If a pharmacist claimed too much money from the NHS, they would be “shown no mercy”, according to David Reissner, head of healthcare at Charles Russell solicitors. Even if the claim was a genuine mistake, he says, the NHS Counter Fraud and Security Management Service would step in and the pharmacist could find themselves at a police station or even struck off the register.
Yet when the boot is on the other foot, and NHS Prescription Services (part of the NHS Business Services Authority, NHS BSA) is underpaying contractors on a seemingly regular basis, no such action is taken. Just a few phone calls to contractors this week uncovered a raft of unsettling stories: NHS BSA is seemingly trying to put contractors off requesting pricing checks; the authority has lost submitted prescriptions; and the underpayments continue.
In her latest batch of recounts, Lila Thakerar, of Shaftesbury Pharmacy in Harrow, was underpaid by almost £4,000. And Umesh Modi, specialist pharmacy financial advisor at Silver Levene accountants, says he too is still seeing errors being made, often to his clients’ detriment.
Speaking at the C+D Conference last month, Sue Sharpe, PSNC chief executive, also admitted pricing errors were still a “massive problem”. She says the NHS BSA automated CIP payment system wasn’t introduced or tested properly and has not been fit for purpose.
The good news is that NHS Prescription Services head of client and customer services Michael Wood says he recognises the importance of accurately paying contractors and that they have a continuous programme of accuracy improvement. He also says staff are committed to pricing accurately.
But sometimes it just doesn’t feel like it. The standard apology note Ms Thakerar says she receives each time she is informed of an underpayment from the NHS Prescription Services does little to reassure her.
And the authority seems to make life difficult for contractors requesting payment checks. Mr Reissner said one client, who had been underpaid by NHS BSA by £180,000, asked for additional payments to be checked.
The NHS BSA refused to do this, despite the previous underpayment, saying it needed evidence for each month to be rechecked. The contractor concludes: “I believe they are trying to reduce their workload by insisting on evidence before rechecking scripts.”
Clearly engaging more proactively with contractors would be a very welcome start.
Ms Thakerar is particularly alarmed that she is never told how the money she is owed has been calculated, nor what the errors have been. Ms Thakerar would like to know this as it might help her see where errors are being made so she could improve her submissions to the NHS BSA and stop future errors. This dialogue, she feels, could help “avoid miscalculations so I’m not having to do this for the next 10 years”.
Mr Modi agrees transparency should be top of the agenda for NHS Prescription Services and Uma Patel, of Dunns Chemist, Cranford, says PSNC could also help with this. He would like to see the auditing data they do on payments. “I would like to see the results of their statistical analyses… that would make us comfortable [about pricing].” Or perhaps more uncomfortable, as the case may well be.
Alongside this apparent reluctance to work with contractors, the fact remains that pharmacists are still having to foot the administrative bill of the failed system. New sorting arrangements introduced in April take more work and, Mr Modi adds: “The administrative costs of checking the statements must run into hundreds of pounds over the year because clients do not have any confidence in the payments they receive.” None of which helps to boost NHS BSA’s reputation among contractors.
While there are little things that could make a difference now – such as a willingness to engage – many believe broader change is needed, and have called for the introduction of a new, transparent payment mechanism for pharmacy. The topic is set to be debated at PSNC’s upcoming LPC conference, where Hampshire & Isle of Wight LPC has submitted the motion that it has “no confidence in the ability of the Prescription Services to deliver their core function”.
Chief officer Mike Holden explains that he hopes this will push PSNC to pursue the matter actively and work to regain trust in the system. Mr Holden believes a new system in which pharmacists can accurately work out what they should be paid, and then invoice the NHS, is needed.
Transparency of payments was an NHS white paper commitment, so Mr Holden says he hopes it will happen, but it may take some work.
PSNC head of pharmacy audit Janet Edginton says PSNC is continuing to have discussions with the DH and NHS BSA to establish ways to improve transparency of payments and Mrs Sharpe told the C+D Conference the NHS BSA needed to be kept under some pressure, so perhaps now is the time to really start stepping that up.
As Mimi Lau, director of professional and training services at Numark, concludes: “It’s high time that we demand a new system which is transparent, robust and has high pharmacist confidence.”#