We should all put patients first - it's our number one priority and is top of the list in our code of ethics...but what if putting a patient first results in a loss?
 
Nobody in business should work for nothing...even worse if it costs money!
 
For the last month we've been putting patients first by ordering gabapentin for them assuming that due to the shortages of the product and the fact that the price was rising - a concessionary price would eventually be agreed.
 
How disappointing it was last Friday to see a price concession far below market price brought in for the month of October...The DOH said  "...indicate that stock is available at a wide range of prices for gabapentin, and we acknowledge that some is quite high when compared to the proposed concession prices, it also shows that the majority of stock on the market is available at or below the proposed price from multiple suppliers." I'm not sure which suppliers the DOH have been looking at, because the price I was quoted today from all our suppliers is well above concession - even from the large suppliers!
 
I recognise that this is a complex area; but we really need an answer that is fair to all.
 
Another non regular patient presented with a prescription for 420 loperamide capsules today...this product is unavailable at the 30 size and is cat M. The only way of dispensing this prescription is to use "over the counter product" at a significant loss...He had visited a lot of pharmacies before he got to us... 
 
I recognise that It's very frustrating for contractors to dispense at a loss, but the alternative is that patients suffer; and sadly many pharmacists are really struggling with this ethical dilemma?

Medicines shortages continue to infuriate pharmacists, and the general public.
 
As I've said before, contractors are sometimes struggling to obtain simple medicines and often, when they get them, these products are priced way above the Drug Tariff. The traditional system to help sort this out NCSO simply wasn't designed to deal with this sort of problem...and individual contractors are losing a lot of money...
 
So, why all the shortages in the first place you may ask? A good question...I'll try to answer it below...
 
Historically there was always an adequate supply of medication in the system, but fluctuation in sterling exchange rates, direct to pharmacy schemes etc have caused major problems. It's an international problem because medicines are a commodity and are sometimes very cheap - (some might argue too cheap?) leading to manufacturers leaving the market...and monopolies can form. Occasionally these monopolies are hidden; for example there is only ONE global supplier of Temazepam raw material! Additional problems for contractors can occur once shortages are apparent, stockpiling leads to price rising and yet more shortages...
 
Overall, the impact nationally on shortages will be picked up, but individual contractors are suffering.
 
We need a solution that is evidence based and that works.
 
NCSO wasn't meant to deal with the type of long term problems we have now - and contractors are urged to let PSNC know if prices are too high - so that appropriate action can be taken.

I noticed that the Prime Minister has recently announced a scheme that will enable pharmacy contractors to receive earlier payment for prescriptions dispensed...so far so good, because it currently takes us 2 months to be completely paid for our dispensing (not a good state of affairs for cash flow!).

The problem is that this new scheme, which will enable contractors to receive advance payments for prescriptions dispensed on day 7 or 8 of the month following that in which the items were dispensed - i.e. a few days after submission of their prescription bundle, will be subject to a charge! 

For example, for prescriptions dispensed in January, contractors - for a fee - would be able to access the NHS Business Services Authority (NHS BSA) advance payment on the 7th or 8th of February. The full and final payment would still be received on April 1st.

The aims of the scheme are to help contractors better manage cash flow and to enable  them to settle their accounts more quickly - which is to be welcomed, but surely now is the time to bring pharmacy contractors in line with other commercial transactions and pay in 30 days, not 60 and then we wouldn't need this scheme!