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Numark: Urgent supply pilot is one way to claw back funding

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Mandeep Mudhar: "No brainer" to sign up to the service

NHS England's emergency supply pilot is one way contractors can earn some money back in the face of the funding cut, says Numark.

Details of the pilot programme – which will see patients who call NHS 111 for urgent repeat medication directed straight to a community pharmacy, instead of an out-of-hours GP surgery – were confirmed on Tuesday (November 29).

Pharmacies taking part in the programme will be paid a total of £12.50 for any request for urgent medicine received from NHS 111, regardless of whether or not a supply is made.

Numark director of marketing Mandeep Mudhar stressed that the service will not be a "panacea" for the sector's funding woes. But he will be encouraging members to sign up, as it is a “no brainer”.

“It is a service pharmacy should have been providing [years] ago. It already works in other countries...and is naturally aligned to what community pharmacy does."

"Now there is some funding attached to it, I’d say roll it out to the whole of pharmacy and let us show you what a good job we can do,” he told C+D today (December 1).

While Mr Mudhar agreed with the Pharmaceutical Services Negotiating Committee’s concerns that the £12.50 fee is on the “lower end” of funding, he said it is one way to help contractors earn some money as the 12% drop in pharmacy funding hits England today (December 1).

“The funding cuts seem to be inevitable and the danger is that if we get stuck in continual negotiating about the amount of money [for services like this], we’ll never get it up and running,” he said.

However, “it is not going to be the panacea”, Mr Mudhar added. “The funding given [for providing the service] is nowhere near the gap that our members will face in the coming months.”

"My concern is that it will be just another thing dangled in front of pharmacy and then fall by the wayside because of the funding cuts. I'm not quite sure what the pilot will establish...only that it works."

“Tinkering at the edges”

When the pilot scheme was first announced, the National Pharmacy Association (NPA) branded it a "smoke screen” for the cuts to pharmacy funding.

A spokesperson for the NPA told C+D today the service is “welcome”, but “a half-hearted gesture”.

“It’s difficult to feel positive about the scheme when it is set against the cuts being imposed on pharmacies across England,” they said. 

“We need the government to sit down with the sector to discuss a long term plan for unlocking the potential of community pharmacy, not just tinkering at the edges.”  

Pharmacists have been able to express their interest in the service by signing up on the NHS Business Services Authority website from today.

Get an insider's view on the funding cut negotiations below:

20 Comments
Question: 
Will you be registering to provide the service?

Valentine Trodd, Community pharmacist

Maybe as a form of protest, once the scheme goes nationwide, all pharmacies should refuse to do emergency supplies unless a referral is received from 111? See how quickly it'll all come crashing down then...

S K, Community pharmacist

Numark seriously? - this service is not a 'no brainer'! the service is poorly thought out and for the time, paperwork and admin related to making an emergency supply under this scheme is not worth the remuneration. I am sorry but PSNC should be ashamed at even suggesting this service is tenable and good-value for money (for taxpayers and pharmacists) and even more worrying the Numark is suggesting that it is a good opportunity! Pharmacists should not accept this service in its current form 

Chris Mckendrick, Community pharmacist

C&D Awards Business Initiative of the Year application out line:

1. Buy 1980s retro pay-phone with "speed-dial" - button No 1 is 111. (Cost £37.14 e-bay, a 1-off expense and tax deductable)

2. Customers who come in asking for urgent emergency meds invited to make request to 111 on "Official Phone" (sorry, it only takes £2.00 coins). Must tell 111 they're quite close to my pharmacy. (profit £2/call)

3. Only 1 medicine to be requested per phone call, so I can generate a "Cluster" of calls for multi-item requests - can't believe DoH still "front loading" a service! ( average 4 items = 4 x £2 call charges + 4 X £12.50 + 4 x £1.50 = £64

4. Whilst they are waiting, invite customer to nominate my pharmacy as their EPS/ETP pharmacy even if they are happy using another one - what's good for PiiU is good enough for me. 

