Basing remuneration for advice on the number of items dispensed is ‘flawed’, says pharmacy negotiator

An audit by the Pharmaceutical Services Negotiating Committee has found that pharmacy staff spend more than one hour per day giving advice.

Pharmacy staff helping a patient

Remunerating pharmacy contractors for the provision of advice based on the number of items dispensed is “flawed”, the Pharmaceutical Services Negotiating Committee (PSNC) has said.

In a report on pharmacy consultations, published on 7 September 2020, the PSNC highlighted that community pharmacies provide consultations to patients with minor illnesses as part of the ‘essential services’ element of the community pharmacy contractual framework (CPCF), meaning that this care comes with “no additional remuneration”.

However, they said an audit of consultations conducted between 29 June and 10 July 2020 found “no statistical correlation between the number of consultations carried out and the number of items dispensed by the pharmacy”.

During the audit, 198,043 consultations were carried out by 9,441 community pharmacies. In 85,648 of these consultations, advice was provided without the sale of a medicine, meaning that “pharmacies were providing this clinical service with no potential for any direct associated income”.

The figure for advice-only consultations, the PSNC said, averages out at around 6.4 consultations per pharmacy per day.

The negotiator said that “items dispensed is not a proxy measure of the number of consultations carried out”, and, therefore, “using this as a method of distributing remuneration for this activity is flawed”.

The PSNC audit found that across all consultations, those carried out by pharmacists lasted 5.3 minutes on average. Consultations that began with the patient talking to non-pharmacist staff took 4 minutes on average, but in 19% those of cases the pharmacist was then consulted, taking a further 4.3 minutes of their time. Overall, around 75 minutes is spent in each pharmacy per day providing these consultations.

In a summary of the findings released alongside the main audit, the PSNC said it would be seeking discussions with the NHS and the Department of Health and Social Care over the “appropriateness of funding for pharmacies to provide what we have shown to be significant informal consultation services” — services which are, it added, reducing pressure on other local healthcare settings.

The PSNC noted that the community pharmacy contractual framework does include some funding to support patients with self-care, but said that it is “no longer sufficient to cover the considerable costs of this increasingly important part of pharmacies’ work”.

Simon Dukes, chief executive of the PSNC, told The Pharmaceutical Journal that the COVID-19 pandemic has “accelerated a change in patient behaviour to visit pharmacies first, and PSNC’s pharmacy advice audit has helped capture evidence of the impact this has had.

“The results are now being used to support the ongoing funding negotiations, including PSNC’s ask for more investment in the sector.”

The NHS Pharmacy First Scotland service, which launched on 29 July 2020, reimburses contractors for advice and referrals as well as for items dispensed.

Speaking to The Pharmaceutical Journal
shortly before the launch, Harry McQuillan, chief executive of Community Pharmacy Scotland, said that the data recorded as part of reimbursement for advice and referrals “demonstrates the amount of activity that the pharmacy network takes on, on behalf of the NHS. The network would say that they’ve always done it: for the first time, we’ll really start to quantify that”. 

  • This story was amended on 11 September 2020 to clarify that the PSNC’s statement refers only to remuneration for patient consultations, and not to remuneration for all activities.
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Citation
The Pharmaceutical Journal, September 2020;Online:DOI:10.1211/PJ.2020.20208341