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PDA: Funding model 'incentivising' prescription volume must change

The PDA said the current reimbursement model for pharmacies must change

The funding model should be changed to reimburse pharmacies for “supporting patients” to self-manage conditions, rather than incentivising dispensing volume, the PDA has said.

The PDA’s statement was in response to a coroner’s report issued in February, calling on NHS England and NHS Improvement (NHSE&I) chief executive Simon Stevens to ensure repeat prescription medication is monitored more closely.

The coroner’s report related to an inquest into the 2019 death of an elderly man with a dementia diagnosis who had been “in receipt of numerous prescription drugs, on repeat prescription” and who was found collapsed in his home. The inquest concluded that the death was “prescription drug related” and that the man had overdosed on tramadol.

Senior coroner Geoffrey Sullivan “did not find a probable contribution” to the man’s death “as a result of the large quantity of repeat prescription drugs”. However, Mr Sullivan said he “heard that [the man] had amassed a large quantity of prescription medication that he was simply not taking and [that] was building up in the house”.

He highlighted a concern that “repeat medication is not being adequately monitored” and that this is “leading to many – often older and/or mentally infirm – patients building up dangerous quantities of prescribed medication”.

NHS working to reduce “over-medication”

In its statement, the PDA said it has received “feedback from pharmacists that some employers incentivise item growth”. As well as changing pharmacy's funding model, it suggested Mr Stevens could ensure pharmacy contractors who “prioritise prescription item volume above all other considerations” are “identified and “meaningful action is taken against them”.

A spokesperson for NHSE&EI told C+D yesterday (August 26) that “while serious patient safety incidents are thankfully rare, a medicines safety programme has already been established meaning more than ever before is being done to ensure safe medicine use”.

“Nearly £80 million has been invested in electronic prescription technology and hundreds of NHS staff across the country are working with care homes to reduce over-medication,” they added.

Dispensed medicines should be “means to an end”

The PDA emphasised that the “priority work” for primary care network pharmacists this year will “include structured medication reviews for a number of patient groups, including those at risk of developing a dependence on opiate analgesics”.

However, pharmacists working in the community also “have a crucial role to play in keeping medicines supply safe”, it added

Under a new funding model, pharmacists could be reimbursed for supporting patients to manage their conditions by, for example, keeping blood pressure within a target range and avoiding the “dangerous accumulation of medicines”, the PDA said. 

In such as system, the  “bulk of reimbursement” would be dependent on pharmacies “supporting patients to self-manage and live well with their health condition,” it added.

“In this model, dispensed medicines would be the means to an end of effective pharmaceutical care, not the prime objective-driven purely by the urge to maximise profits,” the PDA said.

What do you make of the PDA's suggestions?

A.S. Singh, Community pharmacist

We've tried this before haven't we? How would you measure care given? Last time I checked there wasn't units for care. Very difficult, especially with corporates involved in pharmacy now, everything is subject to abuse

Axed Locum, Locum pharmacist

This has been a long time coming!!. Congratulation to PDA for their view on this. The 28 day dispensing should also be reviewed, as this has not delivered medicine wastage, that was envisaged.Along with this "Auto-ordering" patients medications in advance should be dis-allowed.

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