Dispensing practices in difficulty

Brexit, falling profits, FMD and technological barriers all challenges for Scottish dispensing practices

Monday 25th February 2019

A lack of IT provision and falling profits were among the challenges discussed at the latest meeting of the government’s pharmacy dispensing group (PDG).

Chaired by senior adviser to the Scottish Government, Fiona Duff, the group examined issues related to unused stock, the falsified medicines directive, Brexit and drug reimbursement rates.

Funding

The minutes of the meeting identify a series of difficulties for these practices, stating:

Dispensing practices often seemed to fall between the gap of general practice regulations and community pharmacy and in the past have not benefited from initiatives which have supported community pharmacy eg. staff training costs, the non-steroidal anti-inflammatory drugs (NSAID) project, and development of standard operating procedures.’

Turning its attention to funding currently available, the PDG concluded that funding available this financial year should be progressed ‘as a matter of urgency’.

Particular causes of financial pressure discussed included unused stock and drug reimbursement rates.

Without wholesaler dealer licences, practices are unable to sell on unused stock, and the costs of some particular drugs now outweighs drug reimbursements received by dispensing practices, all adding to cost pressures.

Attendees suggested many dispensing practices were concerned ‘they had not received increased funding under the new Scottish Workload Formula, due to the removal of the rural weighting’.

The majority of dispensing practices in Scotland are small and located in remote and rural areas. All of them are in receipt of the income guarantee under the 2018 GP contract, which was introduced partly to address the costs of dispensing.

As many dispensing practices subsidise their general medical services income with funding accrued from dispensing, such practices are at risk of financial instability if their dispensing income was to be withdrawn.

Management of differing VAT returns for different drugs was identified as another issue that ‘would be exacerbated if the duty to dispense were removed (and possibly then given back) from practices should community pharmacies be established in their areas’.

Issues in the running of 2C dispensing practices, which are board-controlled practices, were also highlighted, ‘which have an impact on the financial viability of the practice’.

Technological barriers

Additional IT provision is frequently required for a dispensing practice, but provision is often lacking, it was stated. 

The impact of this on the rollout of the pharmacotherapy service was touched upon alongside barriers to remote prescribing and other innovations, including remote medication reviews.

It was suggested that dispensing practices would benefit from ‘more reliable Scottish guidance and professional standards’, rather than relying on Dispensing Doctors Association guidance which can only be accessed by members. 

Falsified medicines & Brexit

The introduction of the falsified medicines directive is highlighted as ‘causing significant concerns amongst dispensing GPs at the moment’ as it may lead to ‘additional equipment and training costs for both dispensing practices and community pharmacy’.

The 2011 directive is a response from the EU to the ‘serious threat to public health’ that falsified medicines pose. The final part of the directive was implemented this month and introduces several requirements, including that anti-tampering devices are fixed to prescription medicines.

Concerns relating to how Brexit may affect medicines supplies were also touched upon.

Staff & training

A need to develop a long-term, more comprehensive and bespoke training offer was identified by the group, alongside a need to survey dispensing staff, on their training needs.

Specialist training of dispensing staff is currently funded by the practices themselves and while consideration of continued funding of Buttercups courses was agreed ‘in the short-term’, the group concluded ‘ideally in the long term a more bespoke Scottish dispensing staff course should be explored with NHS Education for Scotland (NES)’.

The Buttercups NVQ (QCF) centre for pharmacy services level 2 and level 3 qualifications are available for pharmacists, pharmacy technicians, dispensing assistants, dispensing doctors’ practices and others.

Next Steps

Looking ahead, the group will continue to meet on a three-monthly basis and will invite additional representatives from organisations such as NHS Education for Scotland to future meetings. The views of the Rural GP Association of Scotland on training needs and other areas of support that would benefit them are also to be sought.

In particular, the group intends to invite the chief executive of the Dispensing Doctors Association to share thoughts and will consider publishing an end of year report on its work.

It will also feed information into the ongoing phase two contract negotiations between the Scottish Government and the BMA’s Scottish GP Committee.

It was agreed the group would consider case studies of how the new pharmacotherapy service required under the new GP contract is working in dispensing practices.

 

Also published in Pharmacy In Practice. For daily updates, visit www.pharmacyinpractice.scot