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pharmacists have a good understandingJuly 1 2015

Pharmacists are increasingly appreciating the need to balance quality of specials medicines with costs, the Association of Pharmaceutical Specials Manufacturers has said.

According to its latest annual survey, for the first time since 2012, fewer pharmacists are referring to clinical commissioning groups as a first source of advice about dispensing specials: 34% reported doing so in 2015 compared to 52.5% in 2013. Pharmacists are instead turning to the guidelines issued by the Royal Pharmaceutical Society (47.5%) or discussing the matter with the GP (47%).

However, there is still evidence of pressure to reduce the amount spent on specials with almost two-thirds of pharmacists stating that they are monitoring the amount spent on specials, or that they are being asked by their CCGs to reduce or monitor specials dispensing.

ASPM commissioned the survey of 200 pharmacists and 200 GPs carried out in May. It found that “pharmacists have a good understanding of specials (over 75% feel they have enough information or experience compared with 57% in 2013) and have a positive view of the role of specials, with 80% agreeing that they are essential to meet the special clinical needs of some patients.

“There is also encouraging evidence that the practice of splitting or crushing tablets – perhaps as an option to reduce cost – is losing support. 41.5% are comfortable to dispense tablets with instructions to split or crush, compared with 52.7% in 2013.”

Data from the GP side of the survey showed the number who were comfortable to prescribe a licensed medicine in this way has decreased slightly from 64.2% in 2013 to 53.5% in 2015 “although many would argue that is still too high for such a potentially risky practice which effectively renders the drug unlicensed,” says the APSM.

“Although there is still concern that specials may sometimes be prescribed unnecessarily, this is reducing –to 35% of pharmacists respondents strongly agreeing (compared with 54.6% in 2013). We can see this reflected in the fact that 43% of respondents said that they had declined to dispense a special in the past on the grounds of necessity or cost.”

The APSM sees this as a potentially good sign with pharmacists following guidelines and if necessary questioning the need or formulation with the GP first. It says GPs are generally much less knowledgeable about specials (54% feel they don’t have enough knowledge or experience) and the mechanisms are in place between dispenser and specials manufacturer to avoid unnecessary prescribing.

However, the APSM is aware of anecdotal reports about patients being refused a special on the grounds of cost rather than necessity. “This is a matter of concern and our GP research shows that GPs are certainly less confident and comfortable about specials than pharmacists. GPs are in the frontline and facing difficult decisions about balancing cost and quality.”

Last December, the APSM issued a discussion document, ‘How specials can deliver value to the NHS without compromising patient safety’. It pointed out that 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 three years the overall cost of specials has reduced by almost 30%.”

Links:

APSM    

APSM White Paper    

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