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Sector demands 'fair funding' for Boots sore throat scheme

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NHS England has not yet decided how much contractors will be paid for the service

The community pharmacy sector has called for adequate remuneration from NHS England if the sore throat scheme is to be rolled out nationally.

The service will see pharmacists conduct on-demand throat swab tests on patients to see whether antibiotics are necessary. 

However, NHS England and Boots – which first piloted the scheme in 2014 – have not yet decided how much contractors will be paid for providing the service, a Boots spokesperson told C+D last week (November 15). NHS England have also stopped short of committing to a national scheme

Full remuneration tops the sector's wish-list for the controversial scheme according to comments on the C+D website, and the demands of community pharmacy bodies.

Call for "fair funding"

Pharmacy staff member Stephen Smullen argued that without “adequate remuneration”, pressure on pharmacists would increase and the “overall patient experience would drop”.

“Is someone going to stand back and review what pharmacy has to offer the public and pay for the service as a whole, rather than piecemeal?” Mr Smullen asked.

Pharmacist Stephen Eggleston said that “new services are all well and good”, but questioned where the funding would come from.

While community pharmacist Nat Mitchell questioned whether the scheme fits in with the NHS's free at [the] point of care principle.

Another community pharmacist, Meera Sharma, argued there must be “fair funding” or “this scheme should be rejected”.

“There has been enough goodwill provided by pharmacists for free over the last decade. It needs to stop,” Ms Sharma added.

“Partnerships not cuts”

Pharmacy Voice chief executive Rob Darracott said NHS England’s support of the service highlighted “inconsistencies” between the pharmacy funding cuts and the government’s wish to better integrate the sector into the wider health service.

“If the NHS and the government are serious about working with the community pharmacy sector to develop and embed this type of initiative then we need partnerships, not cuts,” Mr Darracott said.

Result

Would you consider offering a sore throat screening service?
Yes, but only if it is properly funded
70%
Yes in any case, as it would be a good addition to our service offering
4%
No, it won’t benefit patients
9%
No, it would increase pressure on staff
18%
Total votes: 141

Stuart Gale, chief pharmacist, owner and manager of the Frost Pharmacy Group in Oxfordshire, is calling for more clarity on the service. Read his thoughts in his C+D blog.

23 Comments
Question: 
What do you think of the sore throat scheme?

Gerry Diamond, Primary care pharmacist

I think you're very correct on the global sum being spread even thinner, working harder for the same and if you equate it to peice work. So you used to get 20p per widget, now its 15p per widget and it's all about efficiency and improving productivity as far as NHS England is concerned.

Jonny Johal, Pharmacy Area manager/ Operations Manager

Fair funding for contractors is not the right way forward, I believe the money should be paid to the person who do the test ie the pharmacist, and for patients, free at the point of use.

Sam Patel, Community pharmacist

So how is the pharmacy supposed to pay for the scheme if fair funding is not the way forward and it will be free for the patient? Am I supposed to pay for these tests out of my own pocket? 

Jonny Johal, Pharmacy Area manager/ Operations Manager

I think it is the pharmacists who should attract the funding and not the contractor, it won't matter if you own your own pharmacy. Do you understand the concept?

Dave Downham, Manager

I understand the concept and it is pants. As area manager, you should know that.

Jonny Johal, Pharmacy Area manager/ Operations Manager

Yes, I perfectly understand this arrangement would change the entire dynamics between pharmacists and their employers (contractor pharmacists exempt of course), and I think putting pharmacists in the driving seat is a better way forward than the current profit-driven, corporate targets, and costs + development resistant regime. It would make no difference if you are a contractor or proprietory pharmacist. It will be up to the employers to negotiate their portion of the fees from the pharmacists, for providing the premises or platform. May I ask what is your objection to this arrangement? Do you think the current arrangements with MURs/NMSs are fair to employee pharmacists (who gets nothing, while the contractor pharmacists gets all the money)?

SydBashford Sold&Retired&DeRegistered, Community pharmacist

We will be screwed over again..... Will be portrayed to the public by DOH as a NEW payment/service, but will actually be from the Global sum. Bit like the quality payment announcement to parliament... new my arse, more like, if you dont achieve it all, you will be penalised a further £6400 on top of the £25,000 we're taking off you.

Freelance Chemist, Pre-reg Pharmacist

get ready for more targets and milking of the nhs

Jupo Patel, Production & Technical

Some would suggest there is a rather unholy relationship shared by C&D and certain multiples.

Dave Downham, Manager

Some would suggest you are full of BS trying to stir things up, but everyone's opinion is just as valid.

Jonny Johal, Pharmacy Area manager/ Operations Manager

Jupo Patel has some very relevant and valid points. In my view, many C&D articles are confused between contractors' interests and pharmacists' interests. For example, in this article, the C&D wrote "The community pharmacy sector has called for ... ", the term used is so undefined to start with, and one asks what exactly is this "community pharmacy sector"? I know some contractors want the service and promises to train their pharmacists, but does patients want the service, do employed pharmacists, who are not contractors, want to participate?

