The new community pharmacy think-tank
Topic: Devolution of the global sum to PCTs
With PCTs now controlling pharmacy funding, what will this mean to you? The C+D Senate weighs up the potential pitfalls and delivers its verdict on how they can be avoided. Zoe Smeaton reports
The Senators
Graeme Betts
Director of region, Lloydspharmacy
Alastair Buxton
Head of NHS services, PSNC
Michael Cann
Chairman, British Generic Manufacturers Association and commercial director, Actavis
Max Gosney
News editor, C+D
Martyn Lobley
GP, South East London
Fin McCaul
Chair, Independent Pharmacy Federation
Gary Paragpuri
Editor, C+D
Hiten Patel
Managing director, Pharma Plus
Adrian Price
Clinical commercial manager, the Co-operative Pharmacy
Dave Roberts
Co-founder, myrepeats web service
Julie Wood
National director clinical commissioning, NHS Alliance
To secure your income going forwards, you are going to have to master spotting subtle prescribing changes, develop skills to explain the pharmacy contract to PCTs and be prepared to hold the trusts to account if they fail to stick to the rules, the C+D Senate believes.
The Senators met to discuss the devolution of the pharmacy global sum to PCTs and their conclusions suggest that life isn’t going to get any easier in the future.
From April this year, PCTs took control of the global sum in England, but although they do have to pay pharmacy for contracted services, there are fears the trusts will see opportunities to make savings in the difficult financial climate.
Seeking savings
Alastair Buxton, head of NHS services at PSNC, calls this a “significant concern”, especially given that PCTs aren’t actually being given the full amount they need to cover the global sum. Payments have instead been allocated on a historical basis with the expectation that uplifts needed will be made out of efficiencies in procurement.
One possibility for PCTs could be to increase prescription lengths, say to 56 days, which would reduce all volume-related fees paid to the sector. Fin McCaul, chair of the Independent Pharmacy Federation, says that this is already happening in some areas and warns it could be “very damaging to the structure of pharmacy and to the local viability of pharmacy”. And Hiten Patel, managing director of Pharma Plus, points out that increasing prescribing times actually leads to more medicines being wasted, and so to more costs in the long run, too.
Mr Buxton offers reassurance that PCTs have been warned against the practice and that protective measures are in place – contractors seeing a reduction in income as a result of increased prescription lengths can claim money back from trusts, for example. Or if their wholesaler bills rise to cover the cost of the extra medicines dispensed, they can ask the PCT for an advance payment.
But Mr McCaul says while this is good news, it can actually be difficult for businesses to see it is happening. He explains: “Locally, GPs have changed the period of prescribing from 28 to 56 days, but it’s not happened overnight, it has been a gradual process. People have realised there has been a problem but it has been virtually impossible to work out what the problem is. This is a real challenge.”
Another fear shared by the Senators is that PCTs could look to save money by encouraging the prescribing of certain branded medicines or branded generics where their prices are lower than those on the Drug Tariff. This leads to short-term savings for the PCT, but costs the NHS money eventually and means contractors in the area miss out on income.
Michael Cann, chairman of the British Generic Manufacturers Association and commercial director at Actavis, says he thinks this is a “real danger”. In some PCTs the practice is already taking place, with some trusts installing computer systems in GP surgeries to prompt them to make the prescribing changes. These are unpopular even with doctors, as Senator Martyn Lobley, a GP, puts it: “It’s designed as a cost-saving thing so it offers me things that will work out cheaper, but it doesn’t know that some patients can’t take certain medicines, so is little more than an annoyance.”
Taking action
With both these issues, though, the Senators agree the key is spotting problems early on and taking action to ensure PCTs realise their actions are not going to make long-term savings. Mr Buxton says LPCs have received training and guidance on what to look for and how to educate PCTs on the subject. He stresses: “Contractors really need to keep an eye on this and LPCs must do the same. We’ll be looking at some of the national prescribing data to try to look for changes but we need people to do it locally, too.”
Julie Wood, national director, clinical commissioning at NHS Alliance, says the sector needs to be looking to PCTs’ finance directors to find out whether they are planning to use any of these tactics.
She adds that pharmacy will also need to work to ensure that senior people in the trusts understand the pharmacy contract, cautioning that in general the people in trusts who do understand it are working at a fairly junior level. “Higher up in the organisations they haven’t got the understanding or awareness so you’ve really got to be able to articulate that case and sell it,” she says.
As well as explaining the consequences of PCTs manipulating prescription lengths or prescribing, Mr Buxton suggests if things go wrong, pharmacists might need to seek support and start lobbying locally. MPs could be involved, he suggests, as well as asking national pharmacy bodies to step in. Whatever happens, though, he is clear that contractors will have to be sharp on this and, perhaps most importantly of all, will have to be working collaboratively on it.
If this happens the risks of the devolution of the global sum should be minimised. And Mr Buxton concludes with a further ray of hope – a promise that PSNC is doing “lots of work” looking at future payment mechanisms and new financial models that could remove some of these risks for the sector.
“As an industry we need to show that we can help control medicines waste and that PCTs can save from that. We absolutely need to drive that forward and link it in with the message that increasing prescribing lengths can cause more waste”. Graeme Betts, director of region lloydspharmacy
“When I was in my PCT we had quite a debate about medicines issues including software to support generic switches. The short-term lure of those savings when you’re under absolute pressure – and do not be under any illusions about the amount of pressure PCTs would be under – leads you to think about whether these sorts of measures should be implemented.” Julie Wood, national director, clinical commissioning, NHS Alliance
“Altering prescription lengths is a real problem potentially. The reality is that PCTs are under huge pressure and they’ve got to save across the board. This is a really easy win for them.” Fin McCaul, chair, independent pharmacy federation
The Senate ruling
1. There is a real risk PCTs will try to make savings from pharmacy now the global sum has been devolved.
2. Contractors and LPCs need to remain vigilant and spot changes.
3. The sector needs to ensure PCT finance directors and other staff understand the pharmacy contract.
4. New models of funding are needed to reduce the risks for the sector.
“I’m pretty sure PCTs are not aware of how these things work ... Some of them think they are doing the right thing but don’t understand the consequences”
Michael Cann
chairman, British Generic Manufacturers Association
“Any reduction in contractor fees will be billed back to them, so it’s taking any of the benefit out of the system”
Alastair Buxton, head of NHS services, PSNC
Tips for your CPD entry on the global sum
Reflect Am I aware of how the global
sum is now managed?
Plan Identify the potential impact on
me and my services.
Act Talk to my GPs and PCTs about the
pitfalls of extending treatment
lengths.
Evaluate Have I safeguarded my funding
and protected services?
