The National Pharmacy Association (NPA) has called for immediate intervention by Health Secretary Neil Gray to compensate pharmacies left in financial
chaos due to flaws in Scotland's new pharmacy payment system.
Introduced last year, the system was designed to streamline payments to pharmacies, dispensing doctors, and medical appliance suppliers. However, the NPA, which
represents independent pharmacies across the UK, reported that many pharmacies were facing repeated shortfalls in expected funding under the system.
Some pharmacies have encountered discrepancies of tens of thousands pounds due to errors in the Data Capture Validation & Pricing process introduced by NHS National
Services Scotland.
In other cases, NHS Boards have clawed back money from pharmacies at short notice, following processing errors that had initially resulted in an overpayment.
Errors of any kind in medical settings can have dire consequences for patients and healthcare systems. Unfortunately, negligence, misdiagnosis, and
medication errors aren't uncommon in the UK.
In this article, we discuss the nature of medication errors in the NHS, outline potential causes, and delve into how and why technology could be turning the tide
on the issue.
Prevalence and consequences of medication errors
Medication errors are incidents involved with the administering, prescribing, dispensing or monitoring of medicine to patients. It can happen at many different
steps in the healthcare process and by any medical professional in the system. Many cases are avoidable.
According to analysis from BMJ, there are an estimated 237 million medication errors made in England every year. The majority of these are minor errors, but 1 in 4
cases has the potential to cause moderate to serious harm to patients.
Not only do these errors cost the NHS significantly, at almost £100 million every year, but there is a shocking cost to public health. Lives are being lost because
of medication errors which is unforgivable and tragic for the families involved.
Drains on NHS resources have widespread impacts on public health and the operations of healthcare organisations up and down the country. Individual errors and
mistakes may seem inconsequential (in minor cases), but they all add up in the big picture to a significant concern for policymakers.
Titan PMR has been accredited by the NHS to provide electronic prescription services (EPS) to dispensing doctors.
Over 1,000 of these doctors, who provide a vital service to almost 10 million people in rural communities, can now offer their patients the same level of benefits
and efficiencies that electronic prescriptions and Titan PMR have brought to pharmacies around the UK.
These features will also increase efficiency for dispensing doctors, who will reduce dispensing errors and improve organisation, increasing their capacity while
enjoying the ability to integrate with other technologies.
After a full year of testing, including six months of compliance testing at a practice in Cumbria, the new accreditation for Titan also has potential to help the
NHS fulfil its target of all prescriptions being issued electronically.
Currently written paper prescriptions from dispensing doctors account for around seven per cent of the total prescriptions in England - around 6.5 million each month.
"Until now dispensing doctor surgeries have basically been in the digital dark ages when it comes to dispensing medicines," said Tariq Muhammad, a tech entrepreneur
and CEO of Bristol-based Invatech Health, which developed Titan PMR.
The Department of Health and Social Care (DHSC) has published plans to amend current pharmacy legislation on dispensing errors and clarify how registered
pharmacies are governed.
The Department's response to a public consultation on rebalancing medicines legislation and pharmacy regulation programme first proposed in summer 2018 was
delayed due to Brexit and the Covid-19 pandemic.
The programme aims to clarify and strengthen the organisational governance arrangements of registered pharmacies, specifically to define and clarify the core
purpose of the Responsible Pharmacist and Superintendent Pharmacist roles.
It will also give the General Pharmaceutical Council (GPhC) powers to define in professional standards how those roles are fulfilled.
New legislative orders approved by the Privy Council will give the General Pharmaceutical Council (GPhC) and Pharmaceutical Society of Northern Ireland (PSNI)
powers to set professional standards for Responsible Pharmacists, Superintendent Pharmacists and Chief Pharmacists.
The Pharmacy (Preparation and Dispensing Errors - Hospital (and Other Pharmacy Services) Order 2022 and the Pharmacy (Responsible Pharmacists, Superintendent
Pharmacists etc.) Order 2022 have been published and are expected to come into force in December 2022.
Trevor Patterson, Chief Executive of the Pharmaceutical Society NI said: "We have been working with our colleagues in the GPhC and Government for some time on these
two pieces of important legislation and we are delighted they have now reached the statute books.
"Both Orders enable and enhance the powers we, and the GPhC, have to define the roles and responsibilities of Responsible, Superintendent and Chief Pharmacists,
respectively. They also create protections against criminal prosecution for hospital pharmacists where an inadvertent error is made either in dispensing or assembly,
in certain defined circumstances, similar to the protections available to colleagues working in community/registered pharmacy settings. Provisions that allow the
appointment of a Deputy Registrar for our organisation will also be introduced.
The Department of Health and Social Care (DHSC) has announced adjustments to the reimbursement rates for several Aptamil products dispensed earlier this
year, following a pricing error that left pharmacies out of pocket.
The changes, which apply to products dispensed between January and April 2024, come after Community Pharmacy England (CPE) raised concerns about discrepancies
in the pricing data used by the NHS.
The issue stemmed from recent price increases by Nutricia Ltd, the manufacturer of Aptamil, which were not reflected in the NHS Dictionary of Medicines and
Devices (dm+d).
