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PSNC responds to cuts with cost-saving alternative plan

PSNC: Pharmacists can make savings to the NHS prescribing budget

Negotiator has published a short-term counter offer to the government's proposed 6% funding drop

The Pharmaceutical Services Negotiating Committee (PSNC) has published cost-saving measures to combat the government’s planned funding cuts.

PSNC’s counter proposals are a "short-term alternative" to the funding cuts and set out how community pharmacy could make savings in the NHS prescribing budget.

The combined proposals would produce savings "worth at least as much as the government's proposed £170 million cut to pharmacy funding" in England, it said yesterday (April 25). 

They also lay out how the sector could reduce NHS spending on out-of-hours GP services, specifically the emergency supply of medicines. PSNC said this pharmacy service would allow patients requiring medicines to obtain supplies without the need for an urgent prescription.

"A retrograde step"

PSNC branded the Department of Health’s intention to replace the current payment system with a single activity fee for each prescription as a “retrograde step” that would incentivise pharmacies to maximise prescriptions over the provision of other services.

Instead, PSNC suggested developing a funding delivery system that gives higher payments to pharmacies who provide a range of high quality services, such as having a consultation room that meets medicine use review (MUR) requirements or having access to the summary care record.

PSNC first responded to the funding cuts with its long-term clinical vision in February, arguing that the government had “no specific proposals” to broaden the sector’s clinical role. The negotiator's suggestions included increasing pharmacy’s medicines optimisation role and the use electronic repeat prescribing. 

 

How could PSNC save the DH money?
  1. "Not-dispensed scheme" 

    This scheme would reduce NHS expenditure on prescription medicines, by first assessing whether the patient already has sufficient stock at home.

    Following discussions with the patient regarding their repeat medication, contractors would mark any items not required by the patient at that time as "not-dispensed", in a way that could be easily identified by NHS Prescription Services. For each non-dispensed item, contractors would receive the usual professional fees plus a small additional non-dispensing fee.
     
  2. Therapeutic substitution service

    This service would reduce medicine costs by enabling pharmacists to recommend alternative products to prescribers.

    Suggested substitute medicines would be based on a national list of "costly" medicines and their suitable alternatives. The pharmacist would send GP practices alternative prescribing options for individual patients, along with a "clear explanation" of the reason for the suggested change.
     
  3. Generic substitution service 

    This would allow community pharmacists to dispense cheaper generic equivalents in the place of prescribed branded products. A list of medicines that could be generically substituted would be agreed at a national level, ensuring that only safe and clinically appropriate generic products would be considered for a substitution. The pharmacist would discuss the substitution with the patient at the point of dispensing.
     
  4. Care homes

    Community pharmacists would identify the excess prescribing and supply of medicines and dressings to care homes, by conducting regular reviews of their supplies.
     
  5. Unwanted medicines campaign and audit 

    A month-long campaign of waste medicines returned to pharmacies would raise awareness of this issue among patients and prescribers. Pharmacists would then audit the waste and share learning with local prescribers. 


    - Source, PSNC Briefing 026/16: PSNC’s counter proposal to the Government’s plans for community pharmacy in 2016/17 and beyond (April 2016)

 

Do you agree with PSNC's cost-saving proposals?

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36 Comments

Concerned pharmacist, Community pharmacist

We already operate an enhanced service for Emergency Supply.  It has added nothing to the Emergency Supply service we provided previously under law. The only thing that has changed is more paperwork, and the NHS rather than the patient now foots the bill. 

We have a large number of visitors and therefore emergency requests are common. The Medicines Act catered adequately in the circumstances and we will often make several supplies in a day.

The pharmacy does gain more income with the enhanced service, but I cannot see any added value to the NHS. Most patients (even those normally exempt) are happy to pay for their errors if they leave their medicines at home or lose their medicines, and are astounded that the NHS is prepared to provide a free service.

Diana Taylor, Primary care pharmacist

The not dispensed scheme would be good, except it would be too easy for pharmacies to order items the patient didn't want or need via the pharmacy reordering scheme and then claim the fee for not dispensing it. How do PSNC propose to sort that one?

Concerned pharmacist, Community pharmacist

Any system that depends on integrity is doomed to fail with the target setting, profiteering, approach of the multiples.

Sue Per, Locum pharmacist

That is the remit of the fraud Squad, who are on snooze!!., Such fraud has been rife for years, and no one from the DOH is prepared to face up to it.

M Elnemy, Non healthcare professional

Diane ....I bought that argument up earlier to....

 

Leon The Apothecary, Student

Everyone pays a flat fee of £1 per item regardless of exception would earn the NHS ironically the amount that they would need to save. See my article regarding universial prescription fees for the maths.

Concerned pharmacist, Community pharmacist

What is there in the PSNC proposal that any self-respecting pharmacist shouldn't be doing already as a matter of course? Apart from loads of NHS bureaucratic paperwork!

Shaun Steren, Pharmaceutical Adviser

But isn't that what community pharmacy 'innovations' are all about? Digging holes to fill them back in ? Looking for problems that don't exist so as to provide solutions that are not needed? Carrying out the same the activity but under a different name? Superficially affecting change to things that in the important respects remain the same?  Claiming for connections with the rest of the NHS that don't exist? Doing things for free then complaining about no payment? 

