. K. Rayner, MRPharmS
Those who have recently voted in favour of the new pharmacy contract
may find the following facts somewhat disturbing.
My daughter has almost finished setting down the protocols, computer
listings, etc, for the new medical contract in respect of the practice
where she is a partner. The Government has organised a “points” system
in which the practice has been offered a maximum of 116 points to be
achieved. This includes influenza vaccination targets, computer documentation
of scans, X-rays, staff and safety protocols, etc. For each achieved
point there is a payment (new money) of £1,050 giving a total of £121,800
for the practice next year.
At the moment she has achieved 85 points and fully expects to reach the
final total within the next week. Since there are five partners, each
will receive £24,360 in extra gross wages next year.
Perhaps you would be kind enough to ask Sue Sharpe to comment on the
lamentable comparison this makes to the new pharmacy money on offer?
David K. Rayner
Bradford
| |
SUE SHARPE, chief executive, Pharmaceutical Services Negotiating
Committee, replies:
The new community pharmacy contract was negotiated
on the basis of evidence of costs and expert advice on funding.
It is for the community pharmacy service, and it is not relevant
to
compare it in structure or detail of funding with the GMS contract. |
Independent contractors should form own alliance
From Mr B. Nathwani, MRPharmS
At a House of Commons briefing on Wednesday 17 November a question was
put to John Reid that struck such a chord that most of the 250 pharmacists
present burst into spontaneous applause.
The question was, although all pharmacists agree with the new clinical
roles envisaged, why was a model of distribution chosen that could lead
to a number of small pharmacies having to close? Contractors were not
asking for extra money but a fairer distribution. Dr Reid’s assurance
was sought that he would not sign off the new contract unless a fairer
distribution was in place.
We need to know whether it is the Department of Health, or the Pharmaceutical
Services Negotiating Committee, that has failed smaller contractors.
I believe it is the PSNC that is to blame because disadvantaging low
volume contractors located in deprived areas is not in line with Government
policy.
Sue Sharpe (PJ, 24 April, p495) “denied
that the PSNC has analysed how many small pharmacies might close”. She confirmed that the
PSNC has a lot of detailed data and models related to pharmacy remuneration
but that the data “are confidential and we are not going to disclose
them.” The PJ (2 October, p454) also reported: “Mrs
Sharpe declined to provide any pointers to how the money is likely to be shared
out … ”
We can now understand why the PSNC was scared to share these models with
its own contractors. The PSNC failed to provide adequate tools for contractors
to assess the impact of the new contract on their businesses and then
has the temerity to denigrate the North East London Local Pharmaceutical
Committee model.
I openly challenge the PSNC to confirm or deny (only a simple yes or
no) the following points:
· The PSNC put forward to the DoH distribution models which were fairer
towards low volume pharmacy contractors
· The DoH rejected these distribution models, which were fairer towards
low volume contractors
· The PSNC can prove by demographic mapping that smaller contractors
are not disproportionately located in deprived areas
· The PSNC can prove that pharmacies dispensing fewer than 2,000 items
per month and with a 80:20 NHS:OTC split will not be worse off with the
new contract (no other income assumed); this is why it has provided inadequate
comparison tools.
· The PSNC does not have data that show by health authority, or PCT area,
the number of pharmacies that dispense fewer than 2,000 items per month
The answers will be a telling indictment of the PSNC.
The silence of the National Pharmaceutical Association in protecting
its smaller members is worthy of note. The NPA, it seems to me, is
becoming a representative group for the multiples and big business.
Independent contractors should consider forming an independent contractors
only alliance to represent their interests and collect information on
the pattern of distribution of pharmacies that will be worse off. They
also need to meet their local MPs and explain the true consequence of
the new contract. Even at this stage political pressure will have effect.
Bharat Nathwani
Pinner, Middlesex
Controlled release of information?
From Mr C. Morris, MRPharmS
What a joy to see an “overwhelming
majority of contractors said ‘yes’ to
the new contract” (PJ, 27 November, p773). I calculated that around
68 per cent of eligible community pharmacists voted “yes”,
but then that would probably be more than voted for most of our elected
leadership; so perhaps the majority was overwhelming.
I was interested to see the article in Chemist & Druggist of 4 December
where a member of the Pharmaceutical Services Negotiating Committee pointed
out that to carry out the advanced services mentioned in the new contract
most shops will probably need a refit. How amusing that this article was
not written before the cut off for the vote. If the electorate had seen
this article before the incredibly accelerated cut off date it might have
tempered their “overwhelming” enthusiasm.
In the letters pages of The Journal (4 December, p813) Adrian
Korsner points
out that a lot of the facts and figures are not yet known about the contract.
As to whether this is true I cannot attest but the article in Chemist & Druggist does seem to point to a controlled release of information.
I know this is now moot. The contract has been agreed and large stores
will probably gain more than small ones.
With the probable loss
of 22 per cent of part-time pharmacists according
to the PDA vox pop (PJ, 4 December, p805), and the ensuing pharmacist shortage
that this may cause, plus the added costs required actually to get the “brass
ring” offered by the wonderful new contract — who knows? Maybe
the idea of practising or non-practising pharmacist will no longer apply;
maybe we will arrive at the place that pharmacy has been heading for so
long and only the multiples will remain; maybe all that will matter, then,
will be which company you work for.
Chris Morris
Newquay, Cornwall |
The
Pharmaceutical Journal