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Pharmacy sector was consulted on 'risk-sharing' indemnity model for COVID jabs, DH says

The Department of Health and Social Care (DH) reportedly consulted with the community pharmacy sector on proposals for a "risk-sharing" model covering COVID-19 booster vaccinations, C+D can reveal.

Speaking at a webinar for community pharmacies and GP practices last month (July 15), NHS England and NHS Improvement (NHSE&I) director of primary care vaccination Caroline Temmink said that community pharmacies will have to pay for indemnity cover in the third phase of the COVID-19 vaccination programme – moving away from the current state-backed Clinical Negligence Scheme for Coronavirus (CNSC) – while GPs will still be covered by state-backed insurance.

A DH spokesperson told C+D yesterday (August 3) that the department worked with NHSE&I to gather responses from local pharmaceutical committees (LPCs) on its proposed approach for indemnity cover for pharmacies involved in the COVID-19 vaccination programme via a consultation conducted in mid-May.

The consultation document, seen by C+D, detailed a “proposed” three-stage approach for community pharmacy’s indemnity cover, but the “risk-sharing model with insurers… was the subject of our consultation”, the DH wrote. 

The DH’s three-stage approach

Stage 1: Existing state indemnity for COVID-19 vaccination continues until October 31 for pharmacies that are already engaged under local enhanced service agreements
Stage 2: Government shares risk with insurers to cover pharmacies delivering phase 3 of the COVID-19 vaccination programme – expected to run from September 2021 until March 31, 2022
Stage 3: From April 1, 2022 onwards, the “insurance market [would] offer commercial cover in the usual way”.

 

Estimated indemnity costs

 

The DH said in the consultation response that it had received feedback from LPCs and a response from the Pharmaceutical Services Negotiating Committee (PSNC).

PSNC director of operations and support Gordon Hockey told C+D last month (July 26) that the negotiator would “keep an eye on the discussions between government and pharmacy insurers to ensure that contractors are supported on this issue”.

Among the key themes flagged by the LPCs, the DH wrote that many did not welcome the additional costs and pointed at “parity of costs across the vaccination programme”.

However, the DH wrote that it expects insurance premiums to be lower than £100, with “indemnity cost borne by community pharmacies likely to be under 5p per dose”.

The government “intends to support community pharmacies throughout the vaccination programme by ensuring continuity for the existing [community pharmacy local enhanced service (LES)], then keeping insurance premiums at a low level for implementation of the booster programme until March 31, 2022”, the DH wrote in the consultation response.

The government is committed to supporting all insurers, “as well as those pharmacies who self-insure”, the DH wrote.

According to FAQs provided alongside the consultation response, the DH assured that: “The government is providing support to community pharmacy by making arrangements with insurance providers in respect of clinical negligence cover from September to March 31 to ensure cover is available at an affordable price to those community pharmacies engaged under this LES.

“We anticipate that commercial insurance products will be available for purchase in August 2021 and will operate as a standard insurance policy – your insurer will take care of claims in the way they normally do now, with no additional work for pharmacy sites,” the DH added.

 

Costs difficult to estimate at the beginning of the programme

 

The DH wrote that indemnity costs were difficult to estimate at the beginning of the COVID-19 vaccination programme, because the vaccines “were new to the market, had different handling requirement to flu vaccines and had no direct comparator or historical claims data”.

“We now have greater data regarding levels of claims, and this suggests that COVID-19 vaccination has a similar clinical negligence risk profile to flu vaccination,” the DH wrote.

C+D asked the DH if it could share data to prove this is the case. However, the DH said that as phase 1 and 2 of the programme are still ongoing, it is too early to ascertain the impact that COVID-19 vaccination claims have on community pharmacy.

 

GP state-backed scheme introduced before pandemic

 

C+D also asked the DH why GP practices will continue to have their indemnity costs covered through the Clinical Negligence Scheme for General Practice (CNSGP), while pharmacies participating in phase 3 of the vaccination programme will have to bear these costs themselves.

The DH spokesperson told C+D that the CNSGP was put in place before COVID-19, to provide GP indemnity cover routinely. The scheme also covers GP practices for providing the influenza vaccine to NHS patients, the spokesperson added.

The Royal Pharmaceutical Society sent a letter to vaccines minister Nadhim Zahawi on July 22, calling for the state-backed CNSC to continue to cover pharmacies beyond phase 1 and 2 of the COVID-19 vaccination programme.

Association of Independent Multiple pharmacies CEO Leyla Hannbeck told C+D at the time that it would be “unfair if pharmacy is being asked to operate under a different set of rules from the rest of the NHS” for providing the same service.

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