The Pharmaceutical Journal
Vol 273 No 7330 p875
18/25 December 2004

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Scotland moves away from volume-based contract

Community pharmacists in Scotland look likely to have a new contract that moves away from payment by prescription volume for the first time. Instead, subject to the agreement of contractors, the contract will be based on a capitation payment for two of the four core services, a fixed practice payment for one and a volume-based payment for the remaining service.

In preparation for the new contract, which will be implemented in April 2006, transitional arrangements were announced this week (see news item below). This will allow contractors to have a period of stability in which to prepare for the new contract, and will also put them in a more informed position before they are asked to agree the contract, which is still being negotiated.

By moving from a volume-based contract to a service-based contract, contractors would receive capitation fees for the minor ailments service and the chronic medication service (which involves serial dispensing and incorporates the pharmaceutical care model schemes). Prescriptions dispensed through the acute medication service will be funded by a dispensing fee, the only aspect of the core contract to remain volume-based. Funding for the fourth core service, public health, will be a fixed payment.

Frank Owens, chairman of the Scottish Pharmaceutical General Council, said: “Moving away from a purely volume-based contract to one which rewards the quality of the pharmaceutical care we provide our patients will secure pharmacists not only the long-term security we all desire but, more importantly, a future which is both exciting and rewarding.”

Bill Scott, chief pharmaceutical officer at the Scottish Executive commented: “Removing the perceived barriers will enable community pharmacists in Scotland to participate fully as members of the NHS family and deliver pharmaceutical care in its widest sense to the population of Scotland.”

Mr Owens added: “This deal lays down the foundations from which to develop and integrate Scottish community pharmacy as a principal member of the primary care prescribing team.” In future, this will be through supplementary prescribing within the chronic medication service. Further ahead, there is potential for independent prescribing to fit into this part of the contract.

Mr Owens explained that this is why a non-volume-based contract is so important. “If contractors are to be given these prescribing rights we need to remove any perverse incentive to prescribe, ie, you cannot receive remuneration based on the number of prescriptions you write. It is also important that pharmaceutical care activity, which is core within the chronic medication service, is measured and assessed by the clinical needs and outcomes of patients,” he said.