Just wanted to flag up the fact that funding for the dispensing of methadone will change from 1st July. The official announcement (extract) is as follows:
"Under the new arrangements, payment will be based on each occasion the pharmacist provides methadone to the patient i.e. for each instalment collected rather than on the number of “daily doses” supplied. For each interaction with the patient or “pick-up” for oral methadone when prescribed on an FP10MDA form, contractors will receive a professional fee, CD fee, the container allowance and any relevant volume related fees.
In addition to the standard fees for each patient interaction, contractors will also receive an additional fee of £4.05 for every prescription (FP10MDA and FP10) for methadone oral liquid. This fee is paid automatically; therefore no endorsement is required to claim it. The £4.05 form level fee is to help support the contractor with the costs of the additional workload involved in ensuring the patient is able to measure their medicine appropriately, including interaction with the patient or prescriber to understand whether dispensing in daily bottles is appropriate, preparing the daily dose bottles or providing an appropriate measuring device. Where the instructions “daily dose containers” is not included on the prescription, the pharmacist remains able to exercise their discretion to dispense in daily dose bottles where it does not contradict a preference indicated by the prescriber. Where there are concerns regarding the appropriateness of instalment frequency, the pharmacist should discuss these with the prescriber directly."
It is fair to say that this has courted considerable controversy amongst pharmacists. Many have argued that for "simplified structure" read "reduced fees". The impact remains to be seen.
One issue to consider for all prescribers is that if you wish a client to have their methadone in individual daily dose containers but the client is not on daily pickup, you must state this on the prescription (i.e. "Dispense in daily dose containers"). Pharmacists will no longer be funded to do this from 1st July, but will still do so if the prescriber specifically requests it (in order to comply with the directions of the prescriber). If it is not requested, it is entirely possible that the client will get a large bottle to take away each week. Some clients, of course, will be fine with this, but risks may need to be reviewed in others.
At first glance this looks like pharmacies will be subsidising safe practice. I can see many may not wish to do this, as this client group can already take up a lot of time and energy to ensure they get good care.
They'll be asking me to bring my own soap and hand rub next.
Who do we complain to?
Posted 02 June 2012 02:16 AM Hide Post
Who do we complain do we complain[/quote]
And will it make any difference.If services dispense is there an opportunity to recycle some of this money back into treatment. Might only be feasible in larger areas with high numbers in treatment.
There will be no money released to services by this. I'm one of those who thinks this is a highly retrograde step. The Dept says that it has averaged the cuts but in fact because a relatively small percentage of pharmacies provides most of the service it falls very heavily on them.
Put it in perspective - supplying a week's methadone in daily bottles costs around £1.25 for the containers alone. I can foresee plenty of our pharmacies deciding that if the prescription specifies unfunded daily containers, they'll return it to the prescriber for amendment. We can handle a proportion of these if daily containers are really needed, but there is no way that pharmacies can absorb this cost overall. One local pharmacy has already told us it will cost them a five-figure sum in lost fees over a year.
I thought i'd give this a bump as i've heard some pharmacists are thinking of not dispensing Methadone due to this.
Hello again - and apologies for inadvertantly starting another thread on this topic yesterday. Thanks to Simon's prompt, I thought I would move the dialogue back to this thread.
With people mentioning personal knowledge of pharmacies talking about taking big drops in fees and pulling out of opiate substitute prescribing seems to add further weight to this change in funding being a very bad idea.
As I said on the other thread, Susanna Lawrence, as clinical director of Leeds & Hull CDT's, is looking at challenging the move at a national level. I am fully in support of this.
I am wondering if there is a formal SMMGP position on this issue yet?
|SMMGP Project Manager|
Hi Mark, we have discussed this, and contributed to comments via the NTA when the announcement was first made, but not formulated a plan yet for a formal position statement - I've now put it back on the agenda.
I e mailed the Royal college of Nursing who were unaware of the changes which is odd.
We had a meeting yesterday about this and our consultant has sent an e mail to the NTA.
I'm led to believe writing prescriptions for one week instead of two helps a bit.
I don't see why it should, Simon, because the stated aim of the change was to ensure that it didn't matter what the prescription said, the determinant of fees was how often the service user attends the pharmacy.
Pharmacy's negotiating body has responded to criticism within the profession by asking for evidence.
I don't see any reason why people who aren't pharmacists shouldn't feed evidence that way too, because the move was not intended to impact on clients and evidence of client disadvantage ought to be valuable in getting the Dept of Health to think again.
It has undoubtedly impacted on the willingness of pharmacies to take more clients and some of them are losing a lot of money through this move.
Thanks Elsa - will look out for your reaction when it comes.
thanks for your support, just hang fire with the 7 day scripts as I feel it is a sticking plaster rather than a cure
I have had two patients today who have been given a single bottle for a weeks supply...and they asked me for a measure!
They fully understand that as stable and controlled people they can find it difficult to get the measuring correct
In fact the PSNC are expecting Pharmacies to still dispense in daily dose bottles.. just not to get paid for it
But hopefully as Graham has said they are re assessing this
Claire's post has prompted me to ask what I've been wondering since hearing about this - what do people on methadone think of this change? (note to self.. try asking them) Mark, has Susanna got a service user involved with her representation?
I'd be interested to hear if you were able to give them a measure, Claire - and what it cost you?
I've known measures to be about 5ml out and so people can take too much or not enough. Measuring is also often not done correctly and with the miniscus at eye level.
They won't get a crown stamped measure, since those run out around £15 each. My preference is for an oral syringe but it's fiddly at bigger doses.
My view is that this is a major mistake, but I'm not confident that DH will change their minds, since the proposal apparently went past a number of people who ought to have known what it would mean and didn't intervene.
|SMMGP Project Manager|
Dear everyone, we have now sent a position statement to DH via NTA, and also put it on our website: http://www.smmgp.org.uk/html/news.php#140812
Many thanks, i've had some very dedicated and hard working Pharmacists ask me not to send them new patients due to these changes. It's sad as these are the Pharmacists i've always relied on when i've not been able to place someone due to a chaotic history, violence or stealing in the pharmacies.
I think that's an excellent statement. I hesitate to speak for pharmacists generally, but I think they'll be grateful for such unequivocal support.
A point came up the other day which i'd not considered. On Systm1 we can specify a supervised dose and a take home dose, so say a patient takes 100ml in the shop and take 50ml home. Total daily dose being 150ml, then the pharmacist would be even worse off, wouldn't they?
Does anyone else do this sort of prescription in this way?
|SMMGP Project Manager|
There has been some developments since the changes made in the middle of 2012, in the shape of proposed amendments "in response to strong feedback received".
And "...PSNC has decided to propose a two-tier fee level for all methadone prescriptions. This will maintain the payment of fees per interaction with the patient, with a £4.05 fee for all FP10 forms and FP10MDA forms covering 7 days' supply or less of oral liquid methadone, and two £4.05 fees (i.e. £8.10) for any FP10MDA form covering 8 days or more.
This new system takes the modelled costs into account and ensures that contractors are more than meeting their costs of supplying methadone in all modelled prescription scenarios."
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