Minor ailments schemes boost profit nationwide

Running a minor ailments scheme (MAS) is not a new concept, but financial arrangements for a national MAS in England are yet to be agreed.

April 2008’s pharmacy White Paper, entitled “Pharmacy in England: building on strengths — delivering the future”, called on the Pharmaceutical Services Negotiating Committee and NHS Employers to draft proposals for a national scheme by Spring 2009.

In Scotland, a national minor ailment service has operated for almost two years. Pharmacies are paid a set fee, according to the number of patients who register with them for the service.

The average community pharmacy in Scotland is visited by 10 patients with minor ailments every day. In June 2007, almost a quarter of these received their treatment through the minor ailment service.

Establishing an MAS should mean that pharmacy staff no longer have to process prescriptions for products available over the counter.

However, pharmacists are paid a dispensing fee for these items, so the funding for a service should compensate pharmacies for this lost income and increased responsibility.

Every year, GPs in England carry out 57 million consultations for ailments that could be treated in community pharmacies. Assuming the average GP consultation lasts eight minutes, this equates to 7.6 million hours of GP time.

According to the British Medical Association, the average hourly rate for a GP in England is about £50, so an estimated £380m worth of GP time can be saved nationwide.

Although this cost saving will not be transferred to pharmacy services, it will give GPs greater freedom to deliver other patient care services, for which they will be paid extra. If delivering an MAS allows pharmacy to make a significant contribution to patient care, then contractors have a right to expect a suitable reward.

Plans for the national MAS in England or Wales should take into account the experience of local schemes that already exist.

Payment systems

Several schemes that currently operate in England pay pharmacies a set fee per consultation, regardless of whether or not a medicine is issued. However, payment requires the completion of a consultation form that is signed by the patient, to confirm that they are exempt from prescription charges. This may be forgotten if no treatment is supplied.

Various mechanisms are also in place to reimburse the pharmacy for the cost of the medicine supplied.

Heart of Birmingham Teaching Primary Care Trust pays their pharmacies £3 per consultation, and a drug cost that is set by agreement between the local pharmaceutical committee and the PCT. North Tyneside PCT pays £3.28 per consultation, plus the cost of the drug as specified in the Drug Tariff (including VAT).

Sheffield PCT has recently revised its funding arrangements. Pharmacies are now paid a flat fee of £6 per consultation, but no longer receive reimbursement of drug cost. This change is intended to prevent abuse of the system by patients, some of whom would go to the pharmacy with a “shopping list” of medicines that they wanted.

Michelle Black, deputy head of medicines management at Sheffield PCT, says the new arrangement has been agreed after assessing data collected over several years. However, the new arrangement will be monitored to ensure the pharmacies receive a fair deal.

Restrictions

The drugs that can be prescribed or the ailments that can be treated are restricted in different ways by different PCTs. Sefton PCT has produced a formulary of drugs that can be prescribed through the service, and each drug can be prescribed for any of its licensed indications. On the other hand, Heart of Birmingham Teaching PCT has a list of 20 conditions that can be treated.

Scottish minor ailments service

In Scotland, each pharmacy is paid a capitation payment for delivering the minor ailment service. This payment is set according to the number of patients who register with the pharmacy for the service. Patients are registered electronically via the central patient registration system, and can only sign up for the service if they are exempt from paying prescription charges.

They can only register with one pharmacy, but are allowed to transfer their registration at any time. If registration is transferred, the system automatically withdraws the patient from the list at the pharmacy where they were previously registered.

Pharmacies are also reimbursed the cost of the medicine provided to the patient, and pharmacists are advised to prescribe generically whenever possible. A national formulary has been developed that includes all OTC medicines (both general sales list and pharmacy only) that are not blacklisted in the Drug Tariff, plus some prescription-only medicines that can be supplied via a patient group direction.

Every time a consultation is made, the pharmacist must check that the patient is still exempt from prescription charges and complete an electronic form stating what medicine or advice was issued. A record should also be made on the patient’s pharmacy computer record.

Successful service

In Heart of Birmingham PCT, the scheme is offered by 82 of the 84 pharmacies in the area. During 2007, 140,000 consultations were conducted. According to research conducted by the trust, nine out of 10 patients who used the scheme said it saved them a visit to the GP.

Patient surveys conducted by Sheffield PCT show similar results, with 80 per cent of those using the scheme suggesting they would otherwise have visited their GP. The results also reported high satisfaction for the scheme among both GPs and patients. The scheme, previously only available to the patients of GPs who had agreed to it, has now been rolled out for all patients in the area.

Marketing the scheme

The successful uptake of minor ailments services in Birmingham is impressive. By comparison, the Sheffield PCT scheme, which is offered by 101 of the 114 pharmacies in the area, generated 38,000 patient consultations over the past year. A spokesperson from Heart of Birmingham PCT suggests that the high proportion of patients in the area who are exempt from paying prescription charges may explain this.

However, the involvement of almost every pharmacy in the area has helped to spread awareness of the scheme among patients, and, the wide range of ailments included and the high level of support from local GPs has been beneficial.

Conclusion

Delivering a minor ailments scheme to patients increases profit for pharmacies, as shown in the panel above. The consultation fee is greater than the dispensing fee (£0.90 in England and Wales) for an individual item, plus pharmacists are paid for issuing good advice, even when no medicine is supplied.

Some of the success of a national scheme will depend on the development of a quality framework that includes a wide range of minor ailments. However, pharmacy proprietors can help raise the profitability of their own service (see panel, below).