HDA Media And Political Bulletin – 28 October 2016

Lack of funding could jeopardise Five Year Forward View

27 October 2016, The Pharma Times, George Underwood

 

The Kings Fund have released a report that warns of the implications that funding issues could have on the future of the Five Year Forward View. The report highlights that the additional funds available to the NHS 2016/17 have been spent to sustain current services rather than for new innovations. There is evidence that the pressures facing the NHS are caused by a greater demand, due to an ageing population, for a service already under strain. The authors highlight a need for industry leaders to recognise that a transformation of the current NHS is needed to ensure sustainability in the future. Professor Derek Bell, President of the Royal College of Physicians of Edinburgh commented to say that a major part of the problem is that the NHS develop too many short-term initiatives without an adequate evaluation.

 

Stakes are too high for a wait-and-see approach

27 October 2016, The Pharmaceutical Journal

 

Following the Government’s announcement of cuts to community pharmacy funding, to be implemented from December 2016, it is apparent that there will be a new quality payment scheme from April 2017. Pharmacies will have to meet four criteria, as markers of quality, to qualify for the payment scheme. However, the new Pharmacy Integration Fund (PhIF) is being reduced from £300million to £42million by 2018. There is concern that messages coming from the Government in regards to community pharmacy funding are inconsistent.

 

Regulator to investigate drug companies that charge NHS ‘excessive prices’

27 October 2016, The Pharmaceutical Journal

 

The Competition and Markets Authority (CMA) launched an investigation into several drug companies suspected of charging the NHS excessive prices for drugs on the 25th October 2016. If a company is found to have broken the law in this way, they could face fines of up to 10% of its turnover. The CMA has confirmed that a decision will be made as to whether to proceed further in each case by February 2017.

 

Wales to maintain pharmacy funding at current levels

27 October 2016, P3 Pharmacy

 

The Welsh Assembly Government has confirmed that they intend to maintain community pharmacy funding at its current levels despite the cuts to funding occurring in England. Vaughan Gething, the Welsh Cabinet Secretary for Health, Wellbeing and Sport, issued a statement to reassure the pharmacy sector that it’s funding will remain unchanged in order to relieve GP services of excess pressure. Vaughan Gething stated that in the long term safe guarding pharmacy services will be conditional on updating the way pharmacies currently operate.

 

Fund to integrate pharmacy into NHS ‘won’t offset cuts’

27 October 2016, Chemist & Druggist, Annabelle Collins

 

Bruce Warner, NHS England’s Deputy Chief Executive Officer, has insisted that the Pharmacy Integration Fund is not intended to offset the cuts to community pharmacy funding. He said that the fund is being set up to enable pharmacy services to be integrated into the wider NHS. Keith Ridge, the NHS Chief Pharmaceutical Officer, also confirmed that the fund is designed for integration and used the example of granting pharmacists better access to IT and NHS email systems as an example of a use for the funding.

 

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Lack of funding could jeopardise Five Year Forward View

27 October 2016, The Pharma Times, George Underwood

 

The King’s Fund has warned that funding problems could derail the Five Year Forward View’s aspirations to transform NHS services.

 

In a report on the progress of the Forward View, the healthcare think tank says that almost all of the additional funds available to the NHS in 2016/17 have been used to sustain existing services, specifically to reduce deficits in NHS acute providers, rather than on new experimental endeavours.

 

“NHS leaders both nationally and locally have been preoccupied with sustainability because of the growing pressures on health and social care and evidence that NHS organisations are missing key targets for patient care,” the report says. “Much less of their time has been dedicated to transformation than might have been expected given the central importance of the Forward View.

 

The report adds: “This matters because the pressures on health and social care will not be tackled simply by additional funding, staff working harder, and patching up existing services through ‘sticking plaster’ solutions. These pressures result from a growing and ageing population placing ever greater demands on a system already under huge strain. This is evident in year-on-year increases in A&E attendances and emergency admissions to hospital, high bed occupancy rates, and rising delayed transfers of care.

 

“The rationale for new care models is precisely that they hold out the prospect of moderating rising demands for care by focusing on prevention, early intervention, admission avoidance and support for people to remain independent in their own homes. The challenge is that developing alternatives to care in hospitals and care homes requires investment, which is currently in short supply.”

 

The authors point to the transformation of mental health services, which started in the 1970s and resulted in a much-reduced role for hospitals and a much stronger focus on care in the community, as an example of where such experimentation has been done well. “Mental health services were transformed as successive governments provided funding to pump-prime investment in community services… [This] shows that major changes of the kind foreshadowed in the Forward View are possible with adequate funding for transformation and if sufficient time is allowed for them to be planned and implemented.

 

“With two out of the five years covered by the Forward View already elapsed, the lessons are clear and need to be acted on with urgency. Leaders at all levels need to redouble their efforts and recognise that transformation holds the key to dealing with the sustainability of services.”

