Any 'windfall' for pharmacists is unfortunately removed a few months later via clawback.
They give with one hand, and take away with the other!
My comment is completely related to the service of flu vaccines, and the fact that whatever is currently being done wasn't achieving what was required and was bound to change.
As to the organisation and plan of how services are provided and will be provided.... I am not sure there is a plan to be honest!
I can understand that there may be issues with pre-orders of stock and that is unfortunate.
In fact, any of you who are aware of how the PSNC and the DOH work with our funding negotiations, this announcement is over 6 months early!
Lets be plain and leave territorial differences aside; if you look at the influenza vaccination rates over the past 3-4 years, they are flat or falling in almost every group.
This vaccine prevents illness and in reality is cost saving to the health system. The traditional model was not working and something had to be done to change it.
Also, General Practice cannot go on about being so over worked and at breaking point....and then when a chunk of work is removed moan about it. It is quite a mixed message.
Also, we have no idea what the service spec will be, as it seems it hasn't actually been written yet.
Finally, as part of the agreement of flu vaccination, we have apparently agreed to publish our NHS earnings! Is that something that GP practices have to do?
There were a number of PGD's in pharmacy providing Trimethoprim for cystitis and these were stopped on the request of the Dept of Health.
Personally, I think that it is pretty easy to put in safeguards that will allow people with recurrent/complicated UTI's to not be treated in pharmacy, however, uncomplicated UTI is a different matter.
This may free up some time for GP's to see the complicated ones more quickly and prevent further problems.
I agree with Maureen Baker in principal...however, what alternative strategies and treatments does she mean?
I am quite happy for anyone to make a choice and spend their own money as they wish, in fact I really don't care how they do it....however when it comes to spending my money, that's a totally different question.
How can we have NICE and formularies and EMB etc etc, and homeopathy co-existing?
I am sorry, anyone who tries to rationalise the theory of multiple dilutions, to me is deluded!
Anonymous | Salaried GP | 27 March 2015 1:13pm
Apologies for being petty here, I am talking about Pharmacies, not pharmacists, just as this case is related to a Practice not a Doctor. I am responsible for everything that goes on in my Pharmacy, whether I do it or not.
I am in no way questioning the right to appeal a decision, that is an important right.
What I am commenting on is how they managed to get themselves into this situation. If you had the inspectors around a few times are you saying you wouldn't have had a whip round and checked a few things? You know they are going to be interested in your emergency provisions, but then to still have OOD drugs for example?!
How any inspector thinks is human nature. That's is, if I find one thing wrong, then there is likely to be more wrong, and they start looking harder. He had two previous chances and didn't do a few pretty simple things.
I am certainly not one who gives in without thinking, on the flip side, I realise what my time is best spent on...and its not annoying my inspector and getting embroiled in tribunals and appeals.
I write on the calendar for each month one of my staff to spend 20 mins doing a few checks.
At least once a year I go through my SOP's, which takes no more than an hour.
What I am saying is that its not rocket science....and the vast majority of the thousands of practices around the UK seem to have done ok.
If you all have such strong opinions against the CQC and what its doing shouldn't the BMA or similar should be taking them to court/ministerial review etc.
I would suggest that this is not the guy to be fighting your fight. Someone who after numerous visits didn't even bother it seems to have a check around of how the place was running and what was going on.
In pharmacy we have had these types of inspections and more for decades. The one thing that you realise, and I would give this advice to all others, is that if the inspector finds some problems there is only one thing to do and that is sort them out, and quickly! You then take the initiative and write to them and tell them you have done it.
Only a very naïve person would after three visits from the inspector not have gotten the book out, reviewed all procedures, SOP's, training records and ticked every box.
The quicker you get on board with that the easier your life will be.
Sympathy? Not here unfortunately
Media spin aside, all of the practices concerned received remedial notices and were only publicly reported on when they failed to act on the remedial notices after second inspections. We all know that only an idiot does not sort out problems the inspectors raise asap. One of the practices was done for not having doors on the consultation room! One of the others, a dispensing practice didn't have proper CD records. Remember that CD are governed by the misuse of drugs act which is criminal legislation, technically that could have been a police matter.
You point out that the PCT's have in general know about these failings for some time but have done nothing about...which really concretes the case that the CQC is necessary does it not. 99% of practices will have nothing to worry about but standards have to be maintained.
The CQC have also said that they only inspected practices this year that have had complaints made against them.
This really is the shot across the bow from the CQC that we do have power and you need to check what you are doing and act on any problems...and GP's should heed that, spend a little time looking at the criteria and start sorting things out now so when the inspector comes they can tick their box and leave you alone for a few years.
