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Increasing the number of patients on seven-day scripts and, as a result, the number of items dispensed and prescription fees payable, may seem like a good way of countering falling income and increasing costs.
However, the DDA would describe this as "gaming" and only of short-term benefit to your practice. More to the point, in the long-term it increases the workload for all practices, for decreasing financial benefit, and at no incremental benefit to patients.
Let me explain
"Gaming" practices are not generating new income from a new source, and they are not increasing NHS costs. As our pay envelope is fixed, any extra income obtained by a practice from seven-day prescribing can only come from one source - the income available to all other dispensing practices.
In year one, this may benefit the gaming practice, but in subsequent years, as item numbers rise ahead of forecasts, the dispensing fee per item will fall (plus, there may be clawback of excess fees paid due to seven day prescribing).
When this happens, other practices may feel pressure to look around for ‘new' sources of income, and they, themselves, may start seven-day prescribing. Eventually, we all end up doing lots of seven-day prescribing, but the pay envelope stays the same. The end result is that we all end up doing more work for the same amount of pay, for no benefit to patients.
Sue Fairwhether, DDA Board member from Wales believes this is not a dispensing doctor issue, "This is a prescribing issue rather than a dispensing issue . Figures for seven day prescribing (7DP) for non dispensing practices vary greatly. We looked at this in our locality a couple of yearrs ago and found that some practices had a very high rate of 7DP but this had been caused by demand from a group of nursing homes that the practices covered. All were non dispensing patients."
With this comment in mind DDA Online looked at practices over a PCT and we identified one outlier in terms of items per patient per month, but with the overwhelming majority of practices having similar items and net ingredient cost per patient per month, whether they were dispensing or prescribing.
However it is the DDA's job to keep its own house in order. There are we believe only a small number of practices doing an excessive amount of seven day prescribing.
The large, vertically-integrated pharmacy companies compete very aggressively for practices' nursing and residential homes business, and homes are often persuaded to switch to pharmacies - for reasons we, at the DDA, do not understand.
Homes often under pressure from their owners or inspectors to use Monitored Dose Systems, believing it is safer to do so, even though there are no good clinical reasons for this.
We accept, of course, that if a practice is faced with a home that likes the MDS-based offer made by a predatory pharmacy, then the practice needs to compete, and MDS, paid for by seven-day prescribing, may be a way to do this. Practices must be clear that pharmacists have tackled the subject of extra funding for using MDS with the DH, and have been told, quite categorically, that this will not be forthcoming.
However, before you turn to seven-day prescribing in a bid to retain your homes business, we would suggest you try and talk to the home, to discuss issues such as:
The drawbacks of care that is not ‘joined-up' when homes use a large multiple pharmacy for their MDS
The need for the patient to choose the source of their medication and provide informed, signed consent about any change
Get the PCT prescribing adviser involved as they can give an alternative voice against MDS.