Understanding Dispensing Practices Caroline Pond Understanding and supporting

Understanding Dispensing Practices Caroline Pond Understanding and supporting

Understanding Dispensing Practices Caroline Pond Understanding and supporting an efficient and profitable dispensary business in a GP surgery. What we will cover today DT and profits DSQS PAs DACs Maximising income GP Dispensaries The dispensary is a business not a charity! It is not subsidised and needs to turn a profit Effective management improves profits Why? Businesses with proper systems in place are more efficient and have superior customer service Strategies for maximising profits Good stock control (Formulary)

Good management (SOPs) DSQS (why wouldnt you) What else? Dispensary profits (or losses) depend on 3 things in the main: What you buy and at what cost What you get paid Your other costs How does the practice decide what to buy? We buy what is Prescribed But we should be considering what is prescribed Developing a formulary Why? How? Manipulate prescribing behaviours Guide prescribing choices Reduce stock

Embrace profitable opportunities Dispensing lead (GP or Pharmacist) Identify priorities Review regularly Embrace profitable opportunities What to concentrate on when developing a formulary Key Prescribing areas Epact data https://www.nhsbsa.nhs.uk/epact2/epact Generic prescribing - Offers and discounts MDS www.psuk.co.uk Pie chart shows how complicated this can be when we are concerned about dispensary profitability. APM manages your basket of generics in the same way as your personal shopper. Does everybody understand APM?? Manufacturers arrangements limited discounts. Can you change to generic? Enable supply cascade and send just one order

Parallel Imports Pipcode Product Description Nett Price PI Pipcode PI Product Description NHS Price PSUK PI Sell Price PI Profit % Profit 826685 ADALAT LA TABS 30MG 28 6.30 6600571 ADALAT LA TABS 30MG PI 28

6.85 4.12 2.73 40% 826685 ADALAT LA TABS 30MG 28 6.30 6600571 ADALAT LA TABS 30MG PI 28 6.85 4.12 2.73 40%

2050409 ADALAT RETARD TABS 20MG 56 8.11 7530363 ADALAT RETARD TABS 20MG PI 2905776 DIFFERIN GEL 0.1% 45G 14.79 8882029 DIFFERIN GEL 0.1% 3249216 EMSELEX TABS 7.5MG 28 25.48 8866113 EMSELEX TABS 7.5MG 2325538 FENBID GEL 5% 100G 1.49 6598346 FENBID GEL 5%

2656106 FLIXONASE AQU NASAL SPRAY 150DSE 9.69 6615025 FLIXONASE AQU NASAL SPRAY PI PI 60 60G PI PI 28 100G 150DSE 8.81 4.06 4.75

54% 16.43 13.11 3.32 20% 25.48 22.93 2.55 10% 1.50 1.34 0.16

11% 11.01 9.20 1.81 16% 29% 2384253 LIPITOR TABS 10MG 1014 28 12.03 7532393 LIPITOR TABS 10MG PI 28/30 13.00 9.26

3.74 2384279 LIPITOR TABS 20MG 1015 28 22.79 7532419 LIPITOR TABS 20MG PI 28/30 24.64 17.56 7.08 29% 2384287 LIPITOR TABS 40MG 1016 28 22.79 8854788 LIPITOR TABS 40MG

PI 28/30 24.64 17.56 7.08 29% 2467199 LOSEC CAPS 20MG 28 14.70 6600621 LOSEC CAPS 20MG PI 28/30 16.70

11.03 5.67 34% 3059508 LYRICA CAPS 150MG 2765 56 59.57 8851669 LYRICA CAPS 150MG PI 56 64.40 46.50 17.90 28% 3059490 LYRICA CAPS 75MG 2766 56

59.57 8851651 LYRICA CAPS 75MG PI 56 64.40 25.00 39.40 61% 2534220 MAXALT MELT WAFERS 10MG 3 12.43 8863110 MAXALT MELT WAFERS 10MG PI 3290947 NASONEX NASAL SPRAY 140DSE

7.14 6596878 NASONEX NASAL SPRAY 2724466 NEXIUM TABS 20MG 28 14.90 8874265 NEXIUM TABS 20MG 2724508 NEXIUM TABS 40MG 28 20.28 8869729 NEXIUM TABS 40MG 2670552 NOVOFINE NEEDLES 31G 6MM 100 11.98 8853608 NOVOFINE NEEDLES 31G 6MM PI 13.37 9.32

