A local pharmaceutical committee (LPC) chief executive is advising contractors “not to sign up” to a new service level agreement (SLA) for a smoking cessation service over “unacceptable” fees.
Community Pharmacy South Yorkshire’s (CPSY) Vicki Roberts told C+D this week (February 17) that the SLA is “unfairly and unreasonably remunerating a service which if taken up by contractors could result in patient safety concerns” and financially it will mean pharmacies engaging with the service “will be doing so at a loss”.
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She had been updating patient group directions (PGDs) for the supply of varenicline with the local commissioner since a November 26 meeting where she asked to see the SLA, as generic supplies of varenicline were re-introduced after Champix supplies were withdrawn.
South West Yorkshire NHS Foundation Trust (SWYT) is the lead provider commissioning the PGD for varenicline in Sheffield, Barnsley, Doncaster and Calderdale, and Roberts said the fees in the SLA are the same as the fees offered back in 2018.
The fees offered by SWYT see an initial supply in Doncaster remunerated at £15, and a follow-up supply at £3. For Barnsley and Sheffield, the initial supply is at £15, and follow-up supplies at £3.
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Roberts estimated that the fee of £2.50 or £3 only amounts to “three minutes of pharmacists’ time” and said it is “impossible” to “clinically and professionally deliver a PGD service in that short period of time”.
“It creates clinical risk if a pharmacist tries to get through the consultation in three minutes or the pharmacy provides the service at a loss, and that causes even more financial jeopardy,” she added.
“Acting unprofessionally”
Roberts met with SWYT on February 11 and set out that the “fees are unacceptable”.
But SWYT already issued out the SLA to Calderdale that day despite Roberts requesting the varenicline service to be taken out of the SLA while they “continue to discuss the fees for that service”.
On February 14, the SLA was then sent out to Sheffield contractors with the same low fees in the SLA.
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“It’s just completely unacceptable that a commissioner is expecting us to do this,” she told C+D. “They sent out the Calderdale [SLA] and the Sheffield one three days after our meeting. They’re acting unprofessionally.”
Roberts requested to SWYT the SLA fees for varenicline to “address inflationary pressures, rising National Living Wage costs and the cost of providing a pharmacist-led intervention”.
The LPC chief said two options were offered to SWYT of a £15 remuneration fee for each of six bi-weekly supplies, or an initial £30 initial consultation fee plus £12 follow-up supply fees.
“Dire” situation
Roberts said her advice to pharmacy contractors she looks after in her LPC is “don’t sign up” to the Varenicline service until the fees have changed as it would be “a waste of your time”.
The advice is caveated by Roberts’s own admission it may lead to “a situation where no pharmacies sign up and no patients get access to varenicline … that would help them on their stop smoking journey”.
“Historically this service has not been adequately funded, and if we’ve got irresponsible commission of local services, it needs to be called out,” she said.
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“How can a pharmacist deliver a clinical and professional service that allows three minutes for a patient consultation?”
“In these dire financial situations, pharmacies are having to choose and be selective about which services they provide. When you have some national PGD services paying £15 for a consultation, why would you choose to do this at £2.50 or £3?”
It is not known yet if the SLA has been sent out to contractors in Barnsley or Doncaster at the time of writing.
Fees “historically different”
SWYT told C+D today (February 19): “we have met with representatives from Community Pharmacy South Yorkshire and Community Pharmacy West Yorkshire, and explained how each of our smokefree services are commissioned separately by the local public health teams in each geographical area.
“This means that contracts and financial arrangements can differ between areas. All of the contracts are negotiated based on different timeframes with defined budgets and on the specific needs of the local community.
“This ensures we provide value for money within the financial boundaries which are set, while maintaining service levels that meet local need.”
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Roberts wrote to Sheffield City Council’s director of public health Greg Fell on February 17 to make him aware of the “clinical risk and patient safety concerns” over the SLA. C+D contacted Sheffield City Council for comment.
She added one of her issues is that even though Barnsley, Doncaster and Sheffield all have the same commissioner of the service and use the same SLA, the fee structure has “historically been different”.
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While understanding that each area has different funding from their councils, Roberts argues “if you’re asking pharmacists to provide the same service, you need to offer the same fees”.
She added: “if SWYT reconsiders its position and offers a more appropriate fee that better reflects the professional input required, CPSY will reconsider our support for the service and will provide an update to contractors at this time.”