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Letters to the Editor
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NHS
Tender to run primary care trusts
From Mr D. R. Kent, MRPharmS
I am surprised that little or no press comment has been forthcoming on
the advertisement, placed by the Department of Health in the Official
Journal of the European Union, inviting companies to set out their stalls on how
they would run primary care trusts. I would have thought that a leader
in The Pharmaceutical Journal exploring the implications for the profession
might have been appropriate. The publication of this advertisement is welcomed
only in so much as it demonstrates that the DoH now recognises the shortcomings
of PCTs but regrettable in that its answer to the problem is to pay a commercial
company to solve this and further dilute NHS funds. There is no doubt that
running PCTs on a more commercial basis will involve a massive withdrawal
of funds in order that a commercial company taking on this task can earn
a profit; and that the drugs bill is the softest target.
It has been an open secret for many years that the DoH has been talking
to Kaiser Permanente in the US — a company with the expertise and
resources to take on this role. It is the largest health maintenance organisation
(HMO) in the US. It owns hospitals and clinics, and is a significant, if
not the largest, US private health insurance provider. It is probable that
DoH links with other similar companies exist.
There are significant similarities in the way that HMOs and the NHS operate.
To all intents and purposes the NHS is an HMO that is funded through National
Insurance rather than direct subscription. How does this affect pharmacy?
HMOs enter into agreements with pharmacy groups in the US to offer them
accredited status only after agreement to discount prescription pricing.
Insured patients then take their prescriptions to these accredited pharmacies
for full reimbursement of the costs. If patients choose to take their prescription
to a non-accredited pharmacy then a co-payment of, typically, 20 per cent
of the cost is due from the patient. This has led to the almost total destruction
of independent community pharmacy over large swathes of the US; only the
multiple groups can afford to give the level of discount demanded by the
HMOs.
We already have the attack on smaller pharmacies led by their own negotiating
body (the Pharmaceutical Services Negotiating Committee) and the DoH acceptance
of the current discriminatory remuneration model starts to make sense.
The picking off of smaller pharmacies will rise inexorably; we already
know the 2,000 item per month bar is indexed even if that indexation is
not yet implemented. The DoH, or whatever will eventually run PCTs, then
has only to deal with a relatively small number of large groups with, no
doubt, significant savings in administration and drug costs.
Do not put any faith in the PSNC to agree funding which protects your interests;
it still has not published the actual payment to pharmacies for the last
year — remember the promise of £1.766bn?
David Kent
Secretary, Camden and Islington Local Pharmaceutical Committee |
The
Pharmaceutical Journal