practice matters · 2019-06-03 · whatever your commercial or dispensary query, forte members are...

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May 2019

PRACTICE MATTERS

Welcome to our May edition of Forte Your Practice Matters Bulletin.

Spring has now finally sprung and I hope you all had an enjoyable Easter and Bank Holiday period - one of the busiest times in the healthcare calendar.

Speaking of busy times, our team at Forte have been moving fast and implementing some fantastic changes to further enhance our service to members.

It’s been six months since we consolidated our operations and re-launched as Forte - in order to streamline our efforts and offer our members enhanced services. Let’s reflect on what we’ve achieved:

• Complete over haul of functionality and services on our website: www.forte.uk.com

• Migrated our Forte offices over to the Alliance Healthcare Support Centre in Chessington

• Redesigned our financial offering across multiple categories

• Implemented our e-missings service – mandatory for all members since 15 April

• Increased our field team for complete national coverage

• Installed and expanded our new telesales team

• Enhanced our communications – with our quarterly Forte Your Practice Matters Bulletin

Speaking of our Forte Your Practice Matters Bulletin, here’s what you can expect to read in this issue:

• Our E-consultancy service - to support our members with any commercial or dispensary query

• The value of Dispensing Doctors - Mark Stones writes a brilliantly informed piece on the much discussed value of the profession and services it offers the local communities

• Streamlining dispensing - Caroline Thomas shares some practical tips and ways to reduce costs and offer a more efficient service for patients

• MDS updates - to ensure your practice is kept in the know and making the most of your prescribing choices

I am sure you have noticed these improvements and positive changes, and we’re working hard to continue these improvements. If you have any suggestions of how we can better assist you - our members, please don’t hesitate to talk to your Business Development Manager (BDM).

From all here at Forte, we wish you a wonderful Spring.

E – CONSULTANCY SERVICEWhat is E-consultancy service?

It’s an entirely independent consultant and advisor that can answer any queries and offer advice to all our Forte members via our e-consultancy service.

Whatever your commercial or dispensary query, Forte members are able to contact our independent dispensing contractor to answer any dispensary queries you may have.

We can also provide you with advice regarding all dispensing matters, with a particular focus on finance, purchasing and profitability.

We at Forte know that time in the dispensary is scarce, and that running a successful and profitable dispensary requires discipline, protocol and team work. So rather than spend those precious hours

out of dispensary why not simply contact our consult for quick, concise and valuable advice - allowing you to focus on what’s important, your team and your patients.

To find out more about how we can help you, visit www.forte.uk.com/ e-consultancy/- fill in your contact details and provide us with a short description

of your query.

A response will be emailed from our consultant within 3 working days.

The Forte Team

Forte editorial by Ben Miles

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These are the headlines and claims made in recent BMJ Open paper published by the group of Oxford academics that have co-created the ‘Open Prescribing*’. It can be seen by the statements made in the paper that authors hold somewhat arrant opinions on dispensing doctors. The BMJ Open paper seeks to directly compare the prescribing of four classes of medicines (statins, proton pump inhibitors, angiotensin receptor blockers and ACE inhibitors) between non-dispensing and dispensing practices. The authors aim was to determine whether dispensing doctors are more likely to prescribe ‘high-cost’ options for the four medicine classes, because of the stated ‘potential conflict of interest’.

The authors made a key assumption, they state “practices can generate additional income by negotiating lower prices on higher cost drugs” (by higher cost the authors mean a branded medicine), and this they say causes the ‘potential conflict of interest’. All dispensing practices will know that many ‘higher cost’ or branded medicines cause a loss to dispensing practices, because the manufactures limit discount levels to well below the 11% discount clawback taken back from practices by the NHS. Dispensing practices are much more likely to be better off by prescribing generically and seeking the cheapest

deal in the medicines market for that product. This fact shows a fundamental lack of understanding in the authors’ knowledge on the nationally agreed remuneration model for dispensing practices.

Saving opportunities cannot be ignored by an NHS being starved of investment, so of course the headline on the BMJ Open paper that appeared in the daily press was that the authors identified a saving of £7,546,502 per year. However, the validity of this saving is imaginative at best and fanciful at worst.

