Wednesday, 8 July 2015


There are positive signs that the balance between cost and quality is being restored in the Specials market – certainly according to the latest annual Specials Survey, conducted by the APSM.

For the first time since the survey began in 2012, fewer pharmacists are referring to CCGs as the first source of advice about dispensing Specials (34% compared with 52.5% in 2013), turning instead to RPS Guidelines (47.5%) or the GP (47%). However, there is still evidence of pressure to reduce Specials spend with almost two thirds of pharmacists stating that they are monitoring spend on Specials, or that they are being asked by their CCGs to reduce or monitor Specials dispensing. 

The APSM Survey also points to the fact that pharmacists have a good understanding of Specials (over 75 % feel they have enough information or experience compared with 57% in 2013) and have a positive view of the role of Specials, with 80% agreeing that they are essential to meet the special clinical needs of some patients. 

There is also encouraging evidence that the practice of splitting or crushing tablets – perhaps as an option to reduce cost – is losing support.  41.5% are comfortable to dispense tablets with instructions to split or crush, compared with 52.7% in 2013.  This is echoed in a parallel GP survey, which showed the number who were comfortable to prescribe a licensed medicine in this way has decreased slightly from 64.2% in 2013 to 53.5% today – although many would argue that is still too high for such a potentially risky practice which effectively renders the drug unlicensed. 

Although there is still concern that Specials may sometimes be prescribed unnecessarily, this is reducing –to 35% of pharmacists respondents strongly agreeing (compared with 54.6% in 2013).  We can see this reflected in the fact that 43% of respondents said that they had declined to dispense a Special in the past on the grounds of necessity or cost.   This is potentially a good sign that pharmacists are following guidelines and if necessary questioning the need or formulation with the GP first. We know from a parallel survey of GPs that they are in general much less knowledgeable about Specials (54% feel they don’t have enough knowledge or experience) and the mechanisms are in place between dispenser and Specials manufacturer to avoid unnecessary prescribing. 

However, there are anecdotal reports about patients sometimes being refused a Special on the grounds of cost rather than necessity.  This is a matter of concern and our GP research shows that GPs are certainly less confident and comfortable about Specials than pharmacists.  GPs are in the frontline and facing difficult decisions about balancing cost and quality. 

The APSM research still reflects an undercurrent of concern about cost, but this is not exclusive to Specials.  Everyone is trying to find efficiencies across the NHS and we are all mindful of this.  APSM members are operating in an increasingly competitive environment – the demands of the MHRA are greater than ever in terms of quality and this doesn’t come without a cost.  The APSM is committed to continuing to meet these standards required of us.  There are no short cuts to quality.

These are good signs that initiatives such as The Tariff, RPS Guidelines, improved information systems and quality infrastructure have resonated with pharmacists.  Our research continues to underline that the Specials Tariff has restored confidence in the supply chain (67.5% agree).  As an industry we need to continue to work with community pharmacists to ensure that they are well supported and continue to get value from the Specials supply chain.

Source.  A survey of 200 Community Pharmacists and 200 GPs.  Conducted by Opinion Health. May 2015