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More inWhite Papers  

pills1577x362December 17 2014

The Association of Pharmaceutical Specials Manufacturers has issued a discussion document outlining the contribution specials and unlicensed medicines make to the NHS.

Using a series of typical patient scenarios, it sets out the economic value of specials medicines and the benefits to patients and the NHS. It “identifies the potential cost to the NHS of attempting to meet patient need with a lower cost, or higher risk alternative. In all of these cases this additional cost has exceeded that of providing a special and sourcing it according to established guidance.

It also includes the General Medical Council best practice advice on the role of the prescriber, and the Royal Pharmaceutical Society’s advice for pharmacists on assessing the need for using a special.

The White Paper is called ‘How Specials can deliver value to the NHS without compromising patient safety – striking the balance between cost and quality.’ It was commissioned in the light of growing concern about cost pressures leading to higher risk practice in the supply chain.

Another factor is QIPP, the Quality, Innovation, Productivity and Prevention programme. This was introduced via primary care trusts and has continued under clinical commissioning groups to help reduce expenditure across a range of medicines. Unlicensed medicines have often been included in the local QIPP plans.

The APSM points out: “Specials account for approximately 1% of prescription costs and in recent years, as part of overall pressure on NHS budgets, the cost of specials has come under scrutiny. Costs are regulated by Tariff and in the last 3 years the overall cost of specials has reduced by almost 30%.” The total spend on specials in 2013 was £99.7 million.

“Specials must be produced to pharmaceutical standards, but there are concerns that increased pressure to reduce cost could be compromising quality through sourcing lower cost supply, or even reluctance to prescribe a special when required.”

The APSM quotes research it conducted into GP prescribing attitudes: “In a recent survey amongst GPs, 54% said they had been asked by their CCG to reduce prescribing of specials. In the same survey, 45% of GPs stated that they were happy to prescribe a licensed medicine with instructions to the patient to split or crush capsules or tablets – compared with just 29% in 2012.

“The risks of tablet crushing are well documented and, the APSM believes, is just one example of how continued pressure to reduce cost could be forcing prescribers and dispensers to opt for higher risk options for meeting patient need.”

APSM Chair, Sharon Griffiths, commented: “There is regulation and guidance to prevent unnecessary prescribing of a special and as an industry we have a duty to support this. However, when a special is indicated, we’re concerned that there is too much pressure on cost and not enough emphasis on patient safety.

“Cost is an inevitable fact of life and although it’s difficult to quantify the benefit to every patient of every individual special that is provided, as an industry, we felt we needed to find a way to demonstrate the value of specials and define what a high quality supply chain means to the NHS and to the patient. We believe this White Paper provides a very clear justification of that value.’

The APSM notes that the British Medical Association has commented recently on the doctor’s role in optimising the limited resources of the NHS. “While staff and management should work closely to maximize the use of the NHS's very limited resources, a doctor's primary duty is to their patient, and it is vitally important that decisions around patient care are around clinical value.”

Links:

APSM

APSM White Paper

APSM blog announcement

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