Confirmed minutes of 30 October 2001

PRESCRIPTION PRICING AUTHORITY

At a meeting of the Prescription Pricing Authority held in the Royal College of Pathologists, London on Tuesday 30 October 2001, there were:

PRESENT

Professor D J Johns - Chairman
Dr M Ali Dr S Purdy
Mr M Bennett Mr M Ramsden
Mrs A Galbraith Mr N Scholte
Mr J Norman


IN ATTENDANCE

Mr D Ball Mr M Siswick
Mrs C Dalton Mr J Smith
Mr M King Mrs E A Stobbart

1 APOLOGIES FOR ABSENCE

Apologies for absence were received from Dr J Ferguson.

2 CHAIRMAN'S INTRODUCTION

The Chairman welcomed and thanked members of the audience for attending the Public Meeting of the PPA.

3 TRENDS IN PRESCRIBING - GROWTH AND COMPLEXITY

Mrs Dalton, Director of Pharmaceutical Policy and Services, presented a report on prescription cost and volume growth and drivers for the changes in the volume growth.

The percentage change in the growth in prescription numbers had changed from 3.41% in the year to May 2000 to 5.71% in the year to August 2001. The percentage growth in the number of prescriptions and the growth in the number of prescriptions for therapeutic groups were also presented.

The drivers for the changes had been analysed and were due to a number of factors including the implementation of central policy initiatives such as National Service Frameworks. In addition local repeat prescribing initiatives were impacting on the number of days treatment on each prescription. Analysis had shown a marked change in the number of prescriptions for 28 days (or multiples there of) compared with 30 days (or multiples there of) between 1998 and 2001. The trend clearly illustrated a change to prescribing in multiples of 28 days.

Mrs Dalton explained that as a result of the prescription growth and the consequential impact on workloads the PPA had responded by re-training staff, introducing flexible working patterns, re-designing the process by which prescriptions were processed and making modifications to the PPA IT systems.

4 IMPACT OF DH POLICY CHANGES ON PPA INFORMATION SYSTEMS

Mr Ball, Director of Information Technology, presented a report on the policy initiatives from the Department of Health that were impacting on the PPA.

One of the main initiatives was the introduction of electronic transmission of prescriptions. Mr Ball discussed the timescales for implementation and the current status. An illustration of the models for each consortium involved in the pilot was explained and also the expected size of each of the pilots. Further information was provided on the PPA role in the development, evaluation and testing of the pilots.

The Government had recently published the document entitled "Shifting the Balance of Power" and Mr Ball explained the impact on PPA services deriving from that document. The PPA had commenced a communications exercise with various stakeholders to gather information in order to continue to provide its information systems throughout the transitional period and thereafter.

5 MANAGEMENT REPORT

Mr Scholte, Chief Executive, commenced his presentation with an overview of the Authority and the achievements during 2000/2001 on key service targets.

The Authority's recovery strategy in relation to Category D was summarised. The changes implemented to assist the Authority achieve recovery were explained. Mr Scholte reported that the Authority achieved full recovery on 11 October 2001 against a significant increase in prescription intake against that planned.

Improvements and developments during the year were highlighted. Service developments included verification of the Low Income Scheme, notification of prescription items switched, age printed concession and the availability of ePACT.net and the Prescribing Toolkit to PCTs. In addition developments to handle prescription growth and complexity, ETP and Drug Dictionary, scanning, image processing and regulatory changes such as the penalty charge scheme were undertaken.

The Authority made a commitment to improve communications and support its stakeholders by the introduction of the imPACT magazine, improving the web site and involvement in exhibitions and workshops.

Mr Scholte highlighted the future initiatives for the Authority such as nurse prescribing, new pharmacy contract, local pharmaceutical services, hospital prescribing and gluten free foods. At the same time the Authority would continue to improve its services and adapt and support changes deriving from Pharmacy in the Future, ETP and Shifting the Balance of Power.

6 QUESTIONS

i) Dr Rosie Waddingham, representing the Dispensing Doctors Association (DDA), asked that, whilst appreciating the position of the PPA as a body constrained by Government policy, when did the PPA feel they would be able to comply with recent NHS Appeals Authority decisions on personally administered items? Many of the DDA Members were unhappy that both they and more importantly their patients were inconvenienced and out of pocket through the continuation of a rigid but apparently incorrect interpretation of paragraph 44 of the GPs Red Book.

Mrs Dalton responded that Dr Waddingham was correct that the PPA operates the Department of Health (DH) policy within DH guidance. The PPA was in consultation with the DH on this topic and were aware that there had been a range of NHS Appeal decisions. Since those decisions revision 23 to the Statement of Fees and Allowances had been produced on which the PPA was currently taking legal advice and would advise Dispensing Doctors accordingly if its interpretation of the regulation changed.

ii) Dr Paul Thomas was interested to hear that ETP would improve services to patients but was concerned that the subject may have been approached from the wrong position. Dr Thomas advised that Dispensing Doctors provide patients with the prescription at the time it is required and that the information was already contained within their GP systems. He did not want to see tripartite systems in operation and was concerned that Dispensing Doctors had not been considered.

Mr Ball advised that Dispensing Doctors had been considered and would become part of the pilots at a point decided by the consortia.

iii) Dr Waddingham enquired when personally administered items such as "implants" would qualify for reimbursement.

Mrs Dalton responded that this was a policy issue for discussion between Dispensing Doctors and the DH. The PPA would be able to implement once they had been informed of the decision by the DH.

iv) Dr Thomas enquired when would items that were personally administered and included in Paragraph 44.5 be applicable for prescription charges.

Mrs Dalton advised that legislation stated that for those items that were dispensed a prescription charge was payable. If the item was personally administered no prescription charge was payable. For those items used in an emergency a mechanism through the practice allowance was applicable.

v) Mr Peter Nicholas enquired when the PPA would be able to make payments one month in arrears.

Mr Scholte responded that a policy decision would need to be made by the DH.

vi) Professor Ian Jones, Portsmouth University, enquired what mechanism the PPA used to identify whether medicines were in short supply.

Mrs Dalton reported that a mechanism exists between the PPA and the Pharmaceutical Services Negotiating Committee (PSNC) to identify whether a product was in short supply. The information was provided to the DH who make the decision whether that product was classified as "NCSO" for the particular month in question.

vii) Mr Jason Kilby, Leicestershire Health Authority, enquired if the PPA would be producing a timetable of payment and information availability.

Mr Scholte confirmed that it was the intention to publish a programme of future dates on the web site.

viii) Ms Suzanne Warnett, Greenwich PCT, enquired whether it was the intention to use clinical indicators on prescribing information to assist in identifying quality prescribing such as Read Codes.

Mr Ball advised that there was currently no intention to provide links to clinical indicators or Read Codes. If agreement was reached with all parties it may form part of ETP in the later phases.

ix) Dr Waddingham expressed concern regarding confidentiality of patient information as part of ETP.

Mr Ball confirmed that discussions were taking place within the DH regarding the confidentiality of patient information in light of ETP.

x) Ms Sogbetun Abimbola, PSNC, enquired whether the age printed concession would become permanent.

Mrs Stobbart responded that the concession was currently a temporary concession which had been extended for a further twelve months. If it was to become permanent that decision would be made in discussions between the DH and the PSNC. The PPA would be able to implement that decision.

7 CONCLUDING REMARKS

The Chairman thanked the members of the audience for attending and formally closed the meeting.