 

Responding to the publication of the report, Professor Derek Bell, president of the Royal College of Physicians of Edinburgh, commented: “The issues highlighted by the King’s Fund clearly resonate with our members working in England. Investment in services needs to be targeted at the areas for which it was intended, otherwise we risk being unable to achieve the aims set out in the NHS Forward View. Part of the underlying problem is the development of too many short-term initiatives without adequate evaluation.

 

“With growing demands on the NHS and our ageing population, there must be a commitment to invest in and improve health and social care integration to create a sustainable NHS able to deliver the best possible patient care in the most appropriate setting.”

 

Stakes are too high for a wait-and-see approach

27 October 2016, The Pharmaceutical Journal

 

The UK government’s documents on funding cuts for community pharmacy are inconsistent and lack evidence.

 

After ten months of anxious speculation, pharmacy contractors and their staff have received the first concrete details of how the UK government plans to deliver cuts to funding payable to community pharmacies in England. When David Mowat, parliamentary under secretary of state for community health and care, addressed Parliament on 20 October 2016, he told MPs that the current payment structure for community pharmacy is outdated and overly complex and so will be consolidated into one single activity fee. Establishment payments, which pharmacies are entitled to claim if they dispense more than 2,500 items a month, will be phased out by 2018.

 

Every pharmacy will need to survive on less money or close for business. In England, funding for community pharmacy will be reduced by 4% for 2016–2017 to £2.687bn, starting from 1 December 2016. The 4% cut will be taken in its entirety over four months of the year, so contractors will experience a 12% pay cut in that period. This will be followed by a further cut of 3.4% for 2017–2018, reducing the funding to £2.592bn.

 

Up to £75m of the £2.592bn budget for 2017–2018 will be allocated to a new quality payment scheme from April 2017. Pharmacies will have to meet four criteria before they will be considered for the payment, including provision of at least one specified advanced service and ongoing use of the electronic prescription service. A focus on quality must be applauded but the scheme needs to be easy for contractors to navigate if it is to achieve its aims. And whether the quality criteria chosen by the Department of Health (DH) really will reward excellence remains to be seen.

 

The new pharmacy integration fund (PhIF), aimed at supporting the development of clinical pharmacy practice in a range of primary care settings, has been reduced from an expected £300m by 2021 to £42m over the next two years. The sector has been told that part of the PhIF will be used to fund a pilot study to assess a service to supply urgent medicines. However, messages coming from central government are inconsistent. Mowat has said on more than one occasion that a nationally commissioned minor ailment service will be rolled out in England by 2018, but the DH has denied this, saying it is more appropriate that these services are commissioned locally.

 

Also, the government continues to distance itself from a prediction made early in 2016 that up to 3,000 pharmacies could close as a result of the cuts. “Nobody is talking about thousands of pharmacies closing”, Mowat told MPs in response to an urgent question in the House of Commons on 17 October 2016.

 

Is subsidy enough?

 

A pharmacy access scheme, where those pharmacies that have been identified as being either in an area of deprivation or where community pharmacy provision is sparse, will qualify for a monthly subsidy from December 2016 to March 2018. Again, this provision should be welcomed but the jury is still out as to whether the payments — available to less than 12% of all pharmacies in England — will be enough to protect vulnerable pharmacies from closure.

 

The DH’s impact assessment document, released alongside the funding cuts document, says there is no reliable way of estimating the number of pharmacies that may close as a result of the cuts. If it is not possible to estimate the number of closures, then it is impossible to measure the potential impact on patient care, particularly for vulnerable patients within the community. The stakes are too high for this wait-and-see approach.

 

The DH contends that, were a pharmacy to close, it is likely that prescriptions that were dispensed by that pharmacy would be redistributed to nearby pharmacies, and this will improve the viability of remaining pharmacies. However, if a pharmacy that offers several clinical services but has a low dispensing volume closes, patients may lose access to a vital service. If pharmacies respond to the cuts by reducing their opening hours and making staff redundant, it will not only reduce the accessibility of community pharmacy services, but clinical quality, too. And services that contractors are not obliged to offer will be the first to go — such as home delivery of medicines and the supply of medicines in compliance aids. It is clear that the impact on patients has not been considered.

 

Lack of foresight

 

The government continues to command hardworking healthcare professionals across all sectors to “do more for less”. But it is yet again failing to convince those same healthcare professionals that its plans are carefully thought through or to demonstrate that it has a firm grasp of the consequences for patients and the public — a cavalier approach with every prospect of deeper cuts to come.

 

While pharmacy organisations try and make sense of the details released, the sector has been given lots of answers for questions that perhaps the government is not in a position to answer. But the sector must do all it can to engage with the process, prove pharmacies’ worth to the NHS and protect vital service provision and patient care.