“We have identified clear evidence that many doctors

are responding to a financial conflict of interest.”

DISPENSING DOCTORS: CONVENIENT, INTEGRATED, AND HIGH PERFORMING, BUT DO WE COST THE NHS MORE?Mark Stone, Pharmacist partner Tamar Valley Health, DDA board member

“The cost savings for the NHS in England that would accrue if dispensing practices prescribed drugs with the same prices as non-dispensing practices from all four classes are £628,875 per month or £7,546,502 per year”.

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Forte generics dispensing doctors price list

Forte generics price list has gone paperless. For your convenience and in an effort to reduce paper usage and improve our environment impacts.

Download via our web ordering site: Forte - Alliance Healthcare Direct at:

direct.alliance-healthcare.co.ukForte generics

dispensing doctors

price list

September 2018

We are going paperless!

Printed versions will no longer be

available after September 2018

Download now on

Alliance Healthcare Direct. If you are not

yet registered, please do so via

direct.alliance-healthcare.co.uk

Forte Pharma_September_2018_01.indd 1

29/08/2018 17:22

To calculate the saving, the authors who are very adept at using ‘big data’ decided just to use one month’s prescribing figures, from January 2015 and extrapolate the savings for that month over a year. Choosing one month’s data for prescribing will always deliver anomalies as the Drug Tariff price is continually changing, for example ebbs and flows in Category M reimbursement levels, loss of patents, and stocks issues. It then begs the question why did the authors choose January 2015? Most likely to ensure they ended up with a negative headline on dispensing doctors.

In January 2015 there were several one-off occurrences, category M reimbursement levels were decreased by £7.3 million for that quarter (decreasing generic Drug Tariff prices), valsartan was in short supply meaning that dispensing practices would have been prescribing the brand so not to lose money. In addition, there were several patent losses in the four therapeutic areas investigated, Amias and Lipitor had lost patent in (2014 and 2012), while Olmetec and Crestor used commonly prescribed by dispensing practices had not. When you combine all these factors you can see the reason why January 2015 was chosen by the authors, probably over the other months they had analysed.

Finally, the authors make the statement “We have identified clear evidence that many doctors are responding to a financial conflict of interest”. However, in the discussion section of the paper the authors identify the weakness of the work: “given the cross-sectional design of the study, we are unable to determine a causal relationship”. This statement somewhat contradicts the first heading, as the paper does not evidence a link between the financial interests in dispensing and the cost of medicines.

In summary, this paper uses dated prescribing data, chosen specifically to support the authors’ opinions on dispensing doctors. If this data was re-run using more recent prescribing information, it would show that the difference in prescribing costs would be very minor to insignificant. Nevertheless, this does not mean we as dispensing practices give less attention to our responsibilities to the NHS. We need to ensure that our prescribing is (in priority order) firstly: safe and effective, secondly: cost effective for the NHS, thirdly: where necessary - is tailored to the individual patient, and lastly supports our business.

* https://bmjopen.bmj.com/content/9/2/e026886

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E-missing is now the sole route to processing missings claims - please ensure your practice is now using the e-missing portal.

E-missings Going Mandatory Our online portal makes processing a missings claim easier than ever. The process is now mandatory and offers many benefits for the user.

What does this mean?This means that from the end of May 2019, all customers will enjoy the following e-missings system benefits:

▸ Quick processing of missing claims - no more waiting for your driver to collect the paper form.

▸ Reduced risk – operating in a safe and secure setting, your email can’t get lost and you receive an immediate response providing a Claim Reference Number (CRN).

▸ Quicker responses - when your claim has been passed for credit, you will receive an automated email confirmation of receipt and keeping you informed of how your claim is progressing.

We wrote to you last month to inform you of our commitment to doing things differently, and how we have implemented a number of positive changes to make doing business with us easier.

If you recall, as part of this, we recognised that you wanted to see improvements to our missings claims process. Following a successful pilot trial with customers across the country throughout the summer, our new online e-missings system was rolled out to all customers from September 2018.

What is happening now?

▸ Customer are really embracing this new digital system.

▸ Over 75% of customers are using it to claim credits for missing goods.

▸ Please ensure your practice is now using the e-missing portal.

