Delving into diagnostic testing in pharmacies
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Screening for conditions such as vascular disease
and diabetes will be offered to all through the NHS, according
to Prime Minister Gordon Brown. Pharmacy will be asked to help
deliver this initiative, but will it be economically viable?
Gareth
Malson (Retail Round-up staff editor) reports
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ARTICLE CONTENTS
What do people want?
• Contact the PCO
• Patient surveys
• Ask local companies
What are the costs?
• Costs to consider when
setting up a new service
• Purchasing quality equipment
• When to refer
• Writing SOPs
Setting a service fee
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Vascular risk screening
An article in the next issue of Retail Round-up will look at setting
up a screening service for vascular disease.
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Screening patients to determine their risk of developing
a disease is an initiative that Prime Minister Gordon Brown wants the
NHS to deliver to all, it was announced this month. The intention is
to develop a service that delivers “preventative” healthcare,
and not just “curative” healthcare.
Health minister Ben Bradshaw has confirmed that pharmacists and nurses
would have an important role to play in delivering this initiative.
So, at some point in the future, pharmacies may be funded by the NHS
to provide screening services. However, there is no reason why pharmacies
cannot offer a privately-funded service now, if the members of the local
population are happy to pay for it.
Regardless of the source of funding,
pharmacy managers or owners will have to decide whether offering this
service is in the best interest of the business, and this will require
some market research. What do people want?
Investing in a new service will only prove fruitful if
the local population uses it. There are several options for assessing
whether a market exists
among the local population for a particular service. Contact
the PCO Primary care organisations will have
priorities for the services that they want to set up. Raj Nutan, pharmacy
business manager
at the National Pharmacy Association, emphasises that being aware of
the PCO’s agenda and preparing to deliver services that are tailored
to its needs will improve your chances of securing NHS funding.
"Delivering
a service in line with PCO priorities may well help your case when it
comes to submitting a business proposal for the service to be commissioned," he
said.
Patient surveys Undertaking patient surveys is a mandatory
component of the pharmacy contract, but can also be invaluable for determining
the needs of the local community. Mr Nutan suggests that the next patient
survey that you produce includes the following questions: • What health screening services would you like the pharmacy to offer?
• What health screening services would you be prepared to pay for?
• How much would you be prepared to pay for a health screening service?
Grafissimo/iStockphoto.com
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If patients are prepared to pay for the service themselves, this may
avoid some of the difficulties that have been experienced by some pharmacists
in getting funding through practice-based commissioning.
Ask local companies All businesses will
benefit from ensuring their staff are in good health. Mr Nutan suggests
that pharmacy proprietors
should contact local businesses to see if they would be prepared to pay
for health screening for all of their employees.
This could include regular
blood pressure checks, testing cholesterol levels and offering smoking
cessation advice. What are the costs?
The costs incurred in running a service need to be calculated
to determine whether it can be profitable. The types of direct financial
cost that
need to be considered are outlined in Panel 1.
Panel 1: Costs to consider when
setting up a new service
Raj Nutan, pharmacy business manager at the National
Pharmacy Association, says costs that a pharmacy must consider
before setting up a new
service include: • Devices — Capital will be required
to purchase (and eventually replace) devices such as blood pressure
monitors and cholesterol
testing kits.
• Consumables — Equipment such as test strips, cotton wool
or disposable gloves will be required every time the service is
used.
• Disposal services — The provision of some services will
create medical waste, which requires separate disposal arrangements
to normal pharmaceutical waste. The primary care organisation may
collect medical waste from local surgeries and might add your shop
to the collection route. Otherwise, a disposal service will need
to be contracted.
• Insurance — If your pharmacy’s insurance policy does
not provide cover for the additional service, an extra premium
may be required.
• Vaccinations for staff — Staff members that handle sharps
require vaccination against hepatitis. The local GP may agree to
fund vaccinations through the NHS.
• Margin — It is up to the individual manager to decide what
margin of profit will be passed on to the consumer. Typically,
a margin of 30–40 per cent should be factored in.
Most of these costs will require an initial, one-off
investment. This investment can either be written off as a set-up
expense or
added to the service fee for the patient (eg, divided among the
first 100 service users).
On the other hand, if funding will be
received from the PCO, any set-up costs are likely to be paid
for by the NHS. |
These costs are not the
only consideration when deciding whether to offer a new service. Some
other factors will indirectly incur a financial impact. Purchasing
quality equipment Patients will lose confidence
in pharmacy-based services if the results they receive turn out to
be inaccurate. Alastair
Buxton, head of NHS services at the Pharmaceutical Services Negotiating
Committee, says: “Quality assurance of results will be key to ensuring
consumer confidence and securing funding from PCOs. The GPs and nurses
at local surgeries may be able to offer advice on which manufacturers
are the most reputable.”
In addition, leading manufacturers may be able to train staff on the
correct use of their device. This could be negotiated in advance of agreeing
to purchase that particular device.
When to refer Once the results of health screening services have been
interpreted, some patients will need to be referred to the GP. Mr Nutan
recommends engaging the local GPs and the PCO to determine guidelines
for when a patient should be referred to see a doctor or other healthcare
professional.
Writing SOPs The pharmacist may not have time to perform every task required
to deliver an additional service personally, so some tasks may have to
be delegated. Mr Nutan highlights the importance of putting in place
standard operating procedures to ensure the support staff are aware of
their responsibilities. Improved skill mix makes any service more economically
viable.
Setting a service fee
Once the costs of running a service have been established,
a service fee can be suggested. Running costs (and possibly set-up costs)
should
be factored in.
The proposed service fee could be compared with the price that the
patient is willing to pay (if market research has been undertaken)
or the service
fee that the PCO or local company is offering. The manager will then
have to decide whether the predicted profit is sufficient to warrant
the use of staff time. Alternatively, the manager may decide that the
service will create additional footfall into the pharmacy, justifying
the investment.
An estimate of the actual costs of each type of service will be examined
in more detail in subsequent Retail Round-up articles. |
Retail Round-up