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Letters to the Editor
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Oxygen supplies
New contract causing chaos
From Mr K. C. Patel, MRPharmS
A distraught patient came to see me this week to seek assurance about
future oxygen supplies for her ailing husband. She is typical of a large
number of our oxygen patients who have come to rely on their community
pharmacists for a reliable supply of oxygen.
She had telephoned the BOC help line in order to gauge information on
transition to the new service and was told that if she needed any more
information she should go their website. When she told them that she
did not have a computer at home, she was advised to go to her local library
to get access to one.
She was further informed that there would probably be two days in the
week when BOC would deliver. However, the company would not be able to
give her delivery times. This means that she would have to give up a
whole day waiting for her husband’s oxygen delivery.
The question she asked me, for which I had no answer, was what would
happen if she needed an oxygen cylinder on a Friday evening or a Saturday.
In the past we have always been able to help.
Once again we find the Department of Health has conceived a service,
which was once run efficiently by community pharmacists, and has successfully
brought chaos to it. We shall no doubt hear in some not so distant future
how much extra this is going to cost.
Kiran Patel
Luton, Bedfordshire
PCTs should be stepping in
From Mr A. Phillips, MRPharmS
So here we are, nearly a week into the new oxygen supply arrangements
and it appears that all our worst fears are coming true: patients, unaware
of the change in arrangements are panicking over their needed oxygen;
GP surgeries are refusing to issue post-dated prescriptions to allow
us to supply cylinders; patients are requiring new head sets because
cylinders with integral heads were previously supplied by contractors;
our new oxygen supplier is quoting delivery next week; patients are unable
to get through to oxygen suppliers as the suppliers struggle to cope
with the rush; there is a shortage of oxygen nurses to assess patients’ needs
and there is a shortage of actual oxygen cylinders available from contractors.
Now these problems were patently going to occur with such a shambolically
handled change to the arrangements, so why have the primary care trusts
not been working to prevent them? PCTs are quick enough to send out materials
telling us what we must do, but where is the guidance for pharmacists
and GPs in this critical period?
Certainly the response from our local PCT has been complete silence.
Can we not see that when PCTs trumpet a 66–97 per cent acknowledgement
of the change from patients (PJ, 28 January, pp101–2), ie, at best
only three domiciliary oxygen patients in 100 will be without oxygen,
that this handover has been mishandled in an appalling manner? Why have
PCTs not been compelled to make personal contact with all domiciliary
oxygen patients — especially as many such patients are elderly
or confused and have not understood the ramifications of the proforma
letters sent out? I also think that we should be asking why, when the
failings in the new arrangements became clear by Tuesday this week, that
some PCTs have not been seen to be doing their utmost to ease the transition.
Alun Phillips
Liverpool
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JEANNETTE HOWE, head of pharmacy at the Department of Health,
replies:
For many years, pharmacy contractors have been providing
a valued
oxygen cylinder service for patients at home. However, pharmacy
contractors, like others providing and receiving the home oxygen
service, will
be aware that the service has changed little over the years. The
new service’s key principles are that it should support clinical
best practice in assessing and providing oxygen therapy to patients
(this has been recently updated by the British Thoracic Society)
and improve patients’ access to modern, up-to-date equipment
that can help improve their quality of life. Health care professionals,
patient representatives and others have welcomed this opportunity
to provide a modernised service.
The NHS and suppliers have worked hard to introduce the new service
over the past few months. Working with GPs, suppliers have been
able to complete the successful transfer of thousands of patients
receiving
a concentrator service before 1 February 2006. We are greatly encouraged
that GPs and other health care professionals are using the new
home order form, since this supports a six-month transitional programme,
in which there will be a phased transfer of patients (particularly
those using cylinder oxygen) to new suppliers. We expect to see
most
patients transfer to the new suppliers well before July 2006.
However, in the first days of the new service, the new suppliers
received a huge volume of orders, with many providing insufficient
information to support delivery of the required service. All suppliers
are investing significant extra resources to handle these orders
and are working with primary care trusts to ensure that plans for
a managed transfer of patients are back on track. The DoH, with
PCTs, will continue to monitor these plans closely throughout the
transitional
period.
Pharmacy contractors have made a tremendous contribution in helping
us return to these planned arrangements. We and our NHS colleagues
appreciate their immediate and outstanding response in many parts
of the country, which has helped ensure that patients continue
to receive the service they need. I would like to take this opportunity
to say thank you to pharmacists for their continuing support at
this
time. |
Hidden agenda?
From Mr P. Walton, MRPharmS
I am amazed that such an august publication as The Pharmaceutical
Journal can be persuaded by Air Products to publish such a blatant untruth to
deflect criticism of their gross inefficiency.
I refer to your article, 11 February, p155, in which Air Products claim
that transitional arrangements had always included the continuation of
GPs prescribing oxygen on an FP10 prescription.
