Introduction

This is the Strategic Plan of the Prescription Pricing Authority (PPA) for the period 1 April 2003 to 31 March 2008.

It is a statement of our broad aims and aspirations and describes the programmes of work we will undertake over the next five years to support the Government's aims and objectives for modernising the National Health Service (NHS), which have been set out in the NHS Plan and are further described in a number of Government papers. Pharmacy in the Future (PitF), Improving Working Lives (IWL) and Delivering 21st Century IT Support for the NHS are among those with most current significance for us.

Our business environment and the policies that govern our operation evolve and change over time. Consequently, we continue to review, revise and reissue this plan each year. This is the fourth annual publication of our Strategy. Since its inception, we have improved the efficiency and cost effectiveness of our core services. We have radically restructured our information services to reflect the changing structures of the NHS and we have introduced new, successful services to patients seeking help with health costs.


The Organisation
We occupy a unique position within the NHS. Our work is fundamental to the payment and budget management of significant numbers of professionals involved in front-line patient care. Our prescribing information services provide the basic building blocks to enable improved patient care and for performance management in the primary care sector.

Our main functions are:

• To calculate and make payments for amounts due to pharmacists and appliance contractors, and calculate amounts due to General Practitioners (GPs), for supplying drugs and appliances prescribed under the NHS.
  
  
• To produce information for GPs, Nurses, Primary Care Trusts (PCTs) and other NHS stakeholders about prescribing volumes, trends and costs.
  
  
• To manage a range of health benefits including the NHS Low Income Scheme (LIS), Medical (MEDEX) and Maternity Exemption Certificates (MATEX), Prescription Pre-payment Certificates and Tax Credit exemptions.
  
  
• To produce the Drug Tariff containing the reimbursement prices of a range of prescribable items and remuneration rules.
  
  

Context and Scope of Current Services
We process 608 million prescription items per annum (2001/2002 figures). We calculate and make payments to more than 10,000 Pharmacy Contractors and also calculate the payments due to approximately 4,400 Dispensing Doctors in England.

The total value of prescriptions now accounts for £6.6 billion per annum, which equates to approximately 13% of total NHS costs.

The core process of prescription pricing and payment is not complex. However, the operation is made complex because of:

• The need to maintain reference prices for over 236,000 different products which are prescribable.
• The complexity of the NHS contractor reimbursement and
  remuneration rule set, as negotiated and determined over time.
• The need to re-cut dispensing information collected from dispensing contractors in order to link it back to the original prescriber to support management information systems for an increasing range of NHS stakeholders.

We provide secure, high quality prescribing and dispensing information services derived from operational activities to a range of stakeholders. We will continue to develop these services to meet the needs of this expanding service user base.

As a national provider of managed services to the NHS, we support PCTs, Trusts, Strategic Health Authorities StHAs and other NHS bodies in their delivery of patient care.

Our Business

Stakeholders
As a national body within the NHS, delivering a portfolio of shared, centralised services, we have a large number of stakeholders with an interest in our services. Our main stakeholders are Dispensing Contractors, Prescribers, PCTs, StHAs, patients seeking help with health costs, the Department of Health (DH) and taxpayers, represented by the DH as our Government sponsor.

The interests of these stakeholders differ and sometimes compete. We recognise all our stakeholders' legitimate interests and; will aim to ensure that our decisions and actions are justifiable to all those affected by them.


Business Environment
Our stakeholder base continues to change and evolve. The drive to place control of NHS resources closer to the patient has focused our information services towards the needs of PCTs. We aim to provide products which are co-ordinated nationally to deliver a locally responsive service for patients and maintain good value to the NHS overall. Where we provide common services across the NHS, we will work to improve quality and reduce unit costs. We believe it is important to strive for realistic reductions in unit costs, to meet the expectations of the DH and to liberate resources that can be invested in the redesign and improvement of our services and redistributed towards improved patient care elsewhere in the NHS.

Our ability to deliver core payment, prescribing information and supporting services effectively and efficiently is affected by the volume and the complexity of the data that we process. Commitments in the NHS Plan which relate to prescribing and dispensing will continue to affect the levels of growth and the complexity of the information we will deal with.

Pharmacy services have been scrutinised for their role in the procurement and supply of medicines and for the rules which control entry to the market for community pharmacy. There will be significant changes in the detail of how community pharmacy services are delivered by the NHS. These changes may come through renegotiation of the National Contract, the development of Local Pharmaceutical Services, modernisation of the supply-chain for medicines, innovations in medicines management or through other initiatives driven at the PCT level. Innovative ways of delivering pharmaceutical services have the potential to increase the complexity of reimbursement and remuneration.

A new GP contract also has the potential to affect the information flows we have with primary care prescribers.

These changes must be accommodated within the context of the integrated developments across the NHS described in the strategy document Delivering IT in the 21st Century, which was published by the DH in 2002. A National Prescriptions Service, forming a component of the integrated care record specification, is a key strand of that strategy. Contributing to the delivery of that strategy will underpin our activities throughout the period up to 2008 and beyond.

We must achieve effective business processes and supporting IT solutions, which will enable us to reduce unit costs and to deal with increasing volume. This will only be achieved if we can successfully promote standards to remove ambiguity in describing drugs by providing the Primary Care Drug Dictionary (PCDD) to the NHS and simplify the rules governing the pricing and reimbursement of prescription items.

We are entering a crucial period in which the interaction between growth and increasing complexity, on one hand, and our ability to reengineer our processes to increase automation, on the other, must be managed to enable us to contain projected growth within our current processing capacity. We must respond flexibly to these changing demands if we are to maintain the value and the effectiveness of our services to the NHS.

Governance
We operate within a number of frameworks, which govern our activities and provide a mechanism for our accountability. These stem from our status as a public body within the NHS.

Organisation Management
We deal with large amounts of public money. Decisions we take can have a profound impact on the lives and livelihoods of individuals. We must act and be seen to act with the utmost probity. We will continuously monitor and review the systems, which govern our operations. We will also strive to work fairly and responsively and to protect the interests of the owners of the personal data we manage.

Risk Management
We are committed to understanding and managing the risk associated with our business. We will take care to ensure that the management controls we apply to the delivery of our services are predicated on mitigating and reducing risk. Our development activities will be focussed on containing avoidable risk and ensuring the continuity of effective and efficient services to the NHS.

We will ensure that, allied to our approach to risk, we have in place Business Continuity Plans to secure reasonable expectations of our services.

Environmental Issues
We will manage our estate to maximise the efficiency of our energy usage and to reduce, as far as possible, the impact of our activities on the natural environment. Our goal is to promote the move from services based upon paper transactions to those delivered electronically. This will reduce the global environmental costs of production, printing, storage, handling and disposal associated with the 608 million prescription items we currently process annually.

Freedom of Information and Data Protection
We receive, process, transmit and hold vast quantities of information. We have developed systems and protocols to ensure that we comply with the laws governing the use of personal data. We must adapt these approaches to encompass the requirements placed upon us by the Freedom of Information Act to enable structured access to information sources managed by us. Within the context of our business process reengineering, we will structure our information holdings to enable definitive access to relevant data. We will develop a publication scheme and promote access to streams of information through our established publications and by developing our web portal.

We will continue to protect the rights of individuals whose data we hold. We will manage our responsibilities towards the owners of data and to those within the NHS with a need for anonymised clinical information, in the context of the relevant data protection, patient confidentiality and freedom of information provisions.