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Prescription-niMarch 11 2015

A review of prescribing and dispensing in Northern Ireland has been critical of community pharmacists over the failure to reach agreement on a new pharmacy contract. It has also said that the system for reimbursing pharmacists for dispensing medicines is vulnerable to fraud.

The Report on Primary Care Prescribing has been issued by the Northern Ireland Assembly’s Public Accounts Committee. It says it is “unacceptable that the Department and community pharmacists have failed to reach agreement on the terms of a revised reimbursement contract.”

Calling for the matter to be “resolved as a matter of urgency”, it says that “had the Department been successful in agreeing implementation of the new contract (which is in place elsewhere in the UK) in 2006, £46 million would have been released to provide additional, patient-focused pharmaceutical services in the community.”

The report appears to blame community pharmacists in Northern Ireland for having refused to provide information to allow the Department of Health, Social Services and Public Safety to set the terms of a revised reimbursement contract, along the lines of the ones introduced in England and Wales in 2006. This introduced Category M into the Drug Tariff for England and Wales.

“Despite failing to reach agreement with community pharmacists in Northern Ireland, the Department nevertheless effectively introduced the revised contractual arrangements in NI by using the Scottish Drug Tariff (agreed as part of the revised reimbursed contract with pharmacists in Scotland),” says the report.

However in 2010, a judicial review overturned this initiative with the Judicial Review process costing the Department £550,000. “As a result of the Department's failure to agree the new pharmaceutical contract, £46 million (which could have been released to provide additional, patient-focused pharmaceutical services in the community – similar to other parts of the UK) had to be repaid to pharmacists.”

In a recommendation in the report, the PAC says the Department’s decision not to use its reserved powers to obtain information from contractors was flawed. It notes that the Department is currently undertaking a Cost of Service Investigation and is now producing annual Margins Surveys.

However, the PAC considers that “the continued failure to agree a way forward is unacceptable.” It says that a suitable solution should be reached between the parties “as a matter of urgency.”

With regards the potential for fraud, the report says that prescribing decisions rest solely with GPs. “However, the controls currently in place may not be sufficient to ensure due regularity and propriety: for instance, in cases where a pharmacist, against the GP’s instructions, dispenses a generic rather than a branded drug. Such potentially fraudulent behaviour not only results in additional costs but may pose patient safety risks.

“It is not sufficient for the Department and HSC Board to rely on the public to identify such potentially fraudulent behaviour among pharmacists.” As such, it is asking for the Department to outline what controls it has put in place to identify instances where a pharmacist dispenses a generic drug when the GP’s prescription is for a branded drug.

The report is also critical of GPs prescribing practices, saying that they cost Northern Ireland £73 million extra compared to other parts of the UK, through not prescribing generics to the same degree as elsewhere. In addition, GPs’ prescribing of pregabalin was considered high. If it were reduced to levels elsewhere across the UK it would have saved £8.5 million in 2012 and £9.7 million in 2013, says the PAC.

Links:

Northern Island Assembly Public Accounts Committee announcement    

NIA PAC ‘Report on Primary Care Prescribing’ Executive Summary and recommendations    

Full report    

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