If you had checked the facts, you would have been aware that it was an
omission by the Department of Health to change the Prescription Pricing
Authority regulations allowing the continuing use of FP10s. It was neither
planned nor intended, unless of course there had always been a hidden
agenda of which the Pharmaceutical Services Negotiating Committee and
community pharmacy oxygen contractors had not been made aware.
Peter Walton
Workington,
Cumbria
Confusion
From Mr I. Morgan, MRPharmS
I am pleased to be able to say “I told you so” about the
transfer of oxygen supplies from community pharmacies to the oxygen providers
direct.
In the first instance, the changeover was to take place in October 2005
and, despite the time scale for setting this up, it had to be deferred
until the beginning of this month. I am the superintendent pharmacist
of a busy pharmacy close to the town’s GP practices, responsible
for the welfare of about 35 patients on home oxygen therapy at any one
time. I was distressed on Friday (3 February) to discover that no one
could reach this area’s supplier, Air Products, as the telephones
were not being answered. I knew, of course, that we would not be reimbursed
for any prescriptions dated after 1 February, and suggested that patients
and doctors persevere with their telephoning. The decision to give the
contract for supply to Air Products to cover the greater part of the
country was a master stroke on someone’s part, especially as the
company has only one contact number for all their service regions.
On Monday, I discovered that the company had “faxed GP surgeries
informing them to continue using FP10s to cover oxygen supplies” and
that “pharmacists would supply”. I also discovered that the
Department of Health had “faxed primary care trust offices informing
them of this decision”, but, guess what, nobody thought to inform
any pharmacists, so as far as we were concerned there would be no reimbursement
for NHS prescriptions. I contacted the National Pharmacy Association
for a decision on this and was told that the information was on both
their own, and the Pharmaceutical Services Negotiating Committee’s
website, the browsing of which is not possible at this pharmacy. Today,
I have received a new prescription for a cylinder and giving set, the
supply of which, I again presume, will not be paid for, since the information
coming from most bodies seems to suggest that continued supply of cylinders
is allowed, but that new patients should be dealt with by the new suppliers.
There also seems to be a problem with the home oxygen order forms as
some doctors are saying that they have received none and others have,
but have not yet even looked at them.
We are now told that the DoH has yet to amend the regulations to stop
the reimbursement of FP10s, and that this will not happen before April.
Please, will somebody give us a decision, in writing, that we can all
understand, so that patient care will not be compromised.
Ian Morgan
Hinckley,
Leicestershire
Not getting through, not delivering
From Mr T. Mahmood, MRPharmS
The oxygen therapy service handover to Air Products has not been smooth.
I have been calling Air Products since 1 February 2006 to discuss service
to my 23 oxygen patients and have had no success. When one of my patients,
or I, telephones Air Products the message since 1 February is always: “We
are experiencing a high volume of calls.”
I have found that Air Products has not yet delivered on this service,
despite negotiations over the past few years. As a result I think that
money should have been injected into the pharmacy service to improve
it. I understand that the cost for an oxygen service via Air Products
is much more than what would have been incurred through the pharmacy
service.
Pharmacies have been delivered a blow to their service. I hope there
are no more surprises around the corner.
Tariq Mahmood
Romford,
Essex
Failure to deliver — a reflection of how we value the vulnerable?
From Mr L. S. Sprey, MRPharmS
A litmus test for civilisation is to see the way a society values its
vulnerable members. By that standard, England is lagging behind miserably,
by the way it is treating patients requiring oxygen therapy at home.
The new service to supply oxygen to patients at home was in complete
chaos after only its first three days, leaving vulnerable patients without
oxygen supplies. So, after two years of supposedly careful preparation,
the new suppliers failed their patients at the first hurdle.
The collapse of this vital service is unbelievable. The primary care
trusts know exactly how many oxygen patients each pharmacy has and delivers
to. This information should have easily been extrapolated by the new
suppliers, who have had more than ample time to prepare for the start
date of 1 February 2006.
This situation is a dangerous fiasco that smacks of gross incompetence
by the new contractors. Pharmacies in Brighton now have to restart delivering
oxygen to patients in the community, even though many have wound down
their oxygen supply operation. We, at Ashtons Late Night Pharmacy, have
reduced our oxygen stocks and let some delivery staff go, only to find
ourselves having to fill the gap in the name of patient care.
A few years ago, I saw a poster depicting an elderly, stooped and rather
frail looking woman walking down the road with the aid of a cane. All
you could see was her back as she walked. It certainly conjured up a
bleak image, which on its own was moving enough, but the caption underneath
the picture must have touched everyone who read it. The words were: “Let
us not be known as the generation that saved the whales, saved the trees,
but forgot our own kind.”
Laurence S. Sprey
Managing Director
Ashtons Late Night Pharmacy,
Brighton
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To read what the oxygen suppliers have to say on this issue, turn
to News, p191
— EDITOR
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The
Pharmaceutical Journal