 

Regulator to investigate drug companies that charge NHS ‘excessive prices’

27 October 2016, The Pharmaceutical Journal

 

The competition watchdog has launched an investigation into drug companies suspected of charging the NHS excessive prices. Any company found to have broken the law could face fines of up to 10% of its global turnover.

 

While the Competition and Markets Authority would not reveal how many companies were involved in the investigation into suspected unfair pricing, pharmaceutical company Concordia International has revealed that it is part of the inquiry.

 

A Concordia statement says it is “working cooperatively to better understand the CMA’s position and we will continue to work constructively to resolve the matter”.

 

“There has been speculation in the press about these issues and this affords us the opportunity to have an objective discussion about our products and their contribution to the healthcare system,” the statement adds.

 

The CMA investigation into suspected breaches of competition law was launched on 25 October 2016 and will gather initial evidence before a decision is made as to whether or not to proceed further by February 2017.

 

Health secretary Jeremy Hunt called for the CMA to investigate in June 2016 after an investigation by The Times claimed companies were ripping off the NHS by buying the rights to old drugs and dropping existing brand names[1].

 

The newspaper alleged that by “exploiting a loophole”, the companies were able to avoid a cap on profits and raise prices by thousands of per cent without competition from rivals.

 

Information about the case, set out on the CMA website, states: “The investigation is under Chapter II of the Competition Act 1998 (CA98) and Article 102 of the Treaty on the Functioning of the European Union (TFEU).

 

“The investigation relates to suspected unfair pricing by way of charging excessive prices in the supply of certain pharmaceutical products, including to the National Health Service.”

 

Wales to maintain pharmacy funding at current levels

27 October 2016, P3 Pharmacy

 

The Welsh Assembly Government intends to maintain community pharmacy funding at current levels over the next two years, despite significant cuts being made to the pharmacy budget in England. Vaughan Gething, Cabinet Secretary for Health, Wellbeing and Sport, issued a statement saying that the Welsh government is committed to continued investment over 2016/17 and 2017/18, in order to “take pressure off our GP services, reducing unnecessary appointments and making sure people are able to see the right professional in the right setting at the right time.”

 

As part of this investment, the Choose Pharmacy IT system is currently being rolled out across Welsh pharmacies to promote full integration between community pharmacy and GPs and hospitals. Gething described this as a “demonstration of our commitment to invest in realising the benefits of the community pharmacy network.”

 

In the longer term, Gething said, safeguarding investment in pharmacy would be conditional on changes being made to the way in which pharmacies operate, such as: more clinically focused services being provided; improvements in the quality of services delivered; and a reduction in medicines waste.

 

RPS Wales chair Suzanne Scott-Thomas welcomed the announcement, describing it as a “testament to excellent patient care that pharmacists are providing to patients and the public.”

She added that there is potential for pharmacists to do even more, and that RPS Wales “would like the Choose Pharmacy campaign to be developed into a national common ailments services scheme; this coupled with a National Patient Behaviour Change campaign would do a lot to relieve pressure on GP surgeries and A&E departments.”

 

Fund to integrate pharmacy into NHS ‘won’t offset cuts’

27 October 2016, Chemist & Druggist, Annabelle Collins

 

A government fund to help integrate pharmacy into wider care settings was never intended to “offset the cuts”, NHS England’s deputy chief pharmaceutical officer has insisted.

Bruce Warner said he would be “very concerned” if the ‘pharmacy integration fund’ – a £42 million fund to support pharmacy to “develop new clinical pharmacy services, working practices and digital platforms” – is seen as a tool to lessen the impact of the funding cuts scheduled for December.

 

Instead, the money is an “enabler” to help the NHS and pharmacy “do things differently”, he said.

 

“It is intended to integrate pharmacy services into the wider and broader NHS,” Mr Warner told C+D in an exclusive interview last week (October 21).

 

“It is there to make that progress to a more clinical and digital future, in terms of the platforms we are using,” he added.

 

England’s chief pharmaceutical officer Keith Ridge – who also spoke to C+D – said the fund is “designed to do what it says on the tin”.

 

Dr Ridge gave the example of granting pharmacists access to better IT and NHS email systems, as areas which the funding could be used for.

 

“Glass half full, or empty”

 

Mr Warner stressed that the integration fund “absolutely includes community pharmacists” and whether the sector uses it depends on whether you are a “glass half full or empty person”.

 

“It doesn’t mean the fund is there exclusively for community pharmacy. I wouldn’t want anyone to get the impression they are excluded from it,” he said.

 

According to the Department of Health, the integration fund will be used to deploy more pharmacists into primary care settings, such as general practices.

 

It follows NHS England’s announcement earlier this year, that an additional £112m fund had been allocated to quadruple its existing scheme to recruit pharmacists to work in GP surgeries.

 

When asked by C+D how the two funds would run alongside each other, Dr Ridge said the DH is reviewing whether the integration fund will be used for “similar” purposes to the practice pharmacist scheme.

 

“We’re in the process of planning that now,” Dr Ridge added.

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