(2) with reference to the impact assessment of his Department’s proposals on Part IX of the Drug Tariff, what assessment he has made of the likely effect of a cap on reimbursement payments on contractor efficiency; and what factors were taken into account in deciding on 50,000 items as the cap on reimbursement;
(3) what assessment he has made of the likely effect on patient choice of his Department’s proposals to impose a capped payment structure for the reimbursement of stoma and incontinence items;
(4) whether he plans to extend the imposition of a three per cent., reduction in remuneration as referred to in his Department’s proposals relating to Part IX of the Drug tariff to other NHS suppliers.
No explicit assumption on contractors’ ability to secure greater efficiency has been made by the Department. What has been suggested is that the national health service annual efficiency targets should be shared by dispensing contractors as well.
The 50,000 items cap has been raised significantly from previous proposals. For instance, in September 2007 the cap was set at 30,000 items. The cap does not apply to payment for specific services but to the infrastructure payment that has been proposed. The infrastructure payment is intended to contribute towards the cost of elements of essential service provision which are not directly linked to dispensing a prescription item; for instance, operating within a clinical governance framework.
In the consultation entitled “Proposed new arrangements under Part IX of the Drug Tariff for the provision of stoma and urology appliances—and related services— in Primary Care June 2008” there are no proposals relating to a capped payment structure for the reimbursement of stoma and incontinence items.
However, subject to the outcome of the consultation, patient choice could be increased as proposals regarding remuneration for service relate not only to the 100-plus dispensing appliance contractors but also to the 10,000 plus pharmacy contractors.
The consultation document proposes that a uniform price reduction of two per cent., should be applied to all catheters listed in Part IXA—and for items listed in Part IXB and Part IXC.
No reduction in remuneration for services has been proposed. In fact, the Department has estimated that if these proposals had been implemented in 2007 they would have increased overall expenditure by primary care in this area by £5 million. If the proposals are implemented, the level of expenditure will continue to rise in line with any increase in the number of Part IXA, B and C prescription items dispensed in the future.
In the consultation entitled “Proposed new arrangements under Part IX of the Drug Tariff for the provision of stoma and urology appliances—and related services—in Primary Care. June 2008” it has been proposed that dispensing appliance contractors should be required to provide a dispensing service for items that they supply in the normal course of their business and that they should receive a 90p professional dispensing fee for each part IX prescription item dispensed for providing this service.
This reflects one of the Department’s stated aims of the review of the arrangements under part IX of the drug tariff for the provision of stoma and incontinence appliances—and related services—in primary care, which is to ensure equitable payment to dispensing appliance contractors and pharmacy contractors for equivalent services.
An impact assessment was published alongside the consultation.
One of the stated aims of the review of the arrangements under Part IX of the Drug Tariff for the provision of stoma and incontinence appliances—and related services—in primary care is the maintenance and, where applicable, improvement of the current quality of care to patients—and provision of a consistent level of care.
Although many dispensing appliance contractors and pharmacy contractors provide additional services such as home delivery, these services are not required under their National Health Service service provision. Therefore, we want to make sure that key services are included in the arrangements for the provision of pharmaceutical services made by primary care trusts under Part 7 of the NHS Act 2006 and incorporated in to the terms of service set out in the NHS (Pharmaceutical Services) Regulations 2005—and that such services are provided to the same standard.
Consequently, the proposals relating to services set out in the consultation document entitled ‘Proposed new arrangements under Part IX of the Drug Tariff for the provision of stoma and urology appliances—and related services—in Primary Care. June 2008’ apply to single line items.
(2) what assessment he has made of the likely effect on disabled people of his Department's proposals to impose a cap on the payment for stoma and incontinence services provided by contractors;
(3) whether patients will continue to be able to choose any dispensing appliance contractor under the proposals in his Department’s June 2007 consultation document on stoma and urology appliances;
In reviewing arrangements under Part IX of the Drug Tariff for the provision of stoma and incontinence appliances—and related services—one of the Department's key aims has been to maintain, and where applicable improve, the current quality of care to patients—and provide a consistent level of care. The Department recognises that a number of dispensing appliance contractors provide a number of services which many users value. However, these services are not required under the terms of their national health service service provision. Therefore, the Department wants to make sure that key services are included in the arrangements for the provision of pharmaceutical services made by primary care trusts under Part 7 of the NHS Act 2006, and incorporated in to the terms of service set out in the NHS (Pharmaceutical Services) Regulations 2005—and that such services are provided to the same standard.
The latest consultation entitled “Proposed new arrangements under Part IX of the Drug Tariff for the provision of stoma and urology appliances—and related services—in Primary Care. June 2008”, which has just closed, set out a number of proposals relating to remuneration for service provision directly linked to dispensing a prescription item. It was proposed that remuneration for only one such service should be capped. This service is appliance use reviews, which are intended to improve the patient's knowledge and use of the appliance they are using.
It was proposed that the number of total reviews that a dispensing appliance contractor or pharmacy contractor may claim for should be limited to one for every 35 Part IXA (catheter excluding any catheter accessory and maintenance solution), Part IXB and Part IXC prescription items dispensed in a year (April to March). However, the cap that was proposed in the latest consultation was lower than that proposed in earlier consultation published in September 2007; this was one for every 70 Part IXA (catheter excluding any catheter accessory and maintenance solution), Part IXB and Part IXC prescription items dispensed in a year (April to March). The new proposals reflected discussions with Industry and with representatives from the NHS and seeks to address concerns expressed about the previous cap.
Furthermore, the consultation that has just closed (9 September 2008) provided patients and Industry with the opportunity for views to be submitted regarding the current proposal.
The proposals set out in the consultation relate to the reimbursement for stoma and incontinence items dispensed and remuneration for related services. Consequently, patients will continue to be able to choose any dispensing appliance contractor—or pharmacy contractor—subject to the fact that they provide the requisite appliance and related service in the normal course of their business.