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Report argues set fees for pharmacy services are ‘perverse'

An evidence review commissioned to inform the Murray report into pharmacy services has suggested paying pharmacies a set fee reduces productivity.

Set fees for delivering a service regardless of size or outcome – as is the case with the repeat dispensing service – is a “perverse incentive” for pharmacists, the review's authors suggested.

It compared this with some locally commissioned services, such as smoking cessation, which “incentivise the service supplier to obtain positive patient outcomes”.

The review – which was published alongside the long-awaited Murray report last month (December 14) – suggests community pharmacy should move to a “value-based contract”, where pharmacies are rewarded for patient results, rather than receiving a set fee for each service provided.

Volume-based funding increases pressure

Current funding models for advanced pharmacy services are “largely” focused on quantity or volume, rather than quality or patient outcomes, David Wright, professor of pharmacy practice at the University of East Anglia, concluded in the review.

This funding model is "known to result in increase pressure from employers on pharmacy teams to deliver more services," Professor Wright said. "Additionally, evidence suggests that providers delivering services by volume deliver them as efficiently as possible to increase profit margin, with limited concern for the patient."

The evidence review includes examples of health outcomes (see table below) that could be used to measure the effectiveness of current pharmacy services, instead of volume, and “enable rapid payment” to pharmacies.

Mirror the GP funding model?

Professor Wright suggested that “joining up” the Quality Outcomes Framework (QOF) – the payment system for GPs – with community pharmacists could improve the quality of patient care and address some “inter-professional barriers”.

However, the use of targets which are not aligned with current evidence remains a “major limitation” of QOF, and results in GPs focussing on easy-to-treat patients, Professor Wright stressed.

“These criticisms could be addressed by joint working between community pharmacists and GPs,” he said.

“Hard-to-reach patients still visit their community pharmacy...and monthly medicine collections provide an opportunity for closer monitoring and support,” he added.

Potential outcome measures for current UK pharmacy services


Potential outcome


New medicine service

Patients report improvement in medicines taking

Survey automatically electronically sent to patients post-intervention

Chronic disease management

Patients within target range

Identified through medical practice

Emergency hormonal contraceptive supply

Number of underage pregnancies*

Identified through local government

Chlamydia testing

Positive test result

Remuneration based on number of tests usually undertaken to obtain one positive result

Supervised administration

Number of accidental deaths*

Identified through local government

Case finding

Patients report positive outcomes from intervention

Survey automatically electronically sent to patients post-intervention

* In both cases local service reimbursement may remain, but it may be appropriate to provide additional local funding to incentivise medical practices and community pharmacies in the same locality to work collectively to ensure local targets continue to be met.

Source: A rapid review of evidence regarding clinical services commissioned from community pharmacies

This is the first of C+D’s three-part analysis of Mr Wright’s evidence review. Look out for the second and third articles later this week.

How do you think pharmacists should be paid for delivering services?

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