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Government to 'phase out' establishment payments

DH: Will encourage 90-day prescriptions where clinically appropriate

Department of Health plans to remove the £25,000-a-year payments to pharmacies "over a number of years"

The government plans to "phase out" establishment payments for pharmacies in England, it has announced.

The payments – of around £25,000 a year – are made to pharmacists that dispense more than 2,500 prescriptions a month. This "relatively low" payment threshold incentivises more pharmacy businesses to open and "add costs to the taxpayer", the Department of Health (DH) said in a briefing document, published by PSNC last Friday (January 22).

The DH plans to phase out the payment completely "over a number of years", it said.

It criticised the current "complex" system of pharmacy payments, which it claimed results in pharmacies being paid "regardless of the quality of services and levels of efficiency".

The DH plans to create a new payment system specifically for distance-selling pharmacies "in recognition of the difference in their service offering", it added.

Longer prescription durations

The DH also used the document to announce its intention to save money by encouraging longer prescription durations "where clinically appropriate".

"Many prescribers already prescribe 90-day repeat prescriptions. We will be looking at steps to encourage optimising prescription duration," it said.

Some 28-day repeat prescriptions have "no clinical need" and "inconvenience" patients while creating an avoidable cost to the taxpayer, it stressed.

On the same day that the DH published its document, the all-party pharmacy group revealed that the government is braced for more than a quarter of pharmacies in England to close as a result of its 6% cut to the global sum.

 

How will losing your establishment payment affect your business?

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104 Comments

Navid Kaleem, Superintendent Pharmacist

I naively bought my Pharmacy from the Co-op last year hoping to buy an income for myself. I have increased the business from 1,000 items/month to 2,500 items/month. I have dedicated myself to my patients, neglected my family and have been working for nothing over the past 12-months. I may be one of the 1st Pharmacies to close.

It saddens me reading this blog how disunited we are and how little sympathy we have for each other. One misconception I want to clear, in all works of life there are generous people & greedy people. I get this impression there is a stereotype of contractors being greedy. Good luck to those who are doing ok and my sympathies for those who are struggling. Keep me in your prayers.

David Wilde, Community pharmacist

Under a Labour Government Pharmacy increased its responsiblities in Community Pharmacy by introducing extra services and taking work from GP'S which where over stretched at the time. We got paid a resonable amount and Pharmacy Tutors also got paid a realistic payment for taking graduates through the Preregistration programme.

Enter the Tory Goverment who give all responsibility to the GP'S and who have no respect or knowledge of an under paid, presurised pharmacy service where one mistake can cost the life of a patient. More cuts will only put more stress and pressure on the Pharmacy Profession as a whole and to the resposible pharmacist that is on duty who is having to try and cope with less qualified staff that his employers can now only afford.

Who ncomes off worst? Well unfortunately it will be the patient who will be at risk of mistakes from human error. Also this government says that you cannot rely on income from dispensing however income from extra services is no where near enough to compensate for the loss of dispensing revenue. Extra services do not make a profit for pharmacies. 

I ask the question how can you do the same volume of dispensing and the extra services with less staff due to cuts in government revenue and less staff due to pharmacists and technicians taking more time off due to stress related illness?

All I can say is that after 50 years in Pharmacy i am glad I decided last year to retire from this wonderful profession that I had loved for over half a century. Its a sad state of affairs that pharmacy is now recognoised by government and civil servants as the poor relations of thge medical services in England. We are alas back in the dark ages of the Thatcher government. 

i dont usually get political however i feel very strongly about what is happening to the profession at this present time and if we are not careful I can see pharmacy dissapearing in the next decade in its present form.

To all my colleguyes in the profession keep up the good work.

David Wilde

mohamed nanji, Community pharmacist

PSNC need to explain to goverment that with basic practice allowance we work for the safety of people to give free walk in non appointment advice, not sale unwanted medicines (just did a free blood pressure,diabetic test (and save a person kidney last month) , accept returns of unwanted medicne, free blister packs, free deliviers etc

mohammed amier, Other healthcare professional

So not too long ago over 5 new pharmacy schools opened causing an influx in pharmacist numbers. Then an exemption to control of entry was introduced which saw online pharmacies and 100 hour contracts emerge. However, there was clearly more pharmacists than jobs as evident from the declining locum rates. Was the government asleep when this was happening? is there no planning for such laws? You only have one choice now to correct the series of stupid errors if I may add and that is to hand over more responsibility from the GPs over to the pharmacists and please don't forget to budget for that because you will drive away more and more pharmacists and before you know it you will have a shortage of pharmacists as you did just over 10 years ago.

Thomas Edwin Kinrade, Community pharmacist

I cannot understand the proposal to increase prescription treatment lengths , which usually increases wastage. Only today , a patient returned three months supply of injections costing over £2100 . With a 28 day script , NHS would be £1400 better off , . I guess their gamble of not paying two dispensing fees backfired in this case.

