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PSNC responds to cuts with cost-saving alternative plan

Negotiator has published a short-term counter offer to the government's proposed 6% funding drop

The Pharmaceutical Services Negotiating Committee (PSNC) has published cost-saving measures to combat the government’s planned funding cuts.

PSNC’s counter proposals are a "short-term alternative" to the funding cuts and set out how community pharmacy could make savings in the NHS prescribing budget.

The combined proposals would produce savings "worth at least as much as the government's proposed £170 million cut to pharmacy funding" in England, it said yesterday (April 25). 

They also lay out how the sector could reduce NHS spending on out-of-hours GP services, specifically the emergency supply of medicines. PSNC said this pharmacy service would allow patients requiring medicines to obtain supplies without the need for an urgent prescription.

"A retrograde step"

PSNC branded the Department of Health’s intention to replace the current payment system with a single activity fee for each prescription as a “retrograde step” that would incentivise pharmacies to maximise prescriptions over the provision of other services.

Instead, PSNC suggested developing a funding delivery system that gives higher payments to pharmacies who provide a range of high quality services, such as having a consultation room that meets medicine use review (MUR) requirements or having access to the summary care record.

PSNC first responded to the funding cuts with its long-term clinical vision in February, arguing that the government had “no specific proposals” to broaden the sector’s clinical role. The negotiator's suggestions included increasing pharmacy’s medicines optimisation role and the use electronic repeat prescribing. 


How could PSNC save the DH money?
  1. "Not-dispensed scheme" 

    This scheme would reduce NHS expenditure on prescription medicines, by first assessing whether the patient already has sufficient stock at home.

    Following discussions with the patient regarding their repeat medication, contractors would mark any items not required by the patient at that time as "not-dispensed", in a way that could be easily identified by NHS Prescription Services. For each non-dispensed item, contractors would receive the usual professional fees plus a small additional non-dispensing fee.
  2. Therapeutic substitution service

    This service would reduce medicine costs by enabling pharmacists to recommend alternative products to prescribers.

    Suggested substitute medicines would be based on a national list of "costly" medicines and their suitable alternatives. The pharmacist would send GP practices alternative prescribing options for individual patients, along with a "clear explanation" of the reason for the suggested change.
  3. Generic substitution service 

    This would allow community pharmacists to dispense cheaper generic equivalents in the place of prescribed branded products. A list of medicines that could be generically substituted would be agreed at a national level, ensuring that only safe and clinically appropriate generic products would be considered for a substitution. The pharmacist would discuss the substitution with the patient at the point of dispensing.
  4. Care homes

    Community pharmacists would identify the excess prescribing and supply of medicines and dressings to care homes, by conducting regular reviews of their supplies.
  5. Unwanted medicines campaign and audit 

    A month-long campaign of waste medicines returned to pharmacies would raise awareness of this issue among patients and prescribers. Pharmacists would then audit the waste and share learning with local prescribers. 

    - Source, PSNC Briefing 026/16: PSNC’s counter proposal to the Government’s plans for community pharmacy in 2016/17 and beyond (April 2016)


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