Home PCT direct supply of medicines and appliances
The following FAQs relate to centralised purchasing of medicines and dressings:
1. Can a medicine be centrally procured for supply direct to patients?
No. The Medicines Act 1968 restricts who can supply medicinal products by retail (i.e. to a patient). Only a registered retail pharmacy is permitted to supply non GSL medicines. There is an exemption for a doctor, who can supply to a patient of his.
Where a patient requires a medicine, doctors are required by the GMS Regulations to issue a NHS prescription. There are two exceptions - 1) where the doctor administers the medicine themselves (e.g. flu vaccine); and 2) where the patient has an immediate need for the medicine (e.g. out of hours supply).
A wholesaler is not entitled to supply direct to patients, as this amounts to a ‘retail' transaction.
2. Can a nurse employed by a GMS contractor supply a dressing that is being personally administered to the patient?
Yes. The NHS (General Medical Services Contracts) Regulations 2004 Part 4 52 (2) states that a GMS contractor may provide to a patient any drug, medicine or appliance, not being a Scheduled drug, which he personally administers or applies to that patient.
Therefore it would be acceptable for a contractor working under the GMS regulations to supply a dressing being administered to a patient.
3. Can a nurse supply a pack of dressings to a patient - not for personal administration/application by a nurse?
No. Centralised purchasing is a matter on which PSNC have previously sought advice of leading counsel. The NHS Act 2006 sets out, in section 126(1) the duties of a Primary Care Trust. Section 126(3) states that it is the duty of every PCT, in accordance with regulations which shall be made for the purpose, to arrange as respects its area the provision to persons who are in that area of (a) proper and sufficient drugs and medicines and listed appliances which are ordered for those persons by a medical practitioner in pursuance of his functions in the Health Service (further sub-sections make similar provision for other prescribers).
Section 126(8) then goes on to say that these services are referred to in the Act as "Pharmaceutical Services".
Section 129 sets out the provisions under which regulations for pharmaceutical services are made, and at sub-section 129(1)(a) states that regulations shall provide for securing that arrangements made by a PCT under s126 will (a) enable persons for whom drugs, medicines or appliances mentioned in that section are ordered as there are mentioned to receive them from persons with whom such arrangements have been made.
The applicable Regulations are the National Health Service (Pharmaceutical Services) Regulations 2005, No. 641 as amended. The regulations provide that pharmaceutical services shall be provided by persons included in the PCT list. These persons are chemists (persons lawfully conducting a retail pharmacy business and suppliers of appliances (appliance contractors). The High Court has held (Ex parte Moore (No 2) (1995) and Ex parte Wilson (1996) that under the scheme of the NHS legislation, it is the role of GPs to diagnose and prescribe, and that of pharmacists to supply medicines: that GPs are enabled to supply only by exception as provided in the Regulations. The exceptions are for dispensing doctors in rural areas where patients might otherwise have difficulty in obtaining prescribed medication, or where there is an urgent need.
PCTs are creations of statute and only have the powers given to them by Parliament. Their powers are set out in Chapter 2 of the NHS Act 2006, and they do not themselves have a power to provide pharmaceutical services directly. Section 129 requires the PCT to make arrangements - and those arrangements can be made only with pharmacy contractors, appliance contractors and dispensing doctors (appliance contractors are not authorised to provide drugs).
Therefore the PCT could not supply these products directly to patients via central procurement. The products would need to be obtained via pharmacy contractors, appliance contractors or dispensing doctors.
4. Could a PCT arrange for a patient to be supplied dressings from a small number of pharmacies as an enhanced service rather than via the normal prescription route?
The NHS (General Medical Services Contracts) Regulations 2004 Part 3 39 (1) states that a GMS contractor "Subject to paragraphs 42 and 43, a prescriber shall order any drugs, medicines or appliances which are needed for the treatment of any patient who is receiving treatment under the contract by issuing to that patient a prescription form or a repeatable prescription and such a prescription form or repeatable prescription shall not be used in any other circumstances.
Therefore if the dressings are being issued to a patient under NHS care, the dressing should be supplied to the patient using a prescription. It would not be appropriate for the GP to issue a private prescription or order by other means. (The exception is where the dressing is to be personally administered by the GMS contractor - see FAQ 2).
5. Could a nurse choose where to obtain a patient's dressings, on the patient's behalf?
A key standard of the ‘NMC code of professional conduct: standards for conduct, performance and ethics' is that ‘As a registered nurse, midwife or specialist community public health nurse, you must obtain consent before you give any treatment or care'. Patient consent should be sought on where to collect the patients prescription where it a prescription for ongoing care (i.e. not a dressing for personal administration by the nurse which the nurse could supply to the patient directly).
6. Could a PCT reduce its drugs budget by bypassing prescriptions and having medicines ordered under alternative arrangements which provide medicines at less than the price set out in the Drug Tariff?
See question 1. Even if PCTs were able to enter into arrangements which bypass FP10s, the cost savings envisaged would not be as high as expected.
The cost of medicines supplied on prescriptions is less than the prices detailed in the Drug Tariff - the Deduction scale (Part V of the Drug Tariff) is used to reduce the reimbursement of pharmacies for medicines purchased. On average, pharmacies will be reimbursed at about 10% less than the prices in Part VIII of the Drug Tariff.
In addition, medicines supplied against prescriptions are zero rated for VAT - purchasing medicines under other arrangements, could lead to the PCT being charged VAT.
The funding for the nationally negotiated pharmacy service is made up of fees, allowances and agreed margin on purchases. The balance between them is carefully managed, and the Department of Health makes amendments to ensure in year balance. The agreed margin on purchasing represents about £500m of the total funding and this ensures that purchasing of medicines is carried out efficiently. It also encourages competition between wholesalers.
As the global sum is fixed, reducing margin on purchasing means that the shortfall would probably be made up by an increase in the Practice Payment, which is paid directly by PCTs - so a decrease in drug costs leads to an increase in practice payments.
It should also be noted that reduction of prescriptions issued in an area could have a disproportionate adverse impact on the local pharmacies, since any adjustments to ensure full delivery of the nationally negotiated funding to compensate might be applied nationally.
Other Points to note:
For further support on this issue, please contact PSNC's Aylesbury Office
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