To address the shortfall, the DHSC has retrospectively increased the reimbursement prices for the following Aptamil products:
- Aptamil Anti-Reflux powder (800g): From £14.29 to £16.08
- Aptamil Comfort milk (800g): From £14.29 to £16.08
- Aptamil First milk powder (200ml): From £0.92 to £1.06
- Aptamil Follow On milk (200ml): From £0.92 to £1.06
- Aptamil Lactose Free powder (400g): From £7.70 to £8.39
These changes, effective from January 2024, are intended to ensure that pharmacies are appropriately reimbursed for the cost of these products.
The Pharmaceutical Services Negotiating Committee (PSNC) has advised the pharmacy contractors to check that their PMR systems supports correct and complete
SSP endorsements.
Several tips has been shared by the PSNC with pharmacy contractors after NHSBSA received several electronic EPS SSP claims which did not meet the requirements for
a valid SSP between 1 April 2022 and 31 May 2022.
PSNC has been working with NHS Business Services Authority (NHSBSA) to understand whether claims for HRT SSPs are being submitted correctly and in accordance with
the specific supporting guidance for each SSP.
"For any invalid SSP claims, contractors will continue to receive the usual dispensing fee but will not receive any SSP fee (£5.35). Reimbursement for invalid SSP
claims will also be in accordance with the prescribed product rather than the alternative product or quantity supplied in accordance with an SSP," said PSNC.
There has been a lot of coverage in the national and pharmaceutical press of the prices being charged to pharmacy owners for certain medicines.
Leaving aside the reasons for steep price rises, I have been asked on social media and elsewhere whether pharmacy owners can refuse to supply prescribed medicines
if they would make a significant financial loss.
Legal obligation
The first thing to point out is that the National Health Service Act 2006 imposes a legal duty on the Secretary of State and NHS England to make arrangements for
people to receive sufficient prescribed drugs.
These arrangements involve the publication of the Drug Tariff.
The Drug Tariff includes reimbursement prices or a method for determining prices. Various factors can be taken into account in determining reimbursement prices. The
Drug Tariff does not provide a pound for pound reimbursement for medicines that pharmacies supply on NHS prescriptions.
Pharmacists can dispense Paracetamol 120mg suppositories in accordance with the prescription, as the Department of Health and Social Care (DHSC) has confirmed
that sufficient stocks are available to meet normal demand.
This means the Serious Shortage Protocol - SSP033 - for Paracetamol 120mg suppositories has now expired since 26 August 2022.
Top tips for SSP claims
NHSBSA advise that contractors must follow the specific endorsement guidance issued with each SSP and endorsements should be clear and unambiguous - NHSBSA
processing staff must be able to determine what has been supplied. NHSBSA have published information on common SSP endorsing errors they see when processing claims.
Any paper prescriptions with SSP claims need to be placed in the red separator provided by the NHSBSA.
Although an SSP cannot be used outside its period of validity, claims can be submitted up to three calendar months after expiry or withdrawal of the SSP to help
manage any owings for other items issued on the same prescription form. For example, for SSP033 Paracetamol 120mg suppositories, which expires at 23.59pm on Friday
26 August 2022, the NHSBSA would continue to look for the "SSP" endorsement on prescriptions for Paracetamol 120mg suppositories that are submitted with the August
batch (submitted by 5 September), September batch (submitted by 5 October) and October batch (submitted by 5 November).
Diaphragm pumps are positive displacement pumps that use a flexible diaphragm to displace a fluid volume. They're used to move fluids with viscous materials
or solid particles because they can move the fluids without causing damage to the pump. Almost all major industries use diaphragm pumps to move concrete, acid,
and abrasive fluids. Diaphragm pumps use power sources like air pressure, mechanical means, and electricity.
One industry that relies heavily on diaphragm pump operation is the pharmaceutical industry. The diaphragm pump is suitable for the pharmaceutical industry because
it can handle a variety of fluids and provide a gentle flow. This article discusses the various uses of diaphragm pumps in the pharmaceutical industry and how they
have revolutionized it.
1. Filling Vials
Filling vials with liquid medication is a task that has to be accurate and concise. Diaphragm pumps can dispense a precise amount of drugs into a vial. The pump
provides an exact flow rate, ensuring each vial has the correct medication dosage. Diaphragm pumps reduce the risk of medication errors.
The Serious Shortage Protocol (SSP), for Estradot 50mcg patches will expire at 23.59pm on Friday 24 February 2023.
Department of Health and Social Care (DHSC) has confirmed that sufficient stock of Estradot 50mcg patches are now available to meet normal demand.
"After 24th February, any prescriptions for Estradot 50mcg patches must be dispensed in accordance with the prescription, and SSP048 will no longer be valid for
use," said DHSC.
Top tips for SSP claims by PSNC:
Where available, use the claim amend facility on the PMR system to rectify any incorrect EPS claims already submitted this month.
For any supplies made in accordance with SSPs, check that the correct number of patient charges are collected and declared on the end of month FP34C submission.
NHSBSA advise that contractors must follow the specific endorsement guidance issued with each SSP and endorsements should be clear and unambiguous - NHSBSA
processing staff must be able to determine what has been supplied. NHSBSA have published information on common SSP endorsing errors they see when processing claims.