Eight-month variation to Pharmacy Services ent offered
20 District Health Boards
27 July 2011
DHBs offer eight-month variation to Pharmacy Services Agreement
DHBs have decided to offer a variation to the Pharmacy Services Agreement that will take effect on 1 September 2011 for an eight month period to 30 April 2012.
However, DHBs wish to reiterate that the longer-term intent is still to progress to a service model as extensively discussed over the past year rather than the transactional fee per drug dispensed model that we currently have.
The Variation offer contains a provision that DHBs and pharmacies will work together in good faith to agree to long-term conditions criteria and services [We both agree to work together, in good faith, to agree on long-term conditions criteria and the services that shall be provided to such service users who meet the long term conditions criteria, in order to include such long-term condition services in any agreement that may be entered into between the parties relating to the provision and funding of pharmacy services after 30 April 2012.]
First priority is to finalise development of the service for people with long term conditions who have trouble managing their medicines that we have been working on this for several months with pharmacy and prescriber representatives, and other stakeholders.
DHBs will continue to engage with all stakeholders around the purpose and direction of the service, what will be expected to be provided to patients and what outcomes are anticipated.
DHBs expect to finalise and publish the long-term conditions service description and criteria in the next few months, together with the indicators of performance that pharmacists will be expected to meet.
In conjunction with this work, DHBs, pharmacies and prescribers will be expected to focus on how the aspect of the Close Control rules in the Pharmaceutical Schedule that relates to “frail, infirm and those unable to manage their medicines” is being applied. It is expected that expenditure growth in this area will be reduced and some will be able to be released for the long term conditions service.
DHBs also want to continue to work on the services to patients in Age Related Residential Care, another group of high needs patients.
The Variation offer presented by DHBs is consistent with the wide ranging discussions which occurred during the consultation process held from April to July with the four pharmacy agents – Pharmacy Guild, Pharmacy Partners, Radius, Canterbury Community Pharmacy Group.
During the consultation process feedback was also received from pharmacies which responded to the request for Issues Register items and made their submissions directly into the process or through their agents.
The Variation offer and letter have been posted on the DHBNZ website: www.dhbnz.org.nz (Pharmacy) so pharmacies can review it and has also been sent to their pharmacy agents. The Variation offers are being processed by Sector Services and will be posted to pharmacies in the first week of August. DHBs will meet to discuss the Variation offer and any locally specific conditions with pharmacies in their districts over the next few weeks.
During the next eight months DHBs will closely monitor expenditure on Weekly Close Control in conjunction with Audit & Compliance. Close Control has been a strong area of focus since 2009 with recent data showing that Weekly Close Control [i.e. dispensing of, and being paid for, items 52 times per year] has been increasing 20% cumulatively per annum, while Monthly Close Control has remained relatively static.
The effects of Weekly Close Control are different across pharmacies within a DHB and across DHBs. For example, the use of Weekly Close Control across DHBs ranges from 0.7% - 4.8% of all patients and Monthly Close Control ranges from 5% - 13.3% of all patients (2009/10 full year data). The ranges have changed in some DHBs during 2011/12, upwards in respect of Weekly Close Control.
DHBs will also keep a watching brief on the more frequent use of Close Control dispensing and any connection with provision of compliance packaging.
The Variation offer is intended to keep DHBs and pharmacies engaged over the next period. This mutual responsibility will set the scene for ongoing discussions that will renew the trust, respect and understanding that had been developed.
The Variation also contains some amendments to the terms and conditions based on items raised from the Issues Register, and other areas that are consistent with the intention to focus on services in future such as services to people Age Related Residential Care who are highly vulnerable and generally on multiple medications.