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'Here are the anomalies in pharmacy payments the DH must address'

"We incur almost daily additional expenses without any recompense from the government"

Avicenna CEO Salim Jetha highlights examples of the sector being left to pick up the tab for the DH – and says it's time pharmacies are fairly recompensed

This time of year allows me some time to reflect. While considering the ongoing cuts to pharmacy funding in England, and how it will affect me in my pharmacy, I reviewed the almost daily additional expenses we continue to incur – without any recompense from the government.

There are so many anomalies that exist in our current day-to-day practice that I would like to see addressed.

Dispensing “anomalies”

Take the example of a non-regular stock item, which has been specifically ordered for a prescription. This could be a controlled drug, a fridge line or a special order. Suppose that the drug is changed or that the patient is hospitalised – or worse, dies before collection.

This is where the complication starts. Destroying unwanted medicines is part of our service contract. But do we have the right to refuse returned prescriptions that have been dispensed by internet pharmacies? Why should we be their garbage collectors? 

Wholesalers will not accept returns, and pharmacy owners cannot claim for uncollected items, so that means we need to find space in the pharmacy to store or destroy these lines. Is there any other business which would accept such terms? I am certainly not aware of any.

Fairer payment for pharmacies

In my opinion, prescriptions represent an order, and sourcing and dispensing those prescribed medicines equates to fulfillment of that order – which then requires payment. Any uncollected items should then technically belong to the NHS, not to a pharmacy which has no use for them.

Moreover, all the dispensed prescriptions awaiting collection in my pharmacy are incurring overdraft charges. Price concessions can make matters even worse if the reimbursement prices drop the following month. I would suggest that a fairer system would be to pay pharmacies when they dispense medicines, rather than when they are collected.

Losing scenarios

Another example occurs because we can’t claim for undispensed medicines from split packs. If the pack size is 10, but a prescription calls for one tablet, we stand to lose the cost of the remaining nine. Imagine asking a supermarket to sell you one tea bag for the pro-rata price. You could take a Department of Health and Social Care (DH) official with you, to argue your case, but I doubt it would help.

Prescription switching is another area where contractors suffer losses that are outside of their control. When patients, or institutions such as care homes, either tick the wrong box or fail to sign the FP10 prescription, we incur an automatic charge of £8.80 – per item – and often there is no course of redress, as in my experience clinical commissioning groups are unwilling to help.

If you submitted an unsigned cheque or contract, they would not be processed. Instead, they would simply be returned, with a request for signature, before any further processing took place. If the rules of fair play apply, why can’t the same practice be applied to community pharmacy?

The electronic prescription service has cut the workload of both GPs and the pricing authorities, but it has increased costs for pharmacies, including for consumables, hardware, and processing time, without any compensation. But there’s been an unintentional benefit to the DH, which has been that the complexities of the system have meant some contractors have failed to correctly claim their payments.

“Detrimental in the long term”

Short-term savings can be detrimental to the health system in the long term. Outsourcing to Capita is just one example which has been well documented.

I hope this blog stirs up a debate – and draws out more examples which the Pharmaceutical Services Negotiating Committee can take up with the DH. In the interest of transparency, the DH should explain to the sector why community pharmacies are being penalised in this manner.

Salim Jetha is chief executive of independent pharmacy group Avicenna, and owns a pharmacy in Lewisham, south-east London


Paul Dishman, Pharmaceutical Adviser

I'm out of the game now, but at the end of the month I'd always send off all the exempt prescriptions for expensive items that hadn't been collected as I wouldn't tolerate the possibility of the business losing money. 

Have to be careful when doing that, especially if working for a chain who won't back you up if you are found out to have claimed for items that haven't been collected (i.e. fraud). A branch manager I knew was left hung out to dry when the pharmacy was found to have claimed for an expensive special obtain, which was flagged up by the CCGs expensive specials report who had been closely monitoring these items. Turns out the patient had passed away before the item had been electronically claimed. 

Paul Dishman, Pharmaceutical Adviser

I wouldn't have bothered if I'd been working for a multiple, but I owned the business. If I'd been left with an expensive special I'd have claimed for it and had the argument with the CCG afterwards. I had more than one disagreement with the PCT over the years


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