4.05 30% 140DSE 7.68 6.78 0.90 12% PI 28 16.93 10.43 6.50

38% PI 28 23.05 14.20 8.85 38% 13.02 9.58 3.44 26% PI 3

100 4.01 8855900 OVESTIN CRM+APPLICATOR 4.45 3.92 0.53 12% 3202629 PROCORALAN TABS 5MG 56 37.36 8881922 PROCORALAN T 5MG (IVABRADINE) PI 56 40.17 35.30

4.87 12% 3202637 PROCORALAN TABS 7.5MG 56 37.36 8881930 PROCORALAN TABS 7.5MG 40.17 35.30 4.87 12% 2828846 TRAVATAN EYE DROP 40MCG/ML 2.5ML 10.29 6614713 TRAVATAN EYE DROP 40MCG/ML PI 10.95

9.78 1.17 11% 330399 VOLTAROL EMULGEL 100G 4.95 7509276 DICLOFENAC EMULGEL 1% 3752946 XALATAN EYE DROPS 2.5ML 12.48 6596571 XALATAN EYE DROPS (AMBIENT)PI 8.60 6597066 ZINERYT LOTION 179200 OVESTIN CRM+APPLICATOR

84202 ZINERYT LOTION 30ML 15G PI PI 15G PI PI 30ML 56 2.5ML 100G 2.5ML 5.63 3.71

1.92 34% 12.48 8.11 4.37 35% 9.25 7.75 1.50 16% Stock Management Good Stock management Poor stock management

Financial implications Customer complaints Poor service levels Critical incidents Lower profits Increased workload ordering costs holding costs Shortage costs Service implications and image Stock management If you are really going to maximise your profits somebody needs to ensure that all stock is eventually prescribed. How might we achieve this? The dispensary MUST matter to everyone in the practice if it is to maximise its success as a business. Remember THE DRUG TARIFF ?? http://psnc.org.uk/halton-sthelens-and-knowsley-lpc/

wp-content/uploads/sites/ 45/2013/12/Drug-Tariff.jpg Electronic Version link: http://www.nhsbsa.nhs.uk/PrescriptionServices/4940.aspx Endorsing behaviours GP dispensary staff have been misled in the past resulting in very unusual endorsing behaviours! Generics in the DT do not need endorsing unless there is more than one pack size listed. Specials endorsing differs from pharmacy Appliances use a DAC Price Concessions: when a listed generic increases above DT price by a significant amount. In these circumstances the Department of Health may grant a price concession for that month. Endorsement is not required other than if there is more than one pack size available. Forget shopping around PSUK concession basket is extremely profitable 1800000

1600000 1400000 1200000 Concession 17 PSUK 17 Concession 18 PSUK 18 1000000 800000 600000 400000 200000 0 Jan Feb Mar Apr May Jun

Jul Aug Sep Oct Nov Dec 1800000 1600000 1400000 1200000 Concession 17 PSUK 17 Concession 18 PSUK 18 1000000 800000 600000

400000 200000 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov

Dec Part VIIIB - Specials fixed lower cost to the NHS. the price listed is what you will be paid. A specials supplier should supply at greatly discounted prices. If not shop around. 45% plus discount is what you are looking for. End of Month Processing At the end of the month the practice completes an FP34D to claim reimbursement for medications and an FP34D Appendix Form to claim for PAs and vaccines. FP34D Appendix This needs to be completed manually to claim for the following: Influenza, Hepatitis B, Typhoid, Pneumococcal, Hepatitis A, Meningococcal

Prescriptions for the above items will be disallowed. Where do you get the information from? Computer generated printouts Manual checking of items in fridge at the end of the month Vaccine Checking Stock @ 1st Month X Stock received during the month Y Stock @ end of Month Z The amount used: X+Y-Z Does this tie up with the computer records? If not has a vaccine been given but not recorded properly on the system? Remember the FP34D Appendix is the only way you can get reimbursed for these vaccines. Dispensing Fees for dispensing practices Make the most of the Dispensing Fees How many GPs are included on the FP34D

