Colleagues who remember the halcyon days of the pre-2005 contract can be forgiven for feeling as though we have been transported to another galaxy, pining for the days when oxygen supply and regulator flow rates were as complicated as it got.
Don’t misunderstand my position. I am thrilled that in the last 15 years innovative services have been introduced at both a national and local level. After initial teething problems, MURs and NMS have demonstrated their value and gained genuine recognition from commissioners and fellow healthcare professionals. Locally, services continue to innovate, and the wide uptake of systems like PharmOutcomes and Sonar Informatics have made a significant difference, not only to the way we provide services, but to how we evidence their value to commissioners.
However, every innovation brings added complexity. Some is a necessary consequence of our desire to improve quality of service, or is the result of contract negotiations driving the new services we all desperately want. Additional paperwork is a bearable burden if it creates a new income stream and improves patient care. Equally, if audits, patient satisfaction surveys and root cause analysis give you a genuinely fresh insight into how you can improve your practice, the pay-off is worthwhile.
Less desirable is complexity unnecessarily forced upon us by external bodies, with no benefit to the service, to patients, or our sanity. Most of this seems to be the result of the changes in the supply chain. As a Saturday kid in a family run independent pharmacy, it always puzzled me that I had to fill in a different returns claim for Ventolin compared to Atrovent, even though they both went back to the same wholesaler. If only I’d known then what I know now!
There are frequent reports in the trade press and other media about the increased time spent sourcing medicines and the consequential cost pharmacy owners have to absorb just to stand still. It therefore came as a pleasant surprise to see a story this month about a simple, effective change that SystmOne has implemented that will make life easier.
In December, Ben Goldacre’s team at the University of Oxford’s Evidence Based Medicines DataLab published an analysis of generics priced above the Drug Tariff price and the consequent additional cost to the NHS. The cause is SystmOne’s set up, whereby the manufacturer’s name is included after the generic name and ‘ghost branded generics’ are ranked above the true generic as the prescriber tries to pick the product.
Let’s pretend for a moment that you decide to supply, for example, the TEVA specified generic. Would the patient believe you when you try to explain that the Almus pack you have in stock is actually made by TEVA? If you succeed, well done, but I suspect you’re the exception that proves the rule. If we ignore the requirement under the Medicines Act to supply exactly what the prescriber has specified, reimbursement is based on the manufacturer’s list price, not the Tariff price.
EBM DataLabs’ report gained traction because it highlighted an £11.6m additional cost for these ghost brands, and prompted TPP, developers of SystmOne, to announce last month they had issued a fix to ensure the true Cat M generic will always be presented as the top pick. It’s not just CCGs that have lost out to this issue. The mystery of how margin is scattered like pixie dust over Category M prices means it’s as likely an individual contractor is losing money against these ghost generics than gaining from them. And all that’s before you factor in the additional time spent sourcing brands you don’t normally stock and you lose discount on.
In itself this isn’t a big money or time saver, but it is small step in offsetting some of the additional workload faced by contractors. Combine that small step with other tools like Check34, CheckRx and Pro Delivery Manager and the benefits start to be recognisable. Not only can a contractor start to simplify workload, but they can gain valuable insight into their business.
We need more tools like this that use data to show us how to make things simpler and more cost effective. If we get them, we might just start to reduce the unnecessary complexity that gets in the way of providing quality care to our patients.