The Department has been reviewing the arrangements under Part IX of the Drug Tariff for the provision of stoma and incontinence appliances and related services in primary care since October 2005.
The current arrangements under Part IX have not been reviewed in any detail for over 20 years. Nor is there any transparency between what is paid for an item and the cost of services. Furthermore, there is evidence to suggest that the underlying cost structures have changed quite significantly; for instance, manufacturing processes have become more efficient and low-cost.
In addition, there are no uniform standards of care provided by dispensers in relation to these items. Nor are the key dispensing contractors—pharmacy contractors and dispensing appliance contractors—reimbursed and remunerated in the same way.
Therefore, in conducting this review, the Department’s key objectives have been to:
maintain and, where applicable, improve the quality of patient care;
ensure that the national health service, and the taxpayer, is receiving value for money; and
ensure fair remuneration of valued services provided by the pharmacy and appliance contractors.
The most recent consultations closed on 2 April 2007. There were three consultation papers in all:
Arrangements for the reimbursement pricing of stoma and incontinence appliances under Part IX of the Drug Tariff.
Arrangements for the remuneration of services relating to appliances within Part IX of the Drug Tariff.
Proposed amendments to the regulatory terms of service of pharmacy and appliance contractors in relation to dispensing items listed in Part X of the Drug Tariff.
The Department received 137 formal responses. These came from patient groups, the NHS, trade bodies representing industry and dispensing appliance contractors, pharmacy contractors, dispensing doctors and individual providers—both manufacturers and dispensers. The Department also received a large number of letters from patients and MPs who had been alerted to the consultation by the dispensing contractors.
The volume and complexity of the responses are such that the Department has decided that it needs more time to analyse the information provided. This analysis needs to take account of comments made about the Department’s proposals regarding reimbursement for items and on the proposed levels of remuneration for particular services—such as home delivery and product customisation.
Consequently, no changes will be implemented in July 2007 as proposed in the consultation documents. Moreover, we do not expect that the review will be completed before the end of the year.
Critically, throughout the review, the needs of patients continue to be paramount and the Department is committed to ensuring that their care is maintained and improved. The Department also seeks to ensure that the NHS is receiving value for money and that the services provided by all dispensing contractors are to the same standard no matter where in England a user of appliances may live.