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Let's not get carried away!


Let's not get carried away!

Gaining payment for supplying MDS trays is a significant achievement but aspects of the service remain opaque, says Terry Maguire


I should be ecstatic that pharmacies will now be paid for supplying MDS trays. But we need to secure our clinical future too.

For the year 2021-22, £8 million is to be divided up among contractors using some as-yet-to-be-identified “proxy” and should have been paid before the end of April. This is by no means a paltry deal. The commissioned service will continue to be funded this year even though the Department of Health can’t really commit to too much, given that our politicians have crashed the Local Assembly and there are elections for a new Assembly in May.

I have some concerns which might seem churlish given the adrenaline-rush brought on by a significant bung to my business at the month end. Without doubt this is an important strategic win for community pharmacy, allowing us to support medicines optimisation, especially in elderly patients. It is a vital element in helping keep our elderly population well at home and out of hospital.

Of course, leverage was applied. Contractors have been clear since December 2021 that no new MDS trays would be provided without funding - and they weren’t. This focused minds at the DoH and the Health Board as they struggled to improve patient hospital discharges with packages of care that normally included MDS trays. This will now be a part of a compliance commissioned service, and it is the first such service in the UK.

Most aspects of the service still remain opaque and will need to be articulated before we appreciate how fortunate we really are. It is my hope that the service will indeed be, as we are promised, evidenced-based and that only those patients who are likely to benefit from MSD trays get them.

Many pharmacists seem convinced that MDS trays are the solution to all medicine compliance challenges. Some years back I engaged in a long dispute with two colleagues on how ineffective MDS trays were and gave up when one screamed at me during a meeting: “Show me there is no evidence!”

Given the current evidence base on the effectiveness of MDSs trays, it is equally my hope that the service will eventually lead to an overall reduction in patients requiring and expecting trays. At least it might stop the exponential rise in their use.

Where this happens, and I am not hopeful, it will free up much needed time for pharmacy teams to focus on delivery of other parts of the community pharmacy strategy which will attract their own funding streams.

It is important that Community Pharmacy Northern Ireland does not shy away from communicating this to members so we can get the time to develop and deliver our clinical future. Judging by the questions at a recent contractors’ meeting, many pharmacists are unclear what this service is about. It will be about compliance in its widest sense: it certainly is not “pay for the tray.”

For too long MDS trays have been an unnecessary and expensive burden on community pharmacies that have evolved and grown due to business competition rather than any identified or real patient need.

Of course, social services have benefitted greatly from our provision of trays as it has saved that sector investing in proper staff training. Ironically, given our settlement for the last financial year, this amount was estimated to be £8 million. Trays add disproportionately to the pharmacy workload but ultimately they are largely a burden of our own making.

I am more than anxious about the assessment procedure that will be utilised in this service. Assessment for suitability must be independent of community pharmacy. It should be objective and undertaken by pharmacists competent to do so, ideally hospital or practice-based pharmacists.

To have community pharmacists involved in the assessment will only lead us back to the hugely unsatisfactory situation we are currently in but may finally be emerging from. At least 50 per cent of my MDS trays I would judge to be unnecessary.

They are almost fashion statements or virtual signals for how really sick these patients feel they are. Yes, of course some patients will benefit, but weekly dispensing was a means to game the dispensing fee system not necessarily improve care for patients. We were all forced into it to retain business as the unscrupulous attempted to steal patients.

A big thank you to CPNI for securing this deal. It is a significant achievement, but CPNI must now understand that this has to be the last of the many gripes and moans contractors have obsessed with over the last 12 years.

We now need to move on and ensure our clinical future.


Terry Maguire is a leading community pharmacist in Northern Ireland.

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