John Urwin, Community pharmacist

No!

Neeraj Salwan, Superintendent Pharmacist

Welcome to the M Elnemy aka Shami show. One sided views for multi sided issues...

Janet NQ, Community pharmacist

I'm sorry but only the first suggestion offers renumeration the rest don't. They just add burden to the pharmacy team and waste of time. Besides all is being already done most of the time.

M Elnemy, Non healthcare professional

J

whats stopping contractors ordering everything and then endorsing ND

lol

Concerned pharmacist, Community pharmacist

Surely not! Next you will be suggesting they fabricate MURs for £28 pure profit!

G K, Superintendent Pharmacist

Not bad proposals. Finally PSNC talking some sense

Margaret Hook, Superintendent Pharmacist

I agree with some of the proposals -

1. We are discussing with patients if they seem to be requesting items too early but it is so easy to say keep the item this time because it has already been dispensed and don't reorder next time...However if the dispensing computer systems are able to make automatic claims and mark as ND & allow an additional endorsement with a reason code that could include - stopped by hospital/precriber or not needed the record is then on our PMR & sent via EPS.

2. Therapeutic suggestions - are currently usually suggested only during MUR's but if this was separate it would increase the number available for more complex drug regimen reviews

4. Care homes - this used to happen when Pharmacists were paid to Visit the homes and assess their medication/ dressing storage and processes used to record reviews back in the early 1990's - this additional service was locally negotiated and not included in the national contract

5. Waste audits would reveal reasons - Avon LPC completed a short waste audit last year & just after the finish date I had a home delivery of cold chain meds not delivered correctly so patient told to return the item worth over £3500.00 we MUST record on Pharmoutcomes ( need not be the pharmacist if the correct SOP written.

I am NOT so sure about brand to generic (3) as some medication should NEVER be prescribed as a generic due to differences between delivery systems and absorbtion profile and Risks of prescribing/dispensing errors eg. Clenil v Qvar NOT interchangable as Qvar dose per micrograms is double the potency cf Clenil but both have the same ingredient and Slow release Diltiazem NPSA recommends only BRAND prescribing of long acting preparations because of past dispensing and prescribing errors Also there is sometimes a choice of brand because it appears cheaper on GP computer systems.

 

Marc Krishek, Pharmaceutical Adviser

Does this response by PSNC address the concerns raised by DoH/NHS letter?

Mark Galloway, Pharmacy

Is it me or is this looking a bit desperate?

M Elnemy, Non healthcare professional

Mark...this is all a numbers game...the goverment are fully aware that there is a surplus of pharmacists/pharmacies around the country....those contractors that are willing to sell will find that there is no shortage of buyers....and these new buyers will happily buy a contract even after the 6% cuts.............

I used to get weekly rxs for some of my patients and now the dr has stopped them as a local pharmacy will do them on a 28 or 56 day supply...

I can either accept this or just loose the patient.....thi is business....its a dog eat dog world......

Life goes on............

 

Bal Singh, Locum pharmacist

Yet.... The wastage is more with 56 day prescriptions.

M Elnemy, Non healthcare professional

Are you sure you are a pharmacist ?

56 day script has no wastage just like a 28 day script as it's put into a dossete box 

Meera Sharma, Community pharmacist

Really?! And full dossette boxes that are thrown away at month end as pt didn't need them is just imagination. You really need to go out of your pharmacy a bit more.

Mark Galloway, Pharmacy

I tend to agree but I was looking for something a bit more groundbreaking than what has been suggested frankly!

S Morein, Pharmacy Area manager/ Operations Manager

All of those additional schemes would be done with same honesty and accuracy as the current MUR's.

M Elnemy, Non healthcare professional

check yourself before you wreck yourself........ 

S morein for prime minister......

Matt G, Community pharmacist

Why do you keep using full stops?

N O, Pharmaceutical Adviser

Bending over back. Most of these are done already by many pharmacies. And whatever additional steps they are suggesting will simply result in more work, less remunerations and loads of paper work. In my opinion the DoH would still implent these suggestions, yet going ahead with their plans of 6% cuts. We need more blatant refusals of these crazy cuts not suggestions that we will take more workload for less pay.

Yuna Mason, Sales

The PSNC proposal is about keeping the money the same for contractors, but will give people on the ground more to do. Same approach for years which won't increase quality. The contract needs a fundamental review - I hope it is pushing for that and that these proposals are merely a stay of execution.

Harry Tolly, Pharmacist

Same old PSNC. Same old nonsense. Back of an envelope whilst downing a pint or two. Eh !!

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Note that this is an uncosted "counter proposal" and ZERO analysis on how it impacts on workload.

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The Luddite PSNC needs to be disbanded and a new entity that represents PHARMACY rather than contractors should negotiate the new contract in the public and professional interest.

M Elnemy, Non healthcare professional

No doubt............

If you dont like the funding, sell up...just had a call from a buyer a few minutes ago......give me your number I will pass it on....

Dave Downham, Manager

Welcome back Sami!!! Been on your yacht for a couple of weeks?

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