Dear LPC,

We would like to thank you for the opportunity you have offered regards reviewing the pre-existing contract due to end March 2014. You consultation has been invaluable in steering CRI and Turning point in the commissioning of new contracts for pharmacies throughout Kent.

I believe it’s fair at this juncture to recognise that over the past number of years there has been significant strainbeing placed onbudgets in the private, statutory, voluntary and third sector organisations, with a continued expectation to continue and exceed productivity and effectiveness through more innovative ways of working.

CRI and Turning Point as providers of Drug and Alcohol Treatment Services across Kentand Medway, commissioned through local government, have come together to review effectiveness and efficiency in the delivery of supervised consumption and needle exchange services.

CRI and Turning Point are motivated by a commitment to improving and expanding treatment services offered to the wider Kent community, which I am aware, is also a shared value of the LPC.

When reviewing current delivery it was identified that the services we offer through pharmacies is limited to a number of sites. On reviewing the pharmacy coverage across Kentand Medway; we identified significant pockets of unmet need with regards to our client group, often resulting in them needing to travel long distances and causing particular problems when there have been poor weather conditions. From a demand point of view, it’s worth noting we regularly have pharmacies contacting our services stating they would like to offer services on our behalf. Unfortunately at this juncture we have to decline due to not having the additional finances within our budgets.

CRI and Turning Point have offered a number of solutions to the LPC to address this need as we recognise there are a number of barriers to improving the situation. The solutions are based on finances available, recognition of fundamental/practical costs for pharmacies, needs of the Kent and Medway-wide community and anecdotal feedback from both current pharmacies offering our services, and new pharmacists wishing to join the scheme.

Current Barriers:

  1. A high proportion of clients prescribed substitute medication are prescribed methadone. Any increase in payments to pharmacists for dispensing methadone has a significant financial impact.
  2. Suboxone is prescribed to a smaller percentage of our client group and is charged at the same rate as methadone. It is recognised that supervision time by the pharmacist of this medication is significantly more than methadone, which in actual fact is more comparative to Subutex, but not acknowledged in monetary terms for the pharmacists carrying out this task.
  3. Subutex is also prescribed to an even smaller percentage of our client group. Although it is recognised as taking a greater period of time for the pharmacist to supervise this medication, the payment is significantly higher than the national average charged per supervised consumption.
  4. Annual retention fees for pharmacists to remain in the Needle Exchange scheme currently stands at £480. As a standard ongoing cost this presents a significant barrier to expansion of the service as it’s not productivity/output related. There are examples of pharmacists with very low productivity in relation to this service, yet who still receive the retention fee. This is consequently financially ineffective, and it restricts the recruitment of additional pharmacies.
  5. CRI/Turning Point pay pharmacists to attend an annual training event. This is a significant cost paid out whilst also paying for the venue and refreshments on an annual basis, and is not typical of other areas we work in, where a commitment to attend training is negotiated as part of the LES. This funding could be utilised to increase provision in the wider community.
  6. CRI/Turning Point pay £5 to pharmacies who register a new client in Kent. This is a minimal cost as most new clients to a pharmacist are already registered on the system. However there is a financial impact with regards to time for both pharmacists and providers identifying, tracking and paying for these individuals when presenting.
  7. Clinical waste and co-ordinationis a further cost carried by CRI and Turning Point; if you register a new pharmacy for needle exchange, again there is an automatic ongoing financial outlay for the providers irrelevant to the productivity. Equally an impact on time monitoring usage and appropriate management of the removal of clinical waste to ensure cost effectiveness.
  8. “Start up” fees of £500 is an automatic payment to newly registered pharmacies to equip them to enable them to carry out the tasks commissioned. In all cases when CRI and Turning Point have been approached by pharmacies to join the scheme; the pharmacist has said this is an unnecessary payment. On discussion with pre-existing pharmacists, they have also said the same; however there is recognition that there are ongoing costs for the pharmacists that we would like to support.

I reiterate on behalf of CRI and Turning Point; our aim is to effectively use public monies to best serve the needs of the Kentand Medway wider community, to assure funds allocated by local government are used in the best way to provide good quality services, including expanding services to address unmet need.

As mentioned before current provision is both inefficient and does not meet the needs of Kent regarding this client group; as such we would like to invite you to support the following solutions below. The solutions both recognise the work carried out by pharmacies, the ongoing costs that pharmacies face in order to provide the services commissioned by CRI and Turning Point and for providers of the whole service to flexibly provide effective quality services for the whole Kent and Medway community.

Proposed solutions:

  1. CRI and Turning Point will increase the payment for supervision of consumption of Methadone from £1.82 to £1.85
  2. CRI and Turning Point recognise the increased time it takes for the supervised consumption of Suboxone, and will increase this payment from £1.82 To £1.90
  3. The payment for Subutex is significantly higher than the national average, equally not charged at the same rate as Suboxone which has similar timescales. CRI and Turning Point will pay£1.90 from £3.301stAugust14and charge as an overarching buprenorphine as a generic medication.
  4. CRI and Turning Point will no longer pay a retention fee as there is no outcome for this payment; however will increase the payment from £1.60 To £1.70 intotal, splitting the payment into£1.60 per for a single dispensing of needle exchange equipment and an additional 10p if needle exchange equipment is returned and recorded on NEO. This offers the ability for the payment to be incentivised based on productivity. CRI and Turning Point will no longer pay an annual fee for pharmacists to attend training provided by CRI and Turning Point. It is the responsibility of the Pharmacist to ensure their staff are competent to deliver this service, and their responsibility to evidence this to CRI and Turning Point as per national guidelines. CRI/Turning Point will continue to offer and provide annual training events at the costs to themselves. This provision will be free of charge to the pharmacists. CRI/Turning Point will also offer local individual training at the pharmacies throughout the year.
  5. CRI/Turning Point will no longer pay £5 per new client registered in Kent and Medway; this minimal cost will be considered as included in the dispensing costs.
  6. It is recognised that the transfer of clinical waste to pharmacies would create too much of a financial burden on smaller local pharmacies,therefore CRI and Turning Point will continue to fund and manage this element of the Needle exchange. It is worth noting that this decision will restrict the amount of needle exchange sites CRI and Turning Point are able to commission as this is a capped budget.
  7. CRI/Turning Point will no longer pay a “Start Up” fee as “standard” to pharmacies wanting to offer supervised consumption; however we will review each case on an individual site basis where a request is made by the pharmacist to support the implementation should finances be a barrier to offering the services. CRI/Turning Point may financially support the setting up of a pharmacist up to a maximum of £500. In addition to this CRI and Turning Point will also pay for Pharmacists and staff to receive their Hepatitis B vaccination course.

There is a limit on finances available in any service with which we have to work with, which has to be acknowledged, particularly as both Turning Point and CRI are non-profit making organisations.

As such having listened to all concerns, taken into consideration advice and guidance from “commissioned Services”, consultation with the LPC, guidance taken from independent pharmacies and again reviewed against service provision in other areas; CRI and Turning Point consider the new offer of contract to be considered and reasonable.

CRI and Turning Point will finalise the new contract currently in draft with a view to implementation with pharmacies on the 1stAugust2014 for 2 years which will be reviewed on an annual basis should there be a requirement to.

Thank you once again for your time, guidance and support on developing the new contract.

Yours sincerely,

Lee Ashmore. CRI Services Manager. West Kent Recovery Services.

Andy Power. Turning Point Operations Manager East Kent Recovery Services