Andy Gray
Since 1996, pharmacists have become accustomed to looking to the National Drug Policy for guidance. As a Cabinet approved document, it has served to identify possible areas for legislative change, as well as spell out the ways in which practice should change to enable a better service to be rendered for a greater number of people. The policy contains an injunction that pharmacists should not be remunerated by means of a profit margin on medicines dispensed, but rather by means of a professional fee. Such a proposal not only makes perfect sense in terms of promoting rational drug use and generic substitution, but is also in line with efforts to ensure remuneration for activities which contribute to the attainment of desired clinical outcomes. It has often been the failure to provide appropriate remuneration for Pharmaceutical Care activities apart from the actual provision of the medicine itself that has delayed their implementation outside of pilot or demonstration projects. In this light, SAAHIP is particularly perturbed by the continued standoff between the Hospital Association and the Board of Healthcare Funders. While we understand the BCF’s need to contain costs, we would argue that any Pharmaceutical Scale of Benefit should include a fee-for-service component, regardless of whether that service is rendered in a retail or hospital setting. A per diem fee, differentiated by ward type, might well be feasible. Failure to do so will either result in the continued existence of the very perverse practices that the policy seeks to eliminate or in contraction of the range of pharmacy services provided, to the detriment of quality of care. However, the answer does not lie in a different percentage change in the current Scale of Benefit for hospitals, but rather in a total rethink of the system, in line with national policy and international trends.
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