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▸ Reduced information required - all you need to do is enter your account number and postcode, no need to write out the whole address anymore!

▸ More efficient claim process - with the ability to claim for a whole parcel without writing out each line.

▸ Simple to use – just type in the PIP-code and the system will intuitively identify the rest of the description for you.

What you need to do now

You don’t need to wait until the end of May, the e-missings portal is ready to be taken advantage of from now. The system is extremely simple to use and is accessible via our website -

To log in, you just need to have the following to hand:

▸ Customer number

▸ Delivery postcode

▸ Invoice number to identify the account and location where you bought the product. (This is important should you have multiple stores or accounts).

Please also bear in mind that any other type of return process i.e. damages, or products ordered in error remains the same. Time frames for claims and returns will also remain the same. To remind you credits for missings must be submitted within one day of delivery, or immediately for a Controlled Drug’.

Please refer to our T&Cs for claiming missings: www.alliance-healthcare.co.uk/useful-information/ our-terms-and-conditions

We understand change can be daunting, but please be assured that we are here to support you and are confident that once you start using the system, you’ll wonder why you didn’t use it sooner.

And you are helping to make a positive environmental impact – saying goodbye to pink paper slips reduces paper consumption, which has to be a good thing.

SUPPORTING YOU TO GET ONLINEHere’s how you can get some assistance if you need it:

▸ Please read through the enclosed Guide to e-missings, a step by step guide on how to use the new system. It shows you what you will need to do when processing a missing parcel, line or picking error and includes a frequently asked questions section at the end.

▸ This is also available to download from our website at http://www.alliance-healthcare.co.uk/e-missings-portal

▸ Contact customer service on 0330 100 0448 and they can walk you through the process over the phone.

▸ Contact your usual Alliance Healthcare account manager and they can assist accordingly.

▸ Visit our e-missings video user guide at https://www.youtube.com/watch?v=prAJKuk4Haw&t=1s

Thank you in advance for your support and co-operation with moving the claims version on line.

Please do not hesitate to reach out to us if you need any help at all.

*Please be aware that OTC Direct is currently not within scope but we are looking to incorporate it at a later date.

Or if you’ve requested to be set up you can see the parcel number on the invoice as shown below:

6. Does your system work in Chrome and Firefox? Yes, our e-missings site is compatible with Chrome and Firefox internet browsers. Unfortunately our system

does not support Internet Explorer 7. How do I know what pip-code I am claiming for?

On your invoice, the pip-code is the 7 digit numerical reference that can be found immediately underneath the

product description. 8. Can I expect more digital developments to Alliance Healthcare processes?

We are always looking for ways to make doing business with us easier and digital can provide us with an

excellent opportunity to enhance our service to you. What’s more, we are reducing our paper usage therefore

reducing our impact on the environment.

9. The system won’t accept my 5 digit parcel number? Most parcel numbers are 6 digits. Please enter a ‘0’ before the first number and submit your claim as normal.

10. I have a miss-picked item I want to return, can I use this system?

Unfortunately not at the moment. As you have goods to physically return to your Service Centre, please fill out

the standard missing goods claim form and hand the sheet to your driver along with the returned items in the

normal way. 11. I have a miss-picked item that I want to keep, can I use this system?

Yes! Please complete the online form as explained in our Customer User Guide.

12. I’m not sure what to put in a box, help!

Please move your mouse over the box and a handy pop up appears telling you what you need to enter.

13. The system won’t accept the date I am entering, why not?

Please ensure you are using the correct format of DD-MM

7 digit pip-code

Submitting a claim where an alternative product is received (returned items only – sometimes known as a returned

miss-pick) 1. As you have goods to physically return to your Service Centre, please fill out the standard missing goods

claim form and hand the sheet to your driver along with the returned items in the normal way.

1. What email address can I use? We suggest using an email address which you regularly use , as this is the email address we will communicate

with you . We will email your Claim Reference Number and confirmation when it has been completed. Please

note, your credit note will be delivered via your driver as normal.

2. Can I re-submit old claims on this system? The e-missing system is designed for new claims only. Old claims previously submitted will be administered

through the current paper process. 3. Do I still need to complete a Missing Goods Claim Form?

