Tuesday, 9 December 2014

Specials White Paper - Value and quality for the NHS

NEW White Paper – How Specials can deliver value to the NHS without compromising patient safety.

The APSM, Association of Pharmaceutical Specials Manufacturers, has launched a White Paper which for the first time attempts to attribute an economic value to the provision of unlicensed medicines within the NHS.  The paper takes a series of typical patient scenarios where a Special is indicated and then identifies the potential cost to the NHS of attempting to meet patient need with a lower cost, or higher risk alternative.  In all of these cases this additional cost has exceeded that of providing a special and sourcing it according to established guidance.
The White Paper was commissioned in the light of growing concern about cost pressures leading to higher risk practice in the supply chain.

Striking the balance between cost and quality
Specials account for approximately 1% of prescription costs and in recent years, as part of overall pressure on NHS budgets, the cost of Specials has come under scrutiny.  Costs are regulated by Tariff and in the last 3 years the overall cost of specials has reduced by almost 30%.
Specials must be produced to pharmaceutical standards, but there are concerns that increased pressure to reduce cost could be compromising quality through sourcing lower cost supply, or even reluctance to prescribe a Special when required.
In a recent survey amongst GPs, 54% said they had been asked by their CCG to reduce prescribing of Specials1.  In the same survey, 45% of GPs stated that they were happy to prescribe a licensed medicine with instructions to the patient to split or crush capsules or tablets – compared with just 29% in 2012.   The risks of tablet crushing are well documented and, the APSM believes, is just one example of how continued pressure to reduce cost could be forcing prescribers and dispensers to opt for higher risk options for meeting patient need.  
In this respect the APSM strongly supports the cautionary comments of the British Medical Association recently in relation to the doctor’s role in optimising the limited resources of the NHS.     "While staff and management should work closely to maximize the use of the NHS's very limited resources, a doctor's primary duty is to their patient, and it is vitally important that decisions around patient care are around clinical value."2
This White Paper sets out to explore the true cost of selecting a higher risk alternative and how a well regulated and high quality Specials sector can provide value to the NHS.  Through a series of case study scenarios, it looks at what happens when patient need and safety is compromised to the extent that there is additional cost incurred to the NHS.  In all of these cases this additional cost has exceeded the initial cost of providing a Special in line with the established guidance.
There is robust guidance and regulation in place to ensure that Specials should only ever be prescribed when there is no alternative to meet patient need. However, when a Special is indicated, it is clear that attempts to cut cost in the supply chain are likely to result in increased demands on the NHS budget.

Says, APSM Chair, Sharon Griffiths.  ‘There is regulation and guidance to prevent unnecessary prescribing of a Special and as an industry we have a duty to support this.  However, when a special is indicated, we’re concerned that there is too much pressure on cost and not enough emphasis on patient safety.’
Cost is an inevitable fact of life and although it’s difficult to quantify the benefit to every patient of every individual special that is provided, as an industry, we felt we needed to find a way to demonstrate the value of specials and define what a high quality supply chain means to the NHS and to the patient.  We believe this White Paper provides a very clear justification of that value.’

Copies of the White Paper, are available on www.apsm-uk.com and can also be requested from info@apsm-uk.com


1.      1.  Survey conducted on behalf of APSM by Opinion Health