 

Sue Per, Locum pharmacist

Even if this was on monthly scripts, and in particular managed by the pharmacy, the same sort of returns would have resulted, because there is a vested interest in orderring for these patients even if it is not needed. In some pharmacies if they are "in date" they even put it back into stock, profiting both ways!!!. Not rocket science.I have seen such returns with same "drug formulation" item having a separate months dispensing date. How did that arise?? ., simply because of repeat ordering for future script at the time of collection of the present script..

Get a reality check!!

   

Robert Rees, Manager

It wouldn't occur with the Repeat Dispensing Scheme if the pharmacists really did manage the repeats. Much less waste.

As for recycling of meds it is illegal. If a pharmacist is caught doing that they should be struck off

Mi Wa, Community pharmacist

Sami, London, Harry (possibly the same person),

Whatever the post we get the same drivel from you.  I come on here to look for an opinion on the article which has been written and all I see is genuine posters getting snared into responding to your barbed comments that only intend to irritate.

I'm an employee pharmacist, I can't say that I always enjoy my job, but it is my choice to work where I work and I am not a victim.  I would rather be a pharmacist than many other jobs, no matter how cushy they may be.  By the time and frequency of your posts, you seem to have a pretty comfortable existence (mostly preferring to post during work time rather than your own).  Has your poor treatment as a locum actually been a result of your atitude, ability, work ethic etc?

So please grow up and enter into a conversation relevant to the post or leave it to the adults.  I'm not trying to censor what is being said, but we are at a difficult time in our profession and we need sensible dialogue, not poor quality playground banter.

London Locum, Locum pharmacist

I would suggest you're a stooge of a multiple or possibly a contractor. I don't think C&D advocate censorsip yet.

Robert Rees, Manager

But maybe they shouldn't allow anonymous posts!!!

London Locum, Locum pharmacist

No problem. Once the identitiy of all the bloggers are revealed such as Xrayser then I'll follow suit.

Kirit Shah, Community pharmacist

90 day prescription intervals is absolutely stupid, recently did a waste audit, average 16months prescriptions isued per patient when prescribed 3 monthly, and 13months when prescribed monthly. Extra 25% wasted when prescriptions are for 3 months!!

Stephen Eggleston, Community pharmacist

OK Everyone. There has been losts of slagging each other off and saying the government has kicked us in the teeth. Losts of "Get out of pharmacy" advice (or jibes, depending on who authored). I have one question:

What are we going to do about it?

London Locum, Locum pharmacist

I will sit back and observe. As it's not the most imprtant thing on my list of priorities. Probably similar to you when(if) you heard about the PDA campaign to protect locums.

Clive Hodgson, Community pharmacist

Good question Stephen. If nothing else the views expressed in reply to this article show the differences between Independent Contactor and employee/locum Pharmacist. The silence of the large Multiples so far is noted… I suspect they will have their own agenda that will not be the same as everyone else. A united voice is most unlikely and even if there were one I think it impossible that Government is going to be persuaded to change its mind.

Barry Pharmacist, Community pharmacist

There is a LOT we can do about it. If bricks and mortar pharmacies are to survive they have to provide services that patients WANT that distant selling pharmacies cannot provide. What % of Rx are handed out by a pharmacist who is actively offering advice - not just checking the patient's name and address. We have to re-model bricks and mortar pharmacies so that patients choose to use them because they don't want to use an online pharmacy that might get their medicine to them anytime in the next 3 weeks.

London Locum, Locum pharmacist

Do pharmacies also need to provided healthier working environements for their employees Barry? And you must have forgot to answer my question about supporting locums!!

Barry Pharmacist, Community pharmacist

Yes they absolutely do. Some of the working conditions you highlight are appauling. I am a locum myself and I fully support the need to provide a decent and enjoyable workplace. The funding cuts are not about contractors being paid back for the way some of them treated locums over the last 5 years. It is about making sure we have decent, proper pharmacies in the future.

London Locum, Locum pharmacist

So onwards we march. Forget about the workplace conditions which will further deteriorate. Seems it doesn't matter anyway. There is no future

Sami Khaderia, Non healthcare professional

dear stephen...we cant do anything about it.................any closure of pharmacies will be mopped up by competitiors. Anyne who thinks otherwise is deluded. 

Graham Morris, Design

I was concerned when one of my daughters decided to study piano and double bass at University and then continue on a Masters Course. Musicians have always had the reputation of having to scrape together a living and is in sharp contrast to the income I received before retiring as a community pharmacist.

Now, I read of pharmacists working in intollerable conditions and having their salaries slowly eroded by the greed of employers who are also under the cosh of the government. The same government that has also reduced the access of secondary students to studying a musical instrument!

Now, I find, that middle class parents are quite happy to pay my daughter well in excess of a locum pharmacist to teach their children an instrument as their schools don't offer the service. Gigs pay more per hour than sweating in a dispensary. Accompanying students taking their musical grades, playing for ballet schools, and being paid for playing in orchestras all are finacially more rewarding than locum pharmacy.

