Pharmacists and industry experts have slammed an admission from the sector's paymaster that its auditing and transparency processes have not been sufficiently modernised, saying the situation is "simply no longer acceptable".
In an email written to a contractor affected by underpayments last month, a senior NHS Prescription Services (NHS PS) staff member wrote: "I agree with you that [NHS PS] has failed to adequately modernise its processes around audit and transparency following the introduction of the new processing system in 2007. I cannot provide sufficient explanation for this."
The paymaster has promised to focus on improving accuracy and transparency on an ongoing basis, but contractors and legal experts warned the situation needed to improve and called for someone to be held responsible for the ongoing problems.
C+D's Fight for Fairness is campaigning for accuracy in prescription pricing Find out more
"If pharmacists failed in their duty of care to patients and did not have proper systems and procedures in place they would possibly get struck off," said Umesh Modi, a partner at accountancy firm Silver Levene. "I am astounded by this admission from NHS PS and it seems to imply they have thrown in the towel and errors are likely to continue," he said.
David Reissner, head of healthcare at legal firm Charles Russell, agreed. "The admission from NHS PS is remarkable. It may help to resolve any doubts about whether it is probable that underpayments have been made," he said.
The admission follows ongoing problems with prescription pricing and payment accuracy, as highlighted by C+D's Fight for Fairness campaign, which is pushing for improved accuracy and transparency in the payment system. "This is a national scandal," one contractor affected by ongoing pricing errors said. "If we were charged with continuous underpayment of taxes we would be in serious trouble. This simply has to stop immediately."
Graham Phillips, contractor at Manor Pharmacy (Wheathampstead) Ltd, Hertfordshire, said he was pleased to see the paymaster was no longer "in corporate denial" about the problems, but called for more accountability over the errors.
An NHS PS spokesperson told C+D this week that it had "an ongoing programme of work" to improve accuracy within the payment system and said increasing transparency would be a "key initiative" within the agency's 2012-13 business plan. "The established manual system employed to check and re-price accounts is robust from an auditing perspective but we acknowledge that it does not meet some pharmacists' transparency expectations," they added.
But the promises are likely to bring little comfort to the sector, as C+D understands that although measures to increase transparency in the prescription pricing process are now under active discussion, they could be stalled by a wider review of the NHS Business Services Authority (NHSBSA).
PSNC is working with NHS PS to try to ensure "a complete audit trail" to aid the accuracy of prescription payments to pharmacies under the electronic prescription service, chief executive Sue Sharpe revealed at the Avicenna Conference 2012 in Sri Lanka earlier this week.
But although the Department of Health confirmed it was exploring what pricing information contractors would like to receive on a monthly basis, it warned any significant changes to the pricing process would "need to be considered in light of the wider NHSBSA commercial review". This review had been expected to report back in 2010, but has so far not been published.
"There are still significant fluctuations in payments on a monthly basis that would suggest errors are continuing. Clients have confirmed that they have recently received refunds following pricing errors." Umesh Modi, partner, Silver Levene "PSNC's audits confirm improvement of overall accuracy levels but significant problems remain. We are in discussion about improving transparency with the DH, but solutions are complex and we are anxious to manage burdens on contractors. We must also ensure information provided is useable and helpful." Harpreet Chana, head of pricing, PSNC "Further monitoring of NHS PS activity and badgering them for an explanation of what they are doing is no longer acceptable. The picture that emerges is a continued and consistent failure to pay us accurately and this has to stop immediately." Contractor, England (name and address supplied) "What we need to know now is how such a huge amount of NHS spend was ever treated in this cavalier fashion – why was a system that was not fit for purpose introduced, who is taking responsibility for it and how do we know they are not now making more arbitrary decisions? There doesn't appear to be any accountability." Graham Phillips, Manor Pharmacy (Wheathampstead) Ltd, Hertfordshire