Primary care excluded from drug deal because GPs and commissioners cannot be trusted

NHSE issued the note last week to clarify and “ensure consistency” about which providers and organisations can access the medicines frameworks set up by NHSE’s Medicines Procurement and Supply Chain team, formerly known as the commercial medicines unit.

The MPSC negotiates prices for drugs used to treat NHS patients in hospitals, making them available for eligible providers through procurement frameworks.

The main thrust of the guidance is to underline that drugs available under MPSC deals should only be purchased by trusts for treating NHS patients, and there is a particular warning that they must not normally be used within NHS private patient units. However, the notice also explicitly excludes primary care from accessing drugs at prices secured by NHSE for the first time.

The guidance states: “Stakeholders were concerned about sharing confidential information about prices through framework agreements with primary care commissioners, doctors and pharmacists”

Additionally, the policy note said primary and secondary care follow different procurement models and “primary care access would create unintended consequences”. This could include GP practices potentially misunderstanding that the framework listed price for a drug only appears cheaper as it does not include the margin added to cover distribution and community pharmacy costs.

NHSE said it reached the conclusion to specifically exclude primary care after consulting with various stakeholders. The stakeholders included various NHSE policy teams, as well as industry bodies. None of these stakeholders supported primary care access to the frameworks, though NHSE has said it will keep this position under review.

Not for private patients

Independent sector providers are also excluded from the frameworks, regardless of how many NHS patients they treat.

The new policy also aims to prevent any drugs bought through a framework being used on NHS trust private patient units. Where this happens, trusts “must request approval to purchase at MPSC framework prices from the relevant framework holder in advance of treating private patients.”

Previously, access to the frameworks had been “handled on a case-by-case basis”. The policy now lists in-scope organisations. They are:

• secondary care trusts and mental health trusts
• hospices
• organisations contracted to support NHS England commissioned services:
  • prison services
  • ambulance services
  • HIV/pre-exposure prophylaxis or PrEP services

All have full access to the MPSC framework medicine prices except the HIV and PrEP services, which have “access to a restricted list of framework medicine prices to support service provision”.

Eligible organisations that have registered with NHSE as a “purchasing point” can access the framework prices if they meet specific conditions, that:

• medicines are for NHS patients only
• prices remain confidential
• monthly purchasing data must be supplied to the MPSC (via its preferred route)
• any medicines purchased must be from a MPSC framework (where one exists) for an agreed list of medicines, except where there is a strong clinical reason for purchasing “off framework”.