By P3pharmacy editor Arthur Walsh
It was baffling to some that when the prescribing add-on for Pharmacy First was announced back in May, it didn’t come with any uplift to the consultation fee.
Whenever the independent prescribing service lands (we’ve heard for some time it will be in October, but time is running out), pharmacies taking part will earn £17 per consultation, the same as for Pharmacy First PGD consultations.
Really? All that extra professional and legal risk, all the additional staff, training and IT costs – none of it warranted so much as a pound’s worth of uplift? There is the monthly £525 payment for participating pharmacies, of course, but how far will that go?
At least now we know the reason. At the Pharmacy Show, Anne Joshua, deputy director of pharmacy commissioning at NHS England told us it was a “very deliberate” decision made on the grounds that a higher service fee might incentivise pharmacists to write prescriptions.
“Making the payments not dependent on the prescription being issued… was a very key principle,” she said.
The question of whether independent prescribing could be abused is a valid one; in the online sector in particular, we’ve seen reports of target-mad providers take a fast and loose approach to private prescribing, sometimes with tragic results.
However, I’m not convinced this decision on consultation fees counts as evidence of having properly grappled with the issue as it relates to community pharmacies.
As with the PGDs, the prescribing pathways will set out clear patient exclusion criteria. Does NHSE expect pharmacies to behave less responsibly when prescribing a migraine treatment than they have when issuing a sore throat medicine via a PGD?
Pharmacy First may have changed public expectations around the availability of treatments like antibiotics – but pharmacists are turning away those patients who request drugs inappropriately, not handing them out like sweets.
Many are treating the IP service with scepticism, including one contractor body who recently told us why it is recommending that its members not engage with it until a “more realistic” proposal is on the table.
Some believe NHSE’s argument is simply window dressing for austerity. “They didn’t want to incentivise sustainability,” said one bemused pharmacy owner.
I wonder whether there’s a degree of truth in that.