5. Also whilst they are waiting (nhs-net is sooo slow), invite the customer to participate in one of my shiny new MUR services. To quote PSNC.... " A prescription intervention MUR is triggered by a significant adherence issue that comes to light during the dispensing of a prescription". Well, call me Keith Ridge and grind me up in a pestle and mortar * if you like, but I can't think of a more significant adherence issue than running out of your life saving medicines. (£28)

*Kids it's basically a rock and a hard place hence used as a symbol for pharmacy

6. Wait for the cash to roll in

7. Buy a smart bib and tucker to pick up my C&D award, inevitably presented by a celeb who's knowledge and interest in community pharmacy is inversely proportional to their appearance fee.

Valentine Trodd, Community pharmacist

Shame on you - you forgot to offer them a flu jab!

Leroy Jackson, Community pharmacist

I sometimes do this to trick my kids - take something big away then give them something small so they think they haven't actually lost that much!

 

Clive Hodgson, Community pharmacist

Given this new “Service” and its funding, (or lack of..), tonight’s homework will be to write an essay entitled: “The Future of Community Pharmacy is in Services“.

N O, Pharmaceutical Adviser

I don't know from where Mike got the figure of ""ONE REFERRAL PER PHARMACY PER MONTH""", at least the service specification doesn't say so. There are certain areas in England, where the local CCGs have put in place Urgent Medication Supply Service. The only difference is they have good IT platforms, although the payment is a £1.00 less for each patient interaction, but less paper work.

How the DoH scheme works??? You need to have a secure NHS.net email adddress, then, whenever a referral is made you will receive an e-mail to that email address giving patient details and medication to be dispensed. Within half an hour the patient will call you and if you have the stock, you call the patient for a face-to-face interaction. Once you are satisfied with the answers, you will make a supply, else you would then call a HTHP (healthcare to healthcare provider or something like that) number, which is dedicated to OOH GPs and cannot be shared with the patient and refer them for a consultation or ask for a prescription to be sent to you. Whether you supply or not you will still get a minimum of £10+. If you don't have stock of the medication, but another participating Pharmacy has the stock, then you can refer them to that pharmacy and still get paid £10+ and the other Pharmacy gets £12.50. Then by following the paper-work (like the Flu vaccination adv service) you claim payment through NHSBSA along with that months FP34c submission. There is no limit on how many patients you can supply, as long as the patients were referred by 111. Please for gods sake, READ THE SERVICE SPECIFICATIONS BEFORE COMMENTING !!!!!

Ben Merriman, Community pharmacist

But because alll referrals MUST come from 111 (e.g. not from other healthcare providers, including local OOH), the pathway followed by the operator (they quite simply follow what can only be described as an NHS Microsoft Help file) will simply not have the refer to pharmacy option available should NHS England deem there to have been too many referrals.  There is a cap to this service and as it is being controlled by NHSE, it will be strictly adhered to.

Mike Hewitson, Superintendent Pharmacist

total budget divided by item of service fees = 1 referral per pharmacy per month. 

(that is if everybody took part, which they won't) 

They have said that they won't allow the total budget to be exceeded. 

N O, Pharmaceutical Adviser

Their estimate is 200, 000 referrals in year 2015/2016. So the funding is based on these figures. Do you think we have 200,000 Pharmacies?? And how foolish it would be to withdraw a service, without prior notice (at-least a month) Hence, the pilot to see if it is value for money. Even if the take-up is good and poses a threat to surpass the budget allocated, there are only 2 ways, 1. accept the effectiveness of the scheme and extend extra funding 2. Stop the service altogether. So, don't give me this one patient a month per Pharmacy theory, it is just like how the funding cuts were planned by the DoH & NHSE by taking a average without taking in to effect the demographics of smaller pharmacies or pharmacies in deprived/ rural ares. So, what is wrong in just signing up ?? You have to get a nhs.net email anyway for you to get the Quality payment and you would anyway refer the patient asking for a loan. Atleast with this scheme you don't have to lend them (to be deducted from the script, when it arrives) and yet get paid £12.50/ patient INTERACTION.

