Pharmacy management and business Flashcards
What is the economic framework controlling community pharmacy?
- responsibility for profitability lies entirely with the pharmacy owners
- not all pharmacies provide NHS services, though the vast majority do
- most pharmacies are in retail locations, rather than an integral part of NHS systems
- across the sector, the NHS provides the major source of income
Ways in which you make a profit in a pharmacy?
- no of prescriptions dispensed
- payment for services
- accurate renumeration and reimbursement
- cost containment
- quality payments
What is the quality payments scheme?
- introduced as part of the contracutal framework in 2017/18
- payments made to pharmacy contractors meeting certiain quality criteria
What are the gateway criteria for being able to claim quality payments?
- provision of at least one advanced service
- NHS.uk entry up to date (BH opening hours, patient questionnaire results)
- ability for staff to send and receive nhs mail
- link to NHS digital systems (e.g. electronic prescriptions, summary care record)
What are the criteria related to different domains needed to receive a quality payment?
- Patient safety (part 1-3)
- public health
- digital/urgent care
- clinical effectiveness
- workforce
What is the patient safety criteria for quality payments?
1: written patient safety report (incident patterns and analysis, shared learning), identifies risk from LASA errors, reports LASA errors to NRLS
2: 80% registered staff completed CPPE risk management training and risk review complete for one risk with minimisation actions
3: completed an audit on NSAIDs and gsatric protection
What is the public health criteria for quality payments?
HLP status, 80% of staff completed CPPE children’s oral health training
What is the digital/urgent care criteria for quality payments?
NHS 111 directory of services entry up to date
What is the clinical effectiveness criteria for quality payments?
referral of patients >6 short acting bronchodilators, use of spacers in children
What is the workforce criteria for quality payments?
80% staff are ‘dementia friends’
How does renumeration work for community pharmacies?
- payment for NHS services, determined by department of health
- global sum ofr NHS pharmaceutical services in England
- free structure and conditions for individual pharmaceutical services
How does reimbursement work for community pharmacies?
arrangement for repayment of costs of medicines dispensed against NHS prescriptions, determined by the department of health
What is the price at which community pharmacies are reimbursed for dispensing NHS medicines?
- branded products: naufacturers NHS list price
- generic products: current drug tariff price
same for GP prescribing budgets
Cost control of generic medicines dispensed under the NHS?
- fixed price regardless of the actual price paid by the pharmacy
- price determined and updated monthly by the department of health
- price listed in the drug tariff
How does import/export of medicines affect the NHS?
- until the recent weakening of the pound, many licensed medicines could be sourced more cheaply from other EU countries
- it is currently profitable to sell medicines to other EU member states, leading to shortages of some medicines here
Problems caused by stock shortages?
- increased pharmacy workload: double dispensing, phone calls
- inconvenience to patient
- reduced compliance, leading to worsening of condition
- substitution of medicines causes confusion for patient and pharmacist - safety issue
- decreased satisfaction with patient-pharmacist relationship
Adjustment to discounts to community pharmacies?
- pharmacies buy medicines at less than the list price, through wholesaler discounts, bulk buying, parallel importing
- department of health estimates differences between actual costs and list prices
- applies a discount deduction scale to reimbursement of community pharmacy based on monthly total of prices of NHS dispensed medicines
Equation for total monthly reimbursement paid to NHS pharmacy contractors for dispensed medicines
total cost of branded products + total cost of generic products (list price) - appropriate percentage discount deduction (dependant on total monthly value of products dispensed)
What behaviours are induced to pharmacy owners by these cost control mechanisms?
- attempt to purchase medicines cheaper than the list price (bulk buying or parallel importing)
- attempt to increase the level of discount beyonf the NHS scale
- minimise community pharmacy stock levels (commonly affects availability to dispense)
What other costs are involved in running a community pharmacy
- staff, training
- rent, utility bills
- equipment
- stock loss
- loss due to incorrect claims
- collection and delivery services
Where do hospital pharmacies get their money from?
- non-profit organisations, exposed to strict financial restraints
- payment via national tariff: contains fixed prices hat reflect national average prices for procedures
- payment via commissioning for quality and innovation (CQUIN)
What are the CQUIN indicators?
- improving staff health and wellbeing
- reduce impact of serious infections (resistance and sepsis)
- improving physical healthcare to reduce premature mortality in people with serious mental illness
- improving services for people with mental health needs who present to A&E
- transitions out of children and young peoples MH services
- offering advice and guidance
- e-referrals (only for 17/18)
- supporting proactive and safe discharge
- preventing ill health by risky behaviours - alcohol and tobacco
- improving assessment of wounds
- personalised care and support planning
- ambulance conveyance
- NHS 111 referrals
What do CQUIN indicators reflect?
The ambitions of the 5YFV and NHS mandate
Aims of cost control in hospitals?
- increase efficiency, effectivness and reduce costs
- promotion of efficient and rational use of medicines via Drug and Therapeutic committees
Some approaches to reduce costs in hospitals?
- home care services
- NHS procurement division
- Skill mix
- Patient’s own drugs
- recycling drugs e.g. seretide inhalers
