PSNC update Hampshire and IoW LPC Dorset LPC 14 September 2016 Mike Dent Director of Pharmacy Funding Gordon Hockey Director of Operations and Support
Overview • The 17th December letter – Context – Funding issues – Regulatory issues – The campaign • Community Pharmacy Forward View • PwC report on the value of community pharmacy
A reminder of the current environmental context • The NHS has a massive financial crisis – hospital trusts overspent last year – GP recruitment and retention crisis – challenge of providing 7 day services – wage pressures and workforce unrest (e.g. junior doctors) • Demands on the service and resource are seen as unmanageable • Still needs to save £22bn per annum by 2020
17th December 2015 letter • Open letter to PSNC • Announces funding for community pharmacy in 2016/17 will be cut by £170m (from £2.8bn to no higher than £2.63bn) • A reduction of more than 6% in cash terms • Was planned to take effect from October 2016; David Mowat announced this will not be implemented in October
17th December 2015 letter - premise • Government believes efficiencies can be made within community pharmacy without comprising the quality of services or public access – more pharmacies than are necessary to maintain good access – 40% of pharmacies are in a cluster where there are three or more pharmacies within 10 mins walk – large-scale automated dispensing provide opportunities for efficiencies
17th December 2015 letter – key elements • Funding cuts • Pharmacy Access Scheme (PhAS) • Modern services • Hub and spoke • Pharmacy at the heart of the NHS • Pharmacy Integration Fund (PhIF)
PSNC’s proposed service developments • PSNC’s proposals set out how the CPCF could develop in order to meet DH and NHS England’s stated aims • They were presented to DH and NHS England as outline proposals to prompt further discussions with PSNC • Set out in three phases – focussed on a care plan service
PSNC’s counterproposals • Focus was on creating cash releasing cost savings for the NHS – Short term focus; service development proposals still valid – Not dispensed scheme, therapeutic and generic substitution, care homes, unwanted medicines campaign • But also included proposals on service development – Emergency supply service • And a proposal for a Quality Payment/Framework
Quality payment • Having a consultation room that meets MUR/NMS requirements; • Provision of Advanced Services (MUR, NMS and flu vaccination); • Maintenance of an up to date NHS Choices profile and NHS 111 Directory of Services listing; • Having a programme for the provision of public health interventions to meet local population needs • Training staff as health champions; • Making interventions on prescriptions as part of the therapeutic substitution and not-dispensed services (described above); • Participation in available locally commissioned services; • Access to the Summary Care Record; and • Participation in an annual medicines waste campaign and audit
Where have we got to in discussions? • DH and NHS England are interested in – Emergency supply (low fat version) – Quality payments • Clinical services review (chair - Richard Murray) – Independent community pharmacy services review to advise the CPhO – Threat to current services? • Pharmacy First/MAS – No interest nationally – needs a local push…
Where have we got to in discussions? • Post-Brexit - new PM, Cabinet and DH ministerial team • David Mowat – announcement of non-implementation in October (5th Sept) • But that means keeping going with the Campaign is even more important • Further discussions with DH and NHS England underway
Funding issues • December letter – Funding cut of £170m for 2016/17 – Establishment Payment to be phased out – Single Activity Fee to be introduced – Some reimbursement mechanisms to be changed • Other – Margins and Category M
Funding cut • ‘Community pharmacy also has to play its part in delivering the efficiencies required by the Government’s recently published Spending Review’ • Letter indicated a cut of £170m for 2016/17 • This was to be taken in the second half of the year – a 12% reduction on the first half income • PSNC’s response: Service developments, Counter proposals to save NHS wasting money
Establishment Payment • ‘ Funding arrangements promote and reward an efficient community pharmacy sector rather than sustain pharmacies dispensing small volumes of prescriptions ’ • ‘This incentivises pharmacy business to open more NHS funded pharmacies, adding costs to the taxpayer’ • Proposal: Reduce Establishment Payment over several years • PSNC’s response: Logic is ridiculous. Introduce fixed payment for quality
Single Activity Fee • Proposal: – Pay a Single Activity Fee, which will be a flat fee per item dispensed – Abolish repeat dispensing fees, EPS payments, establishment payments and practice payments – Retain the additional fees linked to particular types of prescriptions (for example unlicensed medicines, controlled drugs and expensive items) • PSNC’s response: Totally wrong incentives; will only serve to increase focus on volume
Reimbursement • Seeking to complete the work introduced as part of 2014/15 settlement – ‘changes to the Drug Tariff to equalise access to margin’ – Discount deduction scale – Category A reimbursement – Concession price setting – Non Part VIII reimbursement – Specials reimbursement • PSNC’s response: Making progress as appropriate
Margins • Margins are measured using a survey of independents’ actual purchase prices • Inevitably lagged - 2015/16 survey is nearly complete • 2015/16 will see a significant over-delivery • DH reduced DT from June by £12m pcm to start to recover
Impact • Expected H2 2016/17 impact was huge if cuts had been implemented given margins reductions • There was an expected bounce back in 2017/18 as margin recovery unwinds and the half year effect softened BUT: • Minister has announced a ‘pause and reflect’
Impact Alistair Burt (@AlistairBurtMP) 05/09/2016, 17:39 V pleased to see this. Apologies for uncertainty of which I was part. But now a great opportunity for pharmacy.
Impact • PSNC will produce illustrative income tables and a cash flow model to help contractors understand and plan, when we know what’s happening • Meantime we have been busy…
What else is going on? • PSNC has agreed to undertake a significant piece of work examining the needs of the NHS and how they would want pharmacy to work with them • CPFV published and work on developing the care plan service concept is ongoing • Challenging Falsified Medicines Directive post-Brexit • PwC work
Community Pharmacy Forward View • Workshop of pharmacists, LPCs and other stakeholders to scope out the vision • Worked with Pharmacy Voice to develop a shared narrative on the future community pharmacy service • Endorsed by RPS English Pharmacy Board • Submitted to DH and NHS England as part of our final consultation response • Published 30th August 2016 • psnc.org.uk/forwardview #futureofpharmacy
PwC report • Assesses the value of community pharmacy • Published 7th September 2016 • psnc.org.uk/valueofpharmacy #valueofpharmacy
We have assessed the net value of 12 community pharmacy services – but some important aspects are out of scope Healthcare system (e.g. GPs Pharmaceutical and A&E) manufacture and Community pharmacy Patient/service users distribution Wider society Healthcare system Scope of community pharmacy services NHS efficiency benefits Public health services Other avoided NHS costs Support for self-care Wasted drugs Medicines support services (e.g. enhancing access Compensation payments to medicine and delivering patient management services) Economic and fiscal Other public sector bodies Standard dispensing of medicines activities & all value of supply Avoided costs other essential services chain – indirect and Advanced services (other than MUR and NMS) induced impacts Other locally commissioned services Patient / carer All other type of services that pharmacies provide Wellbeing at their own discretion as part of their business Time savings model Wider society Key: Value of life Avoided lost economic output Included Supporting the viability of local Economic and fiscal value communities Developing specialist pharmacist skills Excluded PwC
Recommend
More recommend
