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Cost Of A Pint
The 'shocking' cost of alcohol misuse in Northern Ireland was highlighted by Health Minister Michael McGimpsey in June after estimates that its cost to society equates to £679.8million with a range of £500million to £884million. "This research shows that the cost to the Health Service alone may be as high as around £160million each year with a further cost of £82million to Social Services,î the Minister said. ìThese figures are particularly pertinent in the context of my Departmentís very challenging financial situation because this is money that could be spent providing key frontline services."
 
Heart In Hands
The British Heart Foundation Northern Ireland is appealing to fundraisers to help it reach its target of £80,000 by August. The campaign is to recruit more heart nurses to support patients throughout the province and to reduce secondary care admissions.
 
Haiti Fundraising
Staff at Holly Villa in the Tyrone and Fermanagh Hospital have raised over £320 for a group who are travelling to Haiti in October to build houses following the earthquake. The Tyrone Haiti Build is a project in conjunction with the Haven Partnership to support those affected by the disaster.
 
Secondary Care Supported
A new hospital in Omaghs fight for funding has been supported by Health Minister Michael McGimpsey. Speaking at a meeting with the Omagh joint liaison group, the Minister said: "I am fully committed to the development of the new Omagh hospital and will continue to press for the essential funding needed to make this a reality."
 
Commissioning Together
Pharmacists and GPs must work together to define the gaps in commissioning data, review how they can be filled and to determine the correct level of care provision for a particular area, according to Stephen Foster, the head of the new Healthcare Professionals Commissioning Network. The network is open to any health or social care professional who would like to engage in commissioning. tinyurl.com/HCPnetwork
 
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Dial M For... PDF Print E-mail
Monday, 16 March 2009 09:43

One could almost forgiven for thinking that the M in Category stands for ‘money’. The shrink on purchase profits in Northern Ireland has rapidly become a strangulation over the past few months, although the situation has been present for the past two years.

Category M and its application is part of a negotiated settlement in England, Wales and Scotland and reflects the true cost of providing pharmaceutical services. The impact in Northern Ireland however, where the cost of individual drugs is the only considered factor, is now threatening services.
 
At a recent Ulster Chemists’ Association Executive Committee meeting comments about how pharmacy businesses are have been facing huge financial concerns. “Many contractors have been in touch telling us they are now experiencing extreme financial pressures. There are real concerns about the future viability and sustainability of a considerable number of community pharmacies,” said UCA president James McKay.
 
“This has hit pharmacy at the worst imaginable time, given the current economic conditions and the unavailability of credit. We provide a very vital service and the government should be supporting us at this time. As pharmacists, we feel as if this has been raised time and time again with the Department. At a rough guess community pharmacy employs in excess of 4,000 people excluding wholesalers, in Northern Ireland, Counter and dispensary staff are mainly women attracted to the family-friendly, flexible working hours offered. There are now serious concerns about the sustainability of these jobs. We need immediate intervention.”
 
In contrast, in Scotland the chief pharmacist and Department were prepared to work with contractors to identify where funding for contract preparation payments for 2007/08 and 2008/09 which permitted monies for investment into the contract. Unfortunately this wisdom is not shared in Northern Ireland. The negotiating body Community Pharmacy Scotland struck a deal to protect pharmacists’ future incomes and vital services. The representative body agreed that clawbacks were to be reduced from 13.2 per cent to one per cent and that pharmacy incomes were no longer to be put at risk or affected until the real cost of service provision and contract delivery were established. “We can empathise with contractors within Northern Ireland who are currently experiencing Category M clawbacks,” said a spokesperson for Community Pharmacy Scotland. “We realise also that it is very difficult for young contractors who are at the beginning of their debt cycle. In Scotland there were instances of contractors having to pay for their wholesale invoices with their personal finance, which is an unacceptable situation for any businessperson.”
 
Of course, aside from the mounting fiscal pressures applied through Category M recovery, such difficulties will impact upon services and subsequently patients. “It doesn’t correspond with the government’s own strategy in moving volume from acute services and secondary care to primary care,” James added. “The Category M pricing mechanism in particular is crippling community pharmacies potential role.
 
Supply channel problems and procurement obstacles due to the falling value of sterling are also presenting difficulties, and raising patient safety concerns. If pharmacy is to play an extended role and contribute to gaining efficiencies within the healthcare sector, then action is needed, but which course is going to be the most effective? Essentially, there are not enough services to map the reimbursement of profits. At the moment the generic clawback is volatile and the Department can still stake a claim to it, but were these funds to be repatriated into pharmacy and kept as part of the global sum, services can be supported.
 