No, by using the e-missing system, you automatically receive a Claims Reference Number (CRN) a few minutes

after you submit your form. If you don’t receive one please check your junk mail and add us to your ‘safe

senders’ list.

4. I’ve tried logging in and there is an error in my credentials, what should I do? Please ensure you are using your registered delivery post-code. If this still doesn’t work please contact

Customer Service who will be able to verify you are using the correct information.

5. How do I find my parcel number? Parcel numbers can be found on your white or green tote labels, as shown below:

Frequently asked questions

Submitting a Missing Claims 1. In order to submit a missing claim, please go to: https://missings.wbasystems.com/pharmacy/login 2. Enter your Alliance Healthcare Account Number and Delivery Postcode, and then Enter. 3. Please type in the email address you want your acknowledgement and response sent to. 4. Select the reason for your claim; you can choose from; Missing Line (no alternatives received)

Missing Parcel (no alternatives received) or Incorrect Item Received – will be retained (sometimes known as a retained miss-pick)

Submitting a missing line claim 1. If you are claiming for a missing line please enter the quantity. Then type in the pip-code and wait a few seconds, select the product from the list presented. The description field will automatically complete. 2. Please enter the invoice number, invoice date and delivery date. 3. If you need to claim for anything else click Add Additional Item. Repeat this step as many times as required. 4. Tick the declaration. 5. Click Submit Claim.

Submitting a missing parcel claim 1. If you are claiming for a missing parcel, please enter invoice number, invoice date, delivery date and the parcel number at the end of the row. 2. If you need to claim for anything else click Add Additional Item. Repeat this step as many times as required. 3. Tick the declaration. 4. Click Submit Claim.

Submitting a claim where an alternative product is received (being kept items only – sometimes known as a retained miss-pick) 1. If you are reporting a claim where you have received an incorrect item, please enter the quantity. Then type in the pip-code and wait a few seconds, select the product from the list presented. The description field will automatically complete. 2. Please enter the invoice number, invoice date and delivery date. 3. If you need to claim for anything else click Add Additional Item. Repeat this step as many times as required. 4. Tick the box that says ‘I received goods in the place of the missing goods’. 5. Please enter the quantity and description of the over supplied lines, that you are keeping, as before once you enter the pipcode, a suggested list of items will appear for you to select from. 6. Tick the declaration. 7. Click Submit Claim. All claims – after clicking submit a) You will then be shown your Claim reference Number (CRN) on the screen. A copy of this will be emailed to you at the email address you entered at the start along with a list of the items you have submitted for credit. If you have received additional items that you are keeping, these will also be confirmed on this email. b) Once your credit has been processed you will receive a confirmation email back advising that your credit has been paid and your credit note will arrive via your driver in the usual way, for your reference this also contains a list of items that have been credited. c) In the unlikely event that your claim is not passed for credit a member of the missings team will email you an explanation along with a list of the items that have not been passed for credit.

This guide is designed to help you process a missing claim via the e-missing system. It shows you what you will need to do when processing a missing parcel, line or picking error. Once you have submitted a claim you will receive an email confirming what you have claimed for and giving you a Claim Reference Number (CRN). As soon as your claim has been processed you will receive a second email confirming the outcome. Credit notes continue to be delivered via your driver as normal. Please also refer to the frequently asked questions section at the end of this guide. If you require any further support or have any additional questions please contact Customer Service on 0330 100 0448.

Customer Guide to E-Missings

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TIME IS MONEYCaroline Thomas, Dispensary & Finance Manager, Baddow Village Surgery

Have you ever thought how you can stream line your dispensing process? What happens when your patient needs to come in for a medication update? Who process’s the update? For me the most expensive person to do the ‘medication update’ is the GP. I decided a few years ago to review the medication update process to see if there was another way.

Coming from a chemist pharmacy background, I had been steeped in a history of SOP’s, (standard operating procedures). SOP’s when written correctly offer a safety net to any GP Practice. They make sure that everyone follows the same protocol and that the protocol is never deviated from.

▸ My objectives (using System One)

▸ Streamline prescription process

▸ Review medication update process

▸ Make sure all QOF targets are incorporated

▸ Avoid un-necessary GP appointments

▸ Avoid spending time on un-necessary TASKS.

