APPENDIX 8
Letter from the Chief Pharmacist George
Elliot Hospital NHS Trust to the Chairman of the Committee (GD
11)
The Pharmaceutical Journal arrived over the
weekend and I noticed that you were inviting evidence about Generic
medicines. In view of the fact that the evidence has to be with
you by 11 a.m. on 1 November, this is going to be a very brief
note. If further details are needed I would be happy to help.
I understand, empathise with and welcome your
concern about the impact on the drug budgets of PCG's due to increases
in prices of generic medicines. I am writing to alert you to the
fact that similar impact has been occurring in the hospital sector,
and the hospital pharmacists have been alerting the various committees
for many months. However, it seems little notice has been taken
of this. It certainly has not resulted in adjustments of the drug
budgets to the hospital sector.
I will illustrate with just two examples. The
price of Digoxin 250 micrograms tablets has increased by nearly
500 per cent (pack of 28 now costs 42p whereas we used to buy
a pack of 1,000 for £2.64). A pack of Thyroxine 28 tablets
now costs us 33p whereas we used to buy 1,000 for £1.29.
This represents an 800 per cent increase. Both the drugs are very
commonly used, one for heart failure and the other for hormone
replacement. Both these purchases have been made in the last few
months so the prices quoted are recent examples. Both drugs have
been purchased through our well established and excellent Central
Division Contracts. So, even when we have the "muscle"
for large volume purchase we are faced with these increases. One
can imagine the Community Pharmacies are likely to be paying even
more. Whilst it is understandable that the patient packs inevitably
increases the costs in packaging it seems to me that this opportunity
is being used to increase profit opportunities.
The supplier of these drugs is a generic house
and has been in operation for many years—long before Regent
was closed down by MCA. Other generic suppliers have similarly
increased their prices. I am sure you are also aware that some
of the generic manufacturers have parent companies which actually
control large sections of the market of branded products used
by the NHS.
A draft Health Circular Version 0.9 HSC1999/XXX
landed on my desk on 19 October. It is concerning the Year 2000
problem and Medicine Supplies. This urges hospitals to ensure
that patients do not need to see their GP's for repeat prescriptions
between 20 December and 10 January. In essence the impact of this
would be that we would have to issue patients with up to five
weeks' supply of medicines. Our normal practice is to give patients
either seven days or 14 days supply depending on the speciality.
If we are required to follow this circular it will have major
impact on stock holding and availability.
To date, hospital pharmacists have had a gentlemen's
understanding not to increase the stocks for Y2K. I know my colleagues
in West Midlands have abided by this. However, I fear this circular
may require us to re-examine our positions so as to ensure patients
do not run out of their medicines.
I would also urge you to bear in mind that hospital
drug budgets are constantly under pressure from advances in new
medicines for which funds do not generally follow. Hospital pharmacists
have been recognised widely as making major contributions in rationalising
medicines usage whilst at the same time ensuring best value for
money for the NHS. We already have very serious difficulties in
recruiting and retaining staff (largely due to poor salaries and
conditions), the last thing we want is to divert our energies
to what is essentially avoidable workload resulting from shortages
in some very basic medicines.
Should the NHS not have its own Manufacturer
of Generics? We have proved it can be done with IV fluids in the
past (Parkfields in Wolverhampton, until under the privatisation
panacea of last government it was sold off).
Please note the views expressed are my own and
do not reflect our Trust's position.
1 November 1999
| 
