Teva Shun Tendering Plans 

The Department’s latest cost-cutting agenda was dealt a difficult blow at the end of July as one of the UK’s biggest manufacturers snubbed the generic tendering process in Northern Ireland. Last issue, NIPinF editor Laure James reported about the changes to generic procurement in the province, speaking exclusively to Terry Hannawin, chief executive of the PCC and Mark James, managing director at AAH Pharmaceuticals. Now this month, we can reveal that Teva UK has declined to submit a bid for the new primary care tender arrangements, due to start in April next year. As one of the UK’s largest drugs manufacturers, this is clearly not a decision that has been taken lightly, since those companies that successfully secure a tender stand to benefit significantly.

Teva MD John Beighton has written to Northern Ireland Health Minister Michael McGimpsey setting out the reasons why the firm has decided to stay out of the process. While Teva says it applauds the DHSSPS’s motives behind the tendering process, the company did not feel that there was enough information available, particularly concerning the impact on pharmacy, for it to be able to submit a tender. The company said there was no clarity on how the move would impact the supply chain and how pharmacists would be reimbursed.

In the letter, Teva told the DHSSPS that it felt the invitation to tender as published was “flawed” and made it “impossible to tender accurately”. It added that the proposals would; “not support a vibrant pharmacy industry in Northern Ireland and could ultimately damage the interests of pharmacists and hence those of patients.” The letter continued to outline a number of detailed objections to the design of the tender arrangements, although stresses that Teva, and the rest of the industry, remain keen to talk to the Department to help it achieve targets in improving patient safety and reducing costs.

According to John Beighton, Teva is particularly concerned that the proposals are not going to help the DHSSPS achieve the objectives it had stipulated and that pharmacy and wholesale could be damaged. “All stakeholders across the spectrum have said that they want to help achieve the Government’s aims of enhancing patient safety and making healthcare cost-effective,” John explained. “But, when even several years into the ‘Go Generic’ initiative generic prescribing is still behind the rest of the UK, it seems to us that there are better ways of getting what the Department wants to achieve; and we can help them do that.”

He added; “We must support the interests of our customers and their patients, but we are saying that, without further clarity, we do not believe this tender is doing the right thing by pharmacy, wholesale or patients across Northern Ireland.”

Neither the Pharmaceutical Contractors’ Committee, who have recently spoken out against the proposals, nor the Department were able to comment at the time of going to press.

DHSSPS ‘Cripple’ Community Care

If tendering had not created enough problems for stakeholders and in turn the Department, even proven programmes are at huge risk. The Department has determined that the Minor Ailments Service must cease on 31 July 2008 and that in order to continue to provide a minor ailments service pharmacy contractors must accept the following terms:

Up to 200 consultations per year will attract a fee rate of £8.00 per consultation. The next 400 delivered in a year will attract a fee rate of £7.00 per consultation. All further consultations in year will be paid at a fee rate of £6.00 per consultation up to a limit of 1300 consultations. Activity above this level will lead to reimbursement of drugs supplied and a normal dispensing fee. This means that pharmacies will go unpaid for every intervention above the 1300 cap.

The decision to cap the number of Minor Ailments consultations that can be carried out by pharmacists in Northern Ireland has sparked a widespread and furious reaction from contractors, the majority of whom have opted out of the scheme altogether, adamant that such a ‘short-sighted approach’ will ‘cripple patient care’.

One contractor, who did not wish to be named, spoke of his disbelief that the Department would take such measures. “Why jeopardise something that has proven benefits and which has had such widespread support from both patients and the profession?” he asked. “I think the real problems will start to emerge when GP waiting surgeries are occupied with twenty or more patients a day seeking treatment for hayfever and cold symptoms. Hopefully since GPs generally have more political weighting, they will campaign to reinstate the scheme.

“It is totally misguided and just as the Department did not hesitate to push through these plans without discussing it with the PCC, I did not hesitate to terminate my participation in the scheme. Minor Ailments was initially a very well managed programme, with comprehensive public promotion and a laudable objective to encourage self care in the community and reduce GP waiting times. It unfortunately is now just another example of the Department attempting to undermine the pharmacy profession.”

Belfast contractor Dr Terry Maguire believes that unless relations between the PCC and Department are restored quickly, negotiations will continue to be met with obstacles. “We have reached a critical point in the negotiation of the new pharmacy contract and therefore any attempt by the DHSSPS to sidestep the pharmacy body mandated to undertake this negotiation (PCC), such as attempting to negotiate directly with contractors on the MAS, is a very serious matter indeed,” he told NIPinF. “This move has angered most contractors and that is a key reason why we are resigning our MAS contracts.

“We all do this with great disappointment since it will disadvantage patients in the short-term but in the long-term we believe this is the right move. I believe that DHSSPS and PCC can reach a negotiated settlement on MAS and the other outstanding matters that make up the new pharmacy contract. But DHSSPS must appreciate that contractors are very much acting as one in these negotiation and should not attempt to use a divide and conquer tactic.”

The PCC has lodged a thoroughly well supported opposition in anger at the Department’s decision to destroy the Minor Ailments Scheme, insisting that the service is set to disappear altogether and that patients will lose out as a result of these “unreasonable” proposals. The PCC, who has said that pharmacies are finding it impossible to continue the service, has launched a vociferous and determined campaign; Save Our Service.

Speaking as the campaign was announced, PCC chair Gerard Greene commented; “The NHS Minor Ailments Service has been working extremely well in community pharmacies in Northern Ireland. Thousands of people have been able to access expert guidance and treatment for a range of conditions since it started in 2005, thus reducing the number of unnecessary visits to GPs. The public clearly value the service. The NHS has saved substantial sums of money through it.

“We are astonished that the Department of Health, Social Services and Public Safety has come along and torn the Service up. They are only willing to see it continue on terms that are completely unfair and unreasonable, and community pharmacies large and small therefore have no option but to withdraw the Service from 31 July, the deadline set by the Department. The Service is set to disappear and the public are set to lose out as a result of the Department’s unreasonable proposals.”

More than 200,000 people have used the service since its introduction. The PCC estimates that the NHS in Northern Ireland has saved £8.05 million through the service, based on the cost of a pharmacy consultation against a GP consultation, although this seems to have had little influence in the Department’s decision.

“Pharmacy contractors are angry and perplexed. We want to continue the Service. Today, the PCC and pharmacies across Northern Ireland are launching a campaign to Save Our Service. We will be seeking the support of the public in urging the Department to allow the Service to continue on fair terms.

“It is unacceptable for officials to play fast and loose with such an important, highly valued public service. It is time for the Department to see sense and behave reasonably.”