With more and more patients holidaying in exotic destinations, the time needed to give appropriate individual medical advice can be extensive.
Many practices invest considerable nursing time in running travel clinics and it would seem reasonable to be paid for this. As well as charging for writing prescriptions for specific medicines, it is also possible to earn from dispensing the medication even if the practice is normally non-dispensing.
Practices can earn money from dispensing medication that is solely for use abroad even if they are normally non dispensing
The NHS regulations for patient charges are clear and summarised in the BMA document Charges to NHS Patients.1 This states that, although no charges may be raised for most private prescriptions, it is possible to charge for prescribing medicines where the intention is solely for use abroad.
Beyond charging for issuing the prescription to cover the time and responsibility, as this is a service that lies outside the NHS, it is perfectly feasible for medical practices to dispense the medicine. This is the case even in an urban environment where the practice does not usually dispense medicines.
Under the changes in relation to the quality scheme that came in for dispensing practices in April 2006, all premises have to be registered for NHS prescriptions and staff must be trained appropriately.
However, as this is for travel medicines which are non-NHS dispensing, there are not the same requirements. The premises must be registered with the Healthcare Commission, but NHS premises including medical practices already are.
If a practice wishes to consider dispensing travel medication for the first time, it will need to plan ahead.
Issues such as storage and collection along with pricing schemes and a cash register will need to be resolved. The prescriptions themselves can easily be produced from the practice's computerised clinical system.
Although the practice could approach any licensed pharmaceutical wholesaler, the simplest solution would probably be to use the one from which you currently buy your personally-administered items. Always ask for a discount; 10 per cent would be a reasonable start.
The overall cost for this private treatment would normally be based on the cost of the medication; an element for profit (often 25-50 per cent) plus VAT.
As this is a private prescription, there is no NHS 'clawback'. VAT is charged on all private prescriptions unless dispensed by a pharmacist or the practice is not registered for VAT.
This anomaly is an important reason to check the prices of similar medications from local pharmacies as it may make your prices uncompetitive. Practices just below the current VAT threshold would need to check their overall position carefully.
Most practices charge patients for providing a private prescription for travel medicines. A check of the websites of a number of NHS practices showed that charges ranged from £12 to £30, but many waived this fee if the practice dispensed the item.
It would be unethical to insist that patients use your dispensing service. However, waiving the fee if they do will help ensure the service remains competitive, as does ensuring the system works quickly and efficiently.
Deciding what to dispense
While it is possible for a normally non-dispensing practice to directly supply a variety of travel medicines, in most cases it is best to stick to a limited number of drugs. This aids simplicity and should minimise problems with slow stock turnover.
However, some practices may wish to extend their service. A practice covering a school may wish to buy in a stock of acetazolamide to cover a high-altitude adventure trip for the pupils, or if involved in occupational medicine, a supply of antibiotics for staff going on a fact-finding mission to a third world country.
As this service lies outside the NHS it would be possible to supply all the party members, not just those registered with you.
The direct supply of travel medicines is worth thinking about to improve patient services and boost practice profits.
- Dr Phipps is a dispensing GP in Lincolnshire
- Contact Sarah Wild at firstname.lastname@example.org or tel (020) 8267 4532
- Plan ahead regarding the purchase and storage of medicines, plus arrangements for patient collection of dispensed items.
- It may be simplest to buy medicines from the pharmaceutical wholesaler from whom you buy your personally-administered items. Be sure to ask for a discount.
- Set your charges: consider waiving the normal private prescription fee for patients who use your dispensing service, to keep charges competitive.
- Smaller practices that are just below the current VAT threshold should check their overall VAT position or may find themselves paying extra as VAT is chargeable on all private prescriptions unless dispensed by a pharmacist.
- To keep things simple, stick to dispensing a limited number of drugs (for example anti-malarials) to minimise problems with slow stock turnover.
- However, look into extending your service to meet specific needs, for example, catering for a local school's trip abroad.
1. BMA. Charges to NHS patients - Guidance for GPs. January 2007. www.bma.org.uk
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