Pharmacies paid for just 43 per cent of NMS interventions in first month

It sums up the attitude of the government to pharmacy. They seem to think we still earn lots of money from retailing, which some of our associates do of course, but for the (small) independent we are 90% reliant on the NHS.

GPs would never accept such a poor deal. 2012 is going to be the most challenging year for independent pharmacy.

Has AB no shame. His comments do not reflect what him and the rest of the PSNC were telling everyone last year before the MNS was launched. They were telling everyone what a great opportunity it was for pharmacists to show what we could do. Others were telling them not to undersell the value pharmacists made to these interventions - PSNC as always did not listen.

I've known government ministers being asked to resign for lesser embarrasments.

I have been an independent contractor for 16 years and as happens every year, this is just yet another payment/scheme where the PSNC has got it completely wrong. Every year, pharmacy just gets a worse deal. In the first place, they claimed that NMS was "new money". It may well have been so, but £38M was cut from category M. Hence, it is not NOT new money. it is the same money, just given from a different pot. Fine, but as this article shows, the structure of the payment scheme means that you cannot possibly get the money back that is owed to you. Hence, it is yet another funding cut. Come April 2013, the NHS employers will turn around and say - "once again pharmacy has failed - the money on offer NMS has not been taken up."
Many pharmacies, in particular the multiples got very excited and could not see past the £750 start-up payment which could be claimed following the completion of 6 NMS's. Pharmacists were almost bullied into completing these 6 in the first month of the scheme, being set an almost impossible timetable for implementation of the scheme, with no additional resources. OK, so they claimed their £750, but mistakenly also submitted the the 6 NMS's for payment as well. Unfortunately, most pharmacies needed to actually submit at least 10 NMS's to get paid because of the bizarre banding system. Hence, 6 NMS's = No payment. The PSNC kept that one quiet! Had this been explained CLEARLY, then we would not be in a position where only 43% of NMS's have been paid for.
Unless the payment structure is addressed, NMS will only turn out to be another funding cut.
I spoke soon after the start of the scheme to the PSNC about the issue of non-payment for NMS's which we had been carried out and did not fit into the banding structure. Their response was, and I quote "think of all the those patients that have benefited from your advice. As a profession we need to be able to show that we can deliver a service, so sometimes we may need to do things for free!" I will ask my staff at the end of the month on pay day if they would like to work for free!
Unfortunately, the PSNC and pharmacy will have to take a reality check very soon if the profession is going to survive. We must stop doing services for free (mainly driven by the multiples), undercutting each other on private prescriptions etc etc Doctors would not do it, so why should we. Just the other day I asked my GP to fax a letter to a third party. He did not hesitate to charge me £50 for the pleasure! We also recall, when some GP's felt they were not being paid enough for administering the swine flu vaccines and they refused to do them However, pharmacists stepped in, and you guessed it, did the service for less!
But I can see a much bigger problem of the horizon - that of Category M collapsing under the weight of all the new patent expiry's. We have just had a CAT M cut last October and there are so many new generics on the horizon and some have already been launched since that cut eg latanoprost, Olnazapine, donepazil, zolmitriptan, atorvastatin but to name a few. All these cannot be funded out of the existing Cat M pot. The current structure means that all these have to absorbed and paid out of the already reduced pot, which is due to be cut further. If it is not addressed, not only will we have a bigger funding crisis, but also many more shortages as generic manufacturers & wholesalers decide not produce and sell, non-profit making generics.
PSNC - Sort yourselves out, sort NMS out and sort Cat M - otherwise we won't have a credible profession left.

As a PCT pharmacist with responsibility for community pharmacy support and development I have been looking at our payment data with much interest. Subsequent month's data may be completely different- I would have been very surprised to see large numbers of completed NMS for October as this would have only been possible for suitable patients presenting during the first days of October.

I am sure there good intention with the payment structure, and there has been an intention for many years to move away from 'piece work'. However, I agree that the first impressions of payment for pharmacies that have undertaken any NMS may indicate a problem. We have seen many pharmacies completing one or two (as expected during the first month) who have not received a payment. In addition one pharmacy completed 10 and recieved nothing (due to the volume of prescriptions they dispense). This seems mightily unfare when another received a payment for having completed just 1. November data will be available to PCTs shortly and I will be giving it my immediate attention to see if there is a fairer distribution.

Please keep the comments coming. Over the coming months C+D will be tracking the performance of NMS because, as has been pointed by Julie McCann here, it is early days for NMS so the figure would be lower.
It will be interesting to see what happens if PSNC sort the payment structure out - perhaps along the lines of MURs.
Thanks
Niall Hunt, Digital Content Editor, C+D

Hi Niall
I noticed that Zoe's article looks suprisingly similar to a comment I posted on 31/1/12 in response to the original article!!! Very cheeky!

Sanjay Shah, Other pharmacist
Posted on 31/01/12 13:58 in reply to Pillman Uk.
Actually according to the data, 43% were PAID which means that 57% WERE DONE FOR FREE!!!
Or put another way, the DH saved £143,000 by getting pharmacists to provide NMS for free!!!
It gets worse... Pharmacy contractors in 15 PCTs claimed for 334 NMS episodes and got paid for NONE of them!! (Worst off were those in Sunderland Teaching PCT who claimed for 60 NMS). I would suggest that the LPCs look at these figures and help their contractors get to grips with this.
From past experiences with PSNC, I'm not holding my breath for them to come up with a solution any time soon

Hi yes. Zoe replied to your comment and said she would follow it up, which she did - so thanks for the tip.

Niall

Actually, I think there has been some confusion - I followed this story up after another reader had asked the same question on a different story! Obviously lots of people have been looking at the data and pulling interesting things out of it, which is always appreciated - please do keep your thoughts and ideas coming and where we can, we'll follow things up or put your questions to the powers that be.

I love the idea of NMS and its objectives but the shortfalls, issues and problems were glaringly obvious from the start and so I am not surprised by this news and have just stuck to MURs totally. I was bemused and expecting all the positive press about how well NMS was uptaken and what a success it has been but what was surprising for me was how the PSNC agreed the payment structure in the first place, how the LPCs were supporting it and how the NPA was excitedly clicking its heels in mid air over it! It's time we got more in-touch and in-tune Chief Execs, LPCs with common sense and representatives with better current practice experience! Ultimately pharmacists should be able to gauge better what they should be doing with their valuable time and NMS under this banding structure is not it.
S.

I congratulate the PSNC for delivering a new advanced service for Pharmacy to deliver, We should all be pushing to deliver reasonable numbers to make the service activity significant However, thresholds can only have one purpose, to control the budget. The real issue should be does a patient have a new medication on the list. If so that patient should be able to have the benefit of the service. If so and the Pharmacy provides that service then they must be paid and not required to go through hoops to know whether they will be paid or not.
Real world may result in compromise , but success of the service is very important. Political point scoring just doent help us at the moment , save that for the right time. In the meantime we need a solution, so that contractors have confidence to engage in the service which is why the need for PSNC to provide a solution now is so important. Otherwise Pharmacy would have wrestled away its own desire to have a service orientated future and sunk back into basic core service, which continues to be erroded and starved of funds.

Sultan , Apologies was meant to be a general reply not specifically to your posting