Most importantly, she looks forward to working in different environments, meeting like minded people, with no more responsibility that being uncomfortable if she plays a "bum" note.

I now know I was wrong to worry that she did not follow dad into pharmacy. Indeed, I am envious and proud of the niche she has carved out of life. We have a responsibility to warn prospective pharmacy students to think again before pursuing their degree. However, if they do play violin, they will have some comfort in playing the fiddle while pharmacy burns under the pressures of this government.

 

 

 

Barry Pharmacist, Community pharmacist

Well said Graham. I fully encourage pharmacy students to move to a different course or stay on for another two years to train as a physician assistant. Mums and Dads need to steer their bright teenagers away from pharmacy. It is heading for a ditch.

Pharmacist Pharmacist, Community pharmacist

Pharmacies will close. Salaries will go below living wage. Yet the greedy universities will continue to churn out pharmacists.

Marc Borson, Community pharmacist

Has anyone bothered reading the briefing paper. Its says in its criteria for preffered pharmacy access. That high non-white areas take prominence.

So white people do not need pharmcy services as much as non-white? 

Is this even legal?

I am hoping this briefing documnet is a copy paste job, because it just seems so incoherent.

 

If this goes to plan In a few months there will thousands of redundant staff with out a pension. Banks will lose out hugely to unrepayable debt. There will men and women with mortgages to pay, school fees, holiday commitments and car loans- but will be unable to meet those commitments. 

The DoH do not reliase what a good deal they are getting, they have no balance sheet human resource costs, property costs, stock etc. They have no civil service pension commitments to the work force. We have provided an instant access health service for years dealing with minor ailments very quickly at little cost. If we go the GP surgerries will be bursting at the seems. All the savings will be spent on general practise and A and E staff.

The stakeholder must ask for even handedness and remove dispensing doctors controlled loacilities once and for all, they must put on the same playing field as PAC.

If they facillitate exit then the payemnts must be tax free and have a pension element. People will be destitute otehr wise.

 

Ebers Papyrus, Pharmaceutical Adviser

Let's examine the facts:

Pharmacy mentioned twice in NHS plan; COSI ignored; minor ailment service scrapped; call to action ignored; emergency supply service scrapped; branded generics increasingly prescribed; dispensing items at a loss .... The list goes on

Pharmacy is being told we don't value you and we won't listen to you. Pharmacy is working harder for less with no future just empty rhetoric. The reply to the parliamentary petition is void of anything the only certain change is another reduction in funds. The government say they are consulting on efficiencies and new models. Consulting means nothing, it's the same as saying we're consulting on sending human beings to Mars in the next 30 years!! Pharmacy has proved it wants to assist the NHS and is working tirelessly but is simply ignored. The profession is rightly perplexed that the government believes patients think pharmacies aren't efficient when dispensing medication. Pharmacies turn prescriptions around incredibly efficiently. Waiting 48 hours for the prescription from general practice or longer as the surgery is closed over the weekend is where the inefficiency lies. There is also no evidence "hub and spoke" can offer any further efficiencies indeed the lead time is currently 7 days. Pharmacy can, should and will defend its position and secure its future. These proposals are a damn right insult.

 

Shaun Steren, Pharmaceutical Adviser

I would say a slight majority of the pharmacies I work in are badly designed, badly organised, understaffed, staffed with people of questionable competence and managed with questionable leadership and authority. Chaotic not efficient is what comes to mind on most days. The fact that community pharmacy is willing to do things for free and the staff  are expected to work themselves into the ground for a pittance, makes them cost-effective for the wrong reasons. 

Pharmacist Pharmacist, Community pharmacist

Agree 100%!

Mr CAUSTIC, Community pharmacist

reduction in practice payments, reduced numbers of scripts with a longer periods of treatment.  increased rents and rates ,increases in minimum wage, increased energy costs.  the perfect combination . is this an april fool joke ? oh no its january 25 th!

Shaun Steren, Pharmaceutical Adviser

Let the record of history be crystal clear, for that those who were critical of the 2005 contract at its inception and who have been negative ever since, have now been absolutely vindicated. When it is asked by those yet to qualify: How did this come to be? Point them in them direction of those credulous fools who, for the best part of a decade, have claimed for a bright clinical future. As we enter the sunset of our profession, at least remind those pharmacy students much younger than ourselves, there is bright dawn ahead in other vocations and they have not at least (unlike many of us), wasted the last ten years of their lives in an intellectually, professionally and spiritually unrewarding government/corporate  trap. 

max falconer, Superintendent Pharmacist

Spot on Shaun. I assume you were with me amongst the 5% who voted no?. Myself simply because the PSNC said we have no choice and 95% followed like leemings. It's a longer journey to the cliff edge than I anticipated but the end game was always inevitable!

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