This actually reminds me a little of the NICE guidance for hypertension where they recommended Chlortalidone 25mg...a product that doesn't exist. Then didn't seem to inform the only manufacturer of the only other product (50mg) and now that isn't available at all.
Vinci, I am sure that the problems in this case are more due to the lack of thought from the government organisations.
How much notice did they give the company that they will now be needing thousands of times more vaccine than they needed previously? Previous to the change in guidance we used a relatively small amount in the UK.
I think that there should be full charging, but shoved into the current system as it is it will not work as the people that you are trying to limit are the ones who invariably be exempt through one method or another. Further to that, if the GP does have a charge and A+E remains free they will be more over-run than they are now! A similar situation exists with prescriptions, take a look at the back of the prescription and see how many exemptions there are, its mind boggling. The last figures I have seen is that 91% of items in England are dispensed free of charge.
Ireland had to introduce measures to reduce waste and decided to introduce a 50c to E1 charge per item to those who would previously been exempt to some success. Whatever is done is not going to be politically popular, but some tough decisions will have to be made.
You could argue that the devolved nations have bitten the bullet on this one by scrapping the prescription charge altogether and focusing on building up the ancillary care with plenty more services to reduce demand on GP and A+E such as national pharmacy minor ailment scheme and CPUS among many others.
Anonymous | 05 November 2013 3:02pm
Thank you for the personal reply which I will have to refute with evidence;
I will admit that these figures are from 2010 but they are from the BMA:
There are 41,349 GPs working in the UK.
Number of GPs according to nation
Northern Ireland 1,128
UK-wide 34,081 are GP partners, sometimes known as 'principals' or 'contractors'.
Number of principals according to nation
Northern Ireland 1,128
There are also up to 7,267 sessional GPs (salaried and locum GPs)
So my crude maths gives about 82.42% of GP are partners. So 82.42% of GP's are commercial GP's to use your terminology. If there was no profit motive in a GP practice why do you actually care about QIPP etc...oh yeah, because if you tick all those boxes you get more money.
In answer to your question, yes I do know how GP's are paid.
GP's get many activity based payments e.g. flu vaccines, NHS health checks, minor ops etc. on top of the capitation payments. Further to that you have failed to consider dispensing doctors, oh, and before you accuse me of not know the numbers or otherwise involved in that...guess what, I do!
To re-focus this back to the actual article, the story is that the pharmacist could give better care if they had more medical information. The article does not mention about prescribing. Would you prefer that I now send anyone with a runny nose (I literally mean everyone) to you as it me selling them something and actually making a few pence on it is somehow professionally reprehensible.
Let me let you in on a secret, stuff costs money! Whether they go to you for a prescription for it or actually take an interest in their own health and buy it directly from me, someone pays for it.
To surmise, your argument is essentially that anyone who has a financial interest cannot be involved in their healthcare they are not impartial.
So, do you offer any of the following in your practice: Vaccines, minor ops, travel clinics, IUD fitting, NHS health checks you should cease them immediately as if you don't you are being hypocritical and not impartial. Can you please confirm that you are going to do this?
We need to look at models of care that we are offering in a socialised health service if we hope for it to continue as it cannot continue in its current form.
p.s. I wonder Anonymous | 05 November 2013 3:02pm if there will be swathes of your colleagues supporting your view and shouting me down....lets see?!
Anonymous | 04 November 2013 10:51pm
Are you suggesting that nearly all GP's are not private contractors also....oh, yes they are.
An adult conversation needs to happen here...GP's are creaking at the seams dealing with people who could be dealt with elsewhere...but when people suggest other ideas there is consternation. We need to have a change in attitude, if you want to be an NHS patient, then you have an NHS record, whats so difficult about that?
Doing anything less is just making the NHS clunky and creating so much more work than is necessary.
We in pharmacy are suffering also, we are having problems even with some common OTC products e.g. kwells, all nicorette gum to name but a few. AAH have no flu vaccines as Novartis are delayed and should be in around 18th of this month.
As you are aware, they have already announced problems with the nasal flu vaccine...and the NHS wont be supplying that one to docs, they need to source themselves.
When you speak to your pharmacists make sure they give you an alternative that is in stock!
Sorry, that should say to Pharmacies that they own....
I think Pulse have missed the main crux of the complaints in their story.
The focus of the complaints is that GP's are directing prescriptions that they themselves own and/or have a financial interest in.
This is where the story originated.
This is old news, the NPC spoke about this at least two years but it does not seem to have been taken up!
Buccal midazolam is now licensed, called Buccolam.
We all need to realise that but the profit level for pharmacy is fixed, just in the last quarter approx £90m has been taken from CatM alone,
The politics of the pricing regime is crazy and the previous level of 68p is far too cheap, however was most likely part of a negotiation by Pfizer on a huge basket of goods that they have.