Do you have salaried GPs who dont have their own prescribing number? Are the prescriptions equalised between GPs? Is your clinical system set to help maximise dispensing fees? Open Exeter Contains all the payment information relating to your drug submissions. Separate sheet for each GP Wrong Group Movements Open Exeter Open Exeter Drug Payment Statement GP Name Month of Claim CTP Payment Date Prescribing/Dispensing(P/D) No.of Forms No.of Prescriptions No.of items Referrd Back/Disallowed DR XXX 07.2013

01.10.2013 D 857 1776 3 Total Credits Basic Prices On Cost Additions Dispensing Fees Container Allowances Oxygen,Basic Prices Oxygen,Rents & Fees VAT Adjustments for Description Advances for Prescriptions Interim Payment Amount Total Credit 0.00 0.00 202.90

08 2045.00 Total Debits 11845.70 0.00 0.00 3603.50 0.00 0.00 0.00 344.47 0.00 13115.61 0.00 28909.28 Discount Adv No.Charges items No.Elastic Hosiery Amt Elastic Hosiery No.Current Charge Rate Amt Current Charge Rate No.Prev Charge Rate

Amt Prev Charge Rate Adjustments for Description Advance Recovery for Previous Interim Amount Total Debit Total Payment % 9.60 0.00 0.00 1137.19 0.00 140.00 1099.00 0.00 0.00 06 14346.93 0.00 16583.12

12326.16 DSQS https://www.bma.org.uk/-/media/files/pdfs/practical %20advice%20at%20work/contracts/ gpgmsdispensaryscheme.pdf?la=en Payment 2.58 per dispensing patient on practice list on Jan1 DSQS continued: Dispensing Staff Training and Experience Governance SOPs Clinical Audit/Survey: to improve patient care and outcomes. Risk Management: - risk management policy DRUM Review 10% of your Dispensing list need to have a face-to-face review. The patients to be targeted should be agreed with your PCT. Evidence of the DRUMs must be entered into the patients records Personally Administered Items PAs There is definite confusion in Dispensing Doctors Practices with regard to what can be classed as a PA Item. Many practices believe that any item which is personally

administered to a patient should be classed as Personally administered, however this is wrong! NHSBSA (National Health Service Business Services Authority) have a very specific list of what they class as personally administered. Not knowing this list, can and will cost your practice money! PA items and VAT VAT is paid on all drugs that are dispensed and taken home for administration there. This VAT is reclaimed back from HMRC as input tax PAs do not attract input tax as they have a PA allowance Some drugs attract both the NHS PA allowance and input tax from HMRC. This is because these items can be dispensed see definition above and because they also appear on the NHS PA list. Examples are insulin, Prostap and Zoladex Conversely, some items attract neither the PA allowance nor input tax (contraceptive implants are an example here) There is no definitive list so you need to check if an item has a PA allowance The Dictionary of Medicines and Devices Contains a PA indicator Determines whether an item is allowed on NHS as a Personally Administered item Information found at AMPP level

If you see attracts an administration fee, thats the PA allowance being paid Checking if an item attracts a PA allowance DM+D https://apps.nhsbsa.nhs.uk/DMDBrowser/DMDBrowser.do To clarify???!!!!! For VAT purposes, its what you do with the item that is important. Items are automatically classed as PA by the NHS, but they can also be dispensed and the VAT reclaimed from HMRC. A good example is administration by district nurses, who are not practice employees. If they do an injection, you have dispensed the item and VAT can be reclaimed from HMRC. The PA allowance, which will be automatically paid by the NHS according to the listing in the dm+d. There is a belief that if a prescription is endorsed PA in the top left hand corner, then the PPA will class it as personally administered, this is not the case. Items incorrectly classed as Personally Administered will get switched on the Open Exeter Statement as a Wrong Group Movement and get taken from the

exempt section to the paid section, and a prescription charge will be taken. Maximising profit (minimising losses) Non PA but used in practice items RAISE an FP10!! GTN, nebules or aspirin given in an emergency situation are not PAs and neither are dressings. An FP10 should be raised and the exemption filled in or the NHSBSA will assume the charge was paid and make a deduction. Is your practice using a Dispensing Appliance Contractor (DAC) Far more profitable than supplying yourself Nucare, Wardles, NWOS AGENCY NOT TRADE Nurses? Any questions?

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