Agenda item

5.1  The Chair stated that the Local Pharmaceutical Committee had contacted the Commission expressing concern about plans to end the current arrangements under the Medicines Optimisation Scheme which they say will adversely impact nearly 4000 patients locally. The Commission last dealt with this issue in March 2018 and had expressed concern then about planned reductions in these services then.

5.2  Members gave consideration to:

a) Briefing NHSE Commissioned Medicines Optimisation Scheme from

b) Briefing from Local Pharmaceutical Committee

5.3  The Chair welcomed for this item:

YogendraParmar (YP), Chief Support Officer, Local Pharmaceutical Committee

RozaliaEnti (RE), Medicines Management at NEL CCG City and Hackney

5.4  YP took Members through his briefing paper which outlined their concern that NHSE was terminating the scheme which had funded dosette boxes and blister packs and it would now only be funded for the much smaller cohort identified as having a need under the Equality Act and carers and care agencies among others had expressed concerns about this.

5.5  YP clarified to the Chair that there were c. 500 patients in Hackney who might still be supported under the Equality Act but there was another c. 3000 who would lose out. Members noted that the scheme had been discontinued in the vast majority of London boroughs. The Chair asked whether the pharmacies were backfilling the funding by requesting 7 day prescriptions and using this as a lever. YP explained that in other boroughs, where it's not funded, there is now a mixed economy in operation and the scheme is funded informally from general practice via use of 7 day prescriptions or the pharmacies absorb the loss so it was difficult to properly benchmark the impacts. The Chair observed that unfortunately it was typical of how central government worked - to provide funding for a new scheme for a time, then to withdraw it and then expect professionals to pick up the shortfall, and this happened in other public sector spheres. The Chair invited the CCG (who are not the commissioners here) to explain their position on the issue.

5.6  Rozalia Enti (NEL CCG) detailed the background and history of the scheme to provide context to NHSE London’s decision. She stated that the NEL CCG City and Hackney had been pushing back on NHSEL to not end the scheme without proper mitigation being put in place. The CCG had started to facilitate the evolution to a new system by analysing the underlying data and providing guidance to the local pharmacies. She explained that some GPs were of the view that as many of the patients did not fall under the Equality Act definition, pharmacies should therefore not be requiring 7 day prescriptions for them. She clarified that the formal national position of NHSE was that pharmacists should not be routinely using 7 day prescriptions to backfill this loss of income. She added too that there was a misconception that having a dosette box would always make patients compliant with the proper use of their medicines. There was a role for them when patients had very complex medicine schedules. In using dosette boxes however errors can go unnoticed and when wrongly utilised the medicines optimisation system can have the effect of actually reducing the therapeutic effect of a medicine. NHSEL’s view was that they were overused, she added.

5.7  YP agreed that providing blister packs was not always ideal but in reality the current system which operates locally generates this demand for them and if NHSEL withdraws the support this would leave an unfunded supply which would not be sustainable for community pharmacies. They wanted to highlight the potential risk to patient care, as care agencies and others had done, and they did not want to see a precipitous or unmanaged change to the arrangements.

5.8  The Chair questioned the expectation that pharmacies’ core contract should backfill this funding and stated that he would, if needed, write to NHSEL to express local concern about the risk to patients if this is not properly resolved. He stated that Members had sympathies on both sides but he would echo their concerns to NHSEL and urge the local partners to come up with a solution that appreciates both the efforts of community pharmacies here while not over burdening local GPs.

ACTION:

Chair to write to NHSEL expressing concern about the withdrawal of funding for the Medicines Optimisation Scheme in City and Hackney.

RESOLVED:

That the report and discussion be noted.