Jupo Patel, Production & Technical

Dave the white knight for multiples and C&D.

Valentine Trodd, Community pharmacist

I think it's more true to say the service was generally regarded as rubbish "according to comments on the C+D website".

Yuna Mason, Sales

The study didn’t take into account the number of the people who, having been alerted by this service to the fact that they could potentially treat a sore throat with antibiotics, decided to visit their GP to try to get some. Also it didn't take into account the people who were dissatisfied at not receiving some antibiotics from the pharmacy who then decided to visit their GP. This could mean more GP appointments. The number of GP appointments “saved” quoted in the paper was not a number actually saved - this was not checked through a multidisciplinary approach with GPs – it was just that some patients who accessed the service but were not given antibiotics said they probably would have visited the GP were it not for the service. Hardly robust.

The saving grace of the paper was that it said at the end “To understand the true impact of this service, a comparative study would need to be undertaken with a full health economic analysis.”

All that doesn’t seem to trouble NHS England though – who seem happy to roll it out without doing that.

Yuna Mason, Sales

16 of the 33 people who accessed the service and received antibiotics said they would have self-treated or done nothing. A further 7 would have taken the advice of a pharmacist. For those 23 people, their typically self-limiting condition could very well have cleared up on its own – but instead they were given antibiotics. What would be the effects of this on antibiotic resistance? The study didn't deal with this question.

Is that a valid question when patients are being treated for a throat infection? NICE does recommend the using the Centor score (which was used in the study) to assist the decision on whether to prescribe an antibiotic. However, it does not go so far as to say that antibiotics should be routinely prescribed following a high Centor score. The study also used a rapid antigen test in addition to Centor - but NICE says "rapid antigen tests should not be carried out routinely in the investigation of acute sore throat​" and according to a GP who wrote to the Guardian this is because "it has a poor sensitivity for picking up relevant bugs."

Would it be possible to do anything else to confirm that someone has a throat infection? Maybe, maybe not, but given that they are typically self-limiting and routine antibiotic prescribing is not recommended, questions should be asked about antibiotic resistance.

Yuna Mason, Sales

The study showed a saving of £2747 to the taxpayer based on 41 fewer GP appointments at £67 each. It did not take in to account the cost to the taxpayer for the test and antibiotics – total £1477.50.
For £1477.50, Boots pharmacies had to deal with, carry out and pay for:
• 1720 queries about the service which didn’t proceed any further
• 367 discussions for a Centor test with pharmacy staff (some including a GP referral)
• 226 further Centor discussions with a pharmacist
• 149 rapid antigen tests with a pharmacist (time and equipment)
• The supply of 36 lots of antibiotics (which take time to dispense plus about £3 cost to purchase each)
• The training of pharmacists and pharmacy staff
Would you want  to be delivering all of that for £1477.50, to save 41 GP appointments?

 

http://jac.oxfordjournals.org/content/early/2016/07/20/jac.dkw264.full

Christopher Ruane, Community pharmacist

I don't see surgeries carrying out this level of activity for such a sum....

Shaun Steren, Pharmaceutical Adviser

I notice that the 'sector' doesn't include anybody who questioned the clinical and economic validity of this service or did their comments disappear into the ether? Another example of the rather dubious relationship between C and D reporting and scientific investigation? You would think the 'sector' only constituted profit obsessed mystics. 

Angela Channing, Community pharmacist

We really, really do live in a Nanny state.  Man-up like previous generations and suck on a Fisherman's friend! If people just increased their intake of Vitamin D and C in the winter, maybe they wouldn't get all these nasty infections. 

PoPeYe- Popeys Car Wash, Locum pharmacist

Yes, you're going to be doing this for some of the money about to be taken from you. In other words, for nothing! What a great way to get healthcare professionals to do more services for less payment and of course for no extra manpower coverage so you will be even closer to being the burnouts sacrificed in order to keep G.P.'s happy. We are plentiful and replaceable, you see, while the medical sector have the luxury of capped student numbers. I hope this doesn't come to Scotland, this part of the world is certainly not the Community Pharmacy Utopia it is painted to be in certain media journals. And is nobody going to comment on the double entendre? Intentional? :-)

Clive Hodgson, Community pharmacist

Absolutely correct Angela. This scheme is a classic case of a solution looking for a problem. There are far more important things that need NHS funding.

Valentine Trodd, Community pharmacist

Ditto.So much for objective reporting...

Bal Singh, Locum pharmacist

What are people talking about? Give funds???? are u MAD? This DoH will only redistribute more of the Global Sum out, and hopefully cut some more away from it using stealth tactics. There is no more money coming into pharmacy....Unless your pharmacy is called Buckingham Palace, regardless of the value YOU as a profession offer, this goverment simply DOES NOT CARE. Hunt can't legally impose the Junior Doctor contracts (so say the courts) but They can seemingly cut the Global Sum and add pharmacy contract changes regardless of opposition. 

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