Mike Hewitson, Superintendent Pharmacist

Not a theory just do the maths: divide 200,000 by 12 months, and again by 11,500 pharmacies in England. 1.44 referrals per month (if everyone signs up) Obviously if only 1,000 pharmacies signed up this would equate to 16 referrals per month to those pharmacies. Even if you don't take out the costs of providing the service in this best case scenario of lets say 20 referrals per month you are still only talking about revenue of £250/month.

PSNC estimates the costs of providing this service potentially exceed the revenue generated. If you want to sign up for it that is up to you, but I strongly urge contractors to read the service spec and do the maths themselves. My problem with this service is that it sets a bad precedent for future commissioning. 

Ben Merriman, Community pharmacist

We can only provide this service once the patient has been referred by NHS111.  Once the budget is reached, there will be no more referrals from NHS111.  It will not be an option to the call handler.  That doesn't mean that the service won't be there;it will still be commissioned and no notice period needs to be given from either party.  111 will simply stop the referrals and patients won't be able to get free of charge emergency supplies from their pharmacy.  

I feel another XRayser type story coming along seeing as C&D don't allow sock puppet demonstration in the comments section...

Ben Merriman, Community pharmacist

Setting aside the fact that the service will be restricted as Mike as said, we couldn't possibly rely upon this as an income stream; it's like EHC - we have absolutely no control as to the number that we will do.  Oh, and being paid 50p for all items after the first one dispensed is an outrageous insult.

Yes, it's a good service and yes, it's something that should have been done a long time ago.  Community pharmacy is all for working as part of the NHS and is all for modernisation but that can't come at any cost.  Contractors (before we start this again, I am an employee) who have invested heavily in their businesses could face personal financial ruin because these cuts but patient choice, wellbeing and safety are all being risked for, what is in government terms, loose change found under the car seat!

Mike Hewitson, Superintendent Pharmacist

ONE REFERRAL PER PHARMACY PER MONTH....

Is the level of funding available for this service. Access to it will be 'throttled' by NHS111 - it will get turned off if it looks like activity will exceed the amount of funding available. The recording is onerous, there is no IT platform, relying on contractors writing the details on a blank EPS token....

Fully in favour of the concept, absolutely against this iteration. 

With the removal of funding front-loading, services such as this one need to be costed and fully funded or we will stretch base-line funding even further in the haste to provide loss-making services. 

 

 

 

Valentine Trodd, Community pharmacist

withdrawing my comment... was based on Mike's ONE REFERRAL PER PHARMACY PER MONTH conclusion, which apparently is not mentioned anywhere in the specification.

Clive Hodgson, Community pharmacist

So, given the funding details kindly provided by Mike, why are Numark (or anyone else) getting even slightly excited by this new "service". Unbelievable.

Mandeep Mudhar, Marketing

Not quite sure which bit of excited I have mentioned or come across as suggesting - suggest you read my piece first - all I am suggesting is that it is better than nothing and in no way comes close to the hammering we are getting through the cuts

Charles Whitfield Bott, Pharmacist Director

I must admit that I have not had time to take a detailed look at the service specification yet. We will sign up, but I do not expect much to come of it. At the moment we "help out" a lot of people on a Sat am, if these were all to produce a fee then that would be very good. The problem is that those patients would need to be refered to 111 to be refered back, this is a bit of an arse for the patient and therefore bad for buisness in the long term.

I suspect if we were all to direct all of our patients to 111 the system would come crashing down, no matter if 111 are refering to pharmacies or not (because they have run out of money). Those in power will not admit how much we protect out of hours services, and at the moment we do it without any fees. For the benift of out patients will continue to do so.

Clive Hodgson, Community pharmacist

Mr Mudhar...I would disagree. This is no way to claw back funding.

I think it is a “no brainer”, as you put it, to have nothing to do with this Service. Dave Downham (below) explains exactly why.

Dave Downham, Manager

I would disagree - it's worse than nothing. Once you add up setup costs, training, SOPs, costs to administer, general administrivia, lack of scalability and inability to fit into planned work - and that's before you factor in the time dealing with a flustered Mrs Jones - you end up with a red number at the bottom.

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