New oxygen contract
Out of pharmacists’ hands
From Mr M. Bennett, MRPharmS
In July 2003, the Department of Health announced plans to “modernise” the
NHS home oxygen service under new integrated arrangements contracted for
10 regions. The new service, expected to start in February 2006, will be
provided direct to patients from manufacturers and pharmacy contractors
will not be involved.
We expected the existing service to be decommissioned properly. We expected
agreement:
· On compensation for the headsets that will no longer be required
· On compensation for delivery vans and staff where appropriate, who may
no longer be necessary
· That pharmacy contractors will not be expected to compensate the suppliers
for cylinders “lost” by patients (a direct arrangement between
the Department and oxygen suppliers would be part of the decommissioning
of the existing service)
· That from the changeover date pharmacy contractors will continue to be
recompensed the rental charges for cylinders that are with patients and
that they will also be funded to collect these from patients once they
are no longer required
· On a national “oxygen cylinder amnesty” to ensure maximum
return of cylinders and, hopefully, avoid shortages within the supply chain
As yet none of these has been agreed, and the third point has emerged
as a major issue with the potential to jeopardise our whole business. Earlier
this year BOC asked contractors to undertake an audit of cylinders, which
we did. We found there was a large discrepancy between the numbers of cylinders
we could identify with current patients and the “paper” figure
that BOC claimed we had when it deducted the number of cylinders returned
from those supplied. We disputed these figures and made the following comments:
· People from a wide area use our service and they may then return the
oxygen cylinders to their local pharmacy.
· We are willing to give BOC whatever help we can in locating missing cylinders
and returning these to BOC.
· We do not accept the figures that BOC show as our “cylinder holdings” — they
bear no resemblance to reality. Over the years, the number of cylinders
returned has never been monitored accurately.
· We reject the idea of paying any compensation from ourselves to BOC relating
to “lost cylinders” supplied via NHS prescriptions to patients.
· Our “cylinder holdings” are made up of those that are in
our possession, in the possession of current patients, with past patients
who now obtain supplies from other pharmacies, returned to other pharmacies
and returned to BOC via house clearances, refuse tips etc.
Despite co-operating with BOC, last month, the company wrote to us requesting
compensation for “lost” cylinders amounting to £197,742.
It also commenced invoicing us a monthly rental charge for size AF/DF cylinders
amounting to £5,200 for the first month.
In my view, the “lost cylinder” issue is something that must
be resolved nationally between the Department of Health and BOC. Unless
the Department steps in and resolves matters, we can expect major problems
ahead:
· I forecast that contractors will not be paying invoices for “lost
cylinders” and consequently it is likely that court action will result.
· Because of this contractors’ oxygen accounts may be stopped and
they may be able to obtain cylinders to issue to patients.
· The delays in implementing the changes mean that many staff, faced with
the threat of redundancy later in the year, are likely to leave oxygen
manufacturers that have not gained a local contract. This will place further
pressure on the service.
· Current companies may not be willing to invest in new cylinders or spend
money retesting existing ones. Consequently, both cylinders and headsets
may become in short supply as the year progresses. We already have a situation
of one-for-one replacement in our area.
Unless there is a major effort made now to resolve these problems then
patients are bound to suffer. This is likely to impact severely over the
Christmas and New Year period resulting in unnecessary hospital admissions
due to reduced numbers of oxygen cylinders in the system and a lack of
pharmacy contractors willing to take on the ongoing financial risk associated
with the decommissioning of the current home oxygen service.
Contractors need to consider seriously whether or not to resign from the
service now rather than face financial attrition and be blamed for failure
to provide oxygen when the matter is out of their hands.
Martin Bennett
Managing Director
Associated Chemists (Wicker) Ltd |
The
Pharmaceutical Journal