The negative externalities of contractor difficulties are beginning to emerge, including redundancies for frontline staff, access to service problems for patients and a lack of work for locums. NIPinF spoke to one locum working within Northern Ireland who wished to remain anonymous but admitted he had underestimated the impact of Category M. “Contractors are not taking holiday as often as they used to since it’s viewed as a luxury that can be foregone for the good of their bottom line,” he said.
 
“Work has certainly slowed. Although we are amidst a general recession and retail sales are down, over-the-counter margins are small enough to absorb the effect of this but as soon as reimbursement purchase profits are compromised then pharmacy is in trouble. I am verging on the opinion that pharmacy is dying as a profession and continued problems at Departmental levels are prohibiting pharmacists from providing services and meeting patient need. There is a lack of involvement for pharmacy at different levels – not through any fault of our representative bodies – and this means real problems and leaves us open to be dictated to. Generic tendering will also pose difficulties. Although I’ve only been a locum for two years, I always had steady flow of work but more recently it has dried up.”
 
Donald Moore, a pharmacy contractor in Banbridge and who was former treasurer of the Ulster Chemists’ Association, maintains that the Department’s actions were unacceptable and fully supports the PCC’s fight in the courtrooms. “The situation is regrettable,” he said. “The Department has unlawfully removed purchase profits via Category M and still refused to accept that there is a basic cost associated with dispensing.
 
“People are becoming disenchanted with pharmacy which is terribly sad and generally speaking it is the single independents which are worst hit, as multiples are better positioned to absorb the impact of purchase profit cuts. However in England some multiples are closing their less viable branches. It is an employer’s market, which is magnified given that I have never known a time when there have been unemployed pharmacists. Salaries have been frozen and they will eventually decrease if nothing is resolved; it is completely unsustainable and there will be closures. A number of contractors are renegotiating overdrafts and seeking increases on their loans but banks are not even getting involved in discussions let alone lending.”
 
While smaller wholesalers in Northern Ireland are concerned about the monetary impact of generic tendering were the controversial plans to go ahead, the bigger players are not blind to the fallout of Category M. "Uncertainty over income streams makes it difficult to manage any business,” Mark James, group managing director of AAH told NIPinF. “Category M has clearly had a considerable impact on some of our customers who have faced problems arising from the uncertainty over their income on a month-to-month basis.
 
“This does, however, reinforce the need for pharmacy to embrace service provision as a means of establishing themselves as local healthcare providers and begin to reap the financial rewards that this offers. We hope the pharmacy bodies and Health Departments will look at what has happened over the past year and agree ways in which Category M adjustments can be made more stable and predictable.”
 
However, questions in terms of the future will remain unanswered for now, or for as long as legal wranglings continue. “Because (Category M) is still subject to judicial review, it would be inappropriate for the Department to make any comment at this time,” a DHSSPSNI spokesperson said. Similarly, PCC chief executive Terry Hannawin added; “The Category M issue is currently subject to judicial proceedings so obviously we don’t want to comment at the moment. However, PCC NI are working hard with our legal team and we hope that a resolution is possible - this is a key issue affecting the livelihood of community pharmacists throughout Northern Ireland.”
 
Managing director of Medicare Pharmacy Group and Northern Ireland NPA representative Michael Guerin maintains that the result of these circumstances is considerable de-motivation among contractors. “There is a very low level of morale within pharmacy at the moment, and people are switching off when proposals about the contract are mentioned, since they are struggling to keep their head above water in the current climate.
 
“Over forty pharmacies are currently for sale in Northern Ireland, which is approaching 10 per cent of the market. Those who have their pharmacy on the market have done so because they do not have an alternative. The mounting financial pressures have left a lot of people simply saying ‘enough is enough’. It is rumoured that in the months ahead some pharmacies may well go into administration and should this happen, the Health Boards will be faced with dealing with a lack of pharmaceutical provision in areas where pharmacies have closed. We would hope that the Health Minister and his team would see the urgency of the situation and work with PCC to deal with our immediate concerns, the shortfall in payments, and work to create a climate which would be more productive and help us to negotiate a new pharmacy contract. We need Department officials to deal with our concerns as of course we all want to work with them in identify savings going forward.”