The first thing that I needed to do was to categorise all medication using the BNF. Working with my lead GP, we

devised a medication up-date protocol. This was based on drug type, blood test, BP and any QOF indicators. My GP’s were spending hours of their time updating medication, which could easily be done by my dispensary team if the correct protocol was followed.

▸ What’s happening now?

▸ Prescription request from patient is either on line or on paper from the chemist

▸ Dispenser prints script and TASKS GP if a medication update is needed

▸ GP updates medication, using their precious time.

Over a period and with the input of all the GP’s I devised a medication up-date protocol. I appreciate that each surgery is different but at my surgery we worked on a 6 monthly medication update protocol. We used the number of issues

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as a basis to communicate with the patient. Using NICE guidelines, we made sure that each patient received the correct blood tests, BP reviews, based on the medication type. Most of all I did not use up my precious GP’s time and they only saw the patient if that was part of the medication up-date protocol.

Using System One, there are numerous ways to communicate with the patient and I used this to make sure that our patients and the chemists were aware of when our patients needed to come in - or if they needed a blood test or BP check. Over time, what happened was that instead of medication updates being ‘bespoke’ to each GP, each has their own way of updating. All patients were treated in the same way. For my surgery this year we have the best

BP and blood test results across the country as every patient follows the exact same update process. All the blood tests result, or BP results are completed before the GP sees the patient, so no unnecessary time is wasted. If for example a patient does not fit into the medication update protocol, then they are automatically tasked to the GP for a medication review.

With every system, there are invariably problems. What if the patient does not come in and have a BP check or a blood test? What if the patient does not read their counterfoil or listen to the message on their mobile phone? As a surgery, the most important thing is that we do not stop the patient’s medication. We first make sure that they have been contacted in the following way:

Forms and order of communication with the patient. 1. Counterfoil 5/6

Task GPReauthorise –

print and send ETP

TASK Team updates with details of what is required.

TASK Team update accordingly to SOP

Send to TASK Team /if GP on holiday go 6/6 if

TASK Team

Forms & order of communication with patient

*Counterfoil**TEXT

***Phone call

Dispensary prints 6/6 with note and appointment on

counterfoil (Highlighted if paper version.

Chemist to ask patient to sign counterfoil if electronic)

Dispensary

Complex? OK?

Requires TEST/APPT?

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Forms and order of communication with the patient. 2. Text 6/6

Forms and order of communication with the patient. 3. Phone call 7/6 (GP made aware)

Dispensary

Check any old tasks or notes?

TASK Team

TASK Team - update according to SOP

Task GP to review

No?

Yes?Has it been done?

Send task to reception if further test/appt needed/

or Dispensary book

OK?

Complex?

Dispensary. Print with note over issue, go 7/6.

Yes?

**Contact patient with copy of message from

counterfoil

No? Requires test/appt?

Dispensary

Send to TASK Team

TASK Team - check previous tasks or notes

(Has previous request been done?)

CD / Methotrexate / Complicated update?

Task GP

TASK Team updates Reception contact patient and book appt or

Dispensary book

Task reception to book appt required

Dispensary re-authorise for one issue

(***Put note on script and send SMS)

Explain to patient that their medication is due for review and that need to do exactly what was previously specified. Prescription can be issued once appointment is booked.

Yes? No?

No?

Yes?

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Ultimately patients need to be responsible for ordering their own medication and managing their own health problems. It is equally important to establish a good relationship with your local chemist so that they understand how the medication update process works. We have been using the medication update process for several years now, and in terms of ‘patient safety’ it is extremely safe, and we have not had one serious incident. If you were to do this at your own GP practice, the most important thing is that you make sure that your ‘medication up-date’ SOP is overseen by all your GP’s. This ensures that they each have had an input into the SOP’s safety. You will also need to make sure that your Dispensary staff do not deviate from the process.

▸ Outcomes

▸ GP time is only used for necessary work that only GP’s can do

▸ Money and time are saved

▸ GP’s have a better work/leisure time balance

▸ Medication TASK update protocol is continually being updated based on evaluation of further outcomes.

Best BP and blood test results in the whole of the UK, based on Eclipse live data.

Forms and order of communication with the patient. 4. Letter 0/1

At this point, we issue the medication but only a week at a time until patient has their blood test or does their BP reading. All of this is documented on their journal.

MANUFACTURER UPDATE

New MDSJANUARY 19 Ethypharm

Supplier Product PIP Code MDS discount

Ethypharm ANGITIL SR CAP 180MG 2129732 30%



Ethypharm ANGITIL XL CAP 240MG 2467264 30%

Ethypharm ANGITIL XL CAP 300MG 2467272 30%

Ethypharm VENLALIC XL PR TABS 225MG 3450616 20%

Ethypharm VENLALIC XL PR TABS 37.5MG 3630167 20%

MARCH 19 A Menarini


A Menarini CALFOVIT D3 SACH 1200MG 28919841-9 packs = 4%

10-50 packs = 9%

A Menarini PRILIGY FC TABS 30MG 3585338

1-9 packs = 15%

10-50 packs = 25%




1010

APRIL 19 B Braun


B Braun FORA ADVANCE BLOOD GLUCOSE TEST 4093282 15%

B Braun FORA ADVANCE KEYTONE TEST 4093290 15%

MAY 19 Ethypharm


Ethypharm FENCINO TRANSDERMAL PAT 12MCG 3649936 25%



Ethypharm FENCINO TRANSDERMAL PAT 50 MCG 3649969 25%

Ethypharm FENCINO TRANSDERMAL PAT 25 MCG 3649977 25%

Ethypharm IPINNIA XL PR TAB 2MG 3948858 25%





Ethypharm PIPEXUS PR TABS 0.26MG 4034716 15%







Ethypharm XAGGITIN XL 18MG 4041752 20%




MDS AmendedJANUARY 19 Leo Pharma


Leo Pharma INNOHEP 20.000 IU/ML VIAL 2337905 12%

Leo Pharma INNOHEP SYRINGE 10.000IU 2372381 12%



Leo Pharma TINZAPARIN SYRINGE 3500IU 2533107 12%


Leo Pharma INNOHEP 10.000 IU/ML VIAL 2599496 12%







Leo Pharma INNOHEP SYRINGE 8.000 IU 3939642 12%


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MARCH 19 Takeda


Takeda VIPDOMET 12.5MG/1000MG TABS 3849296 40%

Takeda VIPIDIA TABS 6.25MG 3850112 40%

Takeda VIPIDIA TABS 12.5MG 3850120 40%

Takeda VIPIDIA TABS 25MG 3850138 40%

MARCH 19 Kora


Kora FLUOMIZIN 10MG VAGINAL TABLETS 3985348Call for details (TBC)

Kora CATEPHEN 10% OINTMENT 3969227

MARCH 19 Kora


Roche Diabetes ACCU-CHEK AVIVA BLD T/STRIP 3171253 10%

Roche Diabetes FASTCLIX LANCETS 3512795 7%

Roche Diabetes ACCU-CHECK PERFORMA T/STRIPS 3981214 15%

Roche Diabetes ACCU-CHEK MOBILE TEST CASSETTE 4026324 20%




Leo Pharma ENSTILAR FOAM 50MCG/G 0.5MG/G 4019568 15%

Leo Pharma ENSTILAR FOAM 50MCG/G 0.5MG/G 4073151 15%

MARCH 19 A Menarini


A Menarini KERAL TAB 25MG 2609303 50%

A Menarini KERAL TAB 25MG 2661502 50%

MDS RemovalFEBRUARY 19 Cipla

Supplier Product PIP Code

Cipla KELHALE BECLOMETASONE 100MG/DS 4081113

Cipla KELHALE BECLOMETASONE 50MG/DS 4081121

MARCH 19 Bayer

Supplier Product PIP Code

Bayer LOGYNON TAB 2409753

Bayer QLAIRA 26+2 FTB TAB 3464237

T 0370 241 8717

E [email protected]

W forte.uk.com

Alliance Healthcare (Distribution) Limited trading as Forte A company registered in England and Wales.

Registered Office: 43 Cox Lane, Chessington, Surrey KT9 1SN. Company Registration Number: 4023414

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practice matters · 2019-06-03 · whatever your commercial or dispensary query, forte members are...

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