Business Economic Note 22
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Dispensing Chemists Table of Contents
1.1. Professional bodies
1.1.1. The Pharmaceutical Services Negotiating Committee 1.1.2. The National Pharmaceutical Association 1.1.3. The Royal Pharmaceutical Society of Great Britain
2.1. Discount Deduction Scale 2.2. Dispensing Fee 2.3. On Cost Allowance 2.4. Basic Practice Allowance 2.5. Professional Allowance 2.6. Graduated Transitional Payment 2.7. Essential Small Pharmacies Scheme 2.8. Containers Allowance 2.9. Rota Service 2.10. Payments by patients 2.11. Expensive Prescriptions Allowance 2.12. Payments in respect of pre-registration trainees 2.13. Advice to residential homes 3. Average rates of GPR on NHS dispensing 4. Rates of GPR on non-NHS sales
5.1. Discounts receivable 5.2. Wholesalers' finance schemes
Comparison of anticipated gross profit rates for pharmacists dispensing 1500 and 3000 prescriptions per month at average, high and low ingredient costs.
Prescription charges applicable since April 1979
Rota payments (per Hour)
There are in excess of 38,000 pharmacists registered in the UK either with the Royal Pharmaceutical Society or with the Pharmaceutical Society of Northern Ireland. Of these, about 20,000 are employed in the 12,000 "community pharmacies" (pharmacists shops), with the remainder working in hospitals or the pharmaceutical industry. There are statutory controls on pharmacy businesses, and all premises used for pharmacy have to be registered, and pay an annual fee to retain registration. A clear distinction exists between the businesses of pharmacies and those commonly described as drugstores. The latter are limited in the range of drugs and medicines that they can sell, as they do not employ registered pharmacists. In essence, this type of business is simply a retail outlet for "general sales listed" drugs and medicines together with toiletries and cosmetics. The vast majority of pharmacists shops combine the role of dispensers of prescribed medicines with the provision in a retail capacity of a wide range of goods, which is not necessarily confined to items connected with health. Registration is necessary in order to use the title "pharmacist". The registration requires particulars to be given of the pharmacist by whom, or under whose supervision the business is to be run. By law, when a pharmacy is open, there must be a qualified pharmacist in control at all times. Qualification as a pharmacist is achieved by means of a degree in Pharmacy followed by a years practical experience and membership of the Royal Pharmaceutical Society. The degree course covers every aspect of the structure and actions of medicines, providing the pharmacist with a greater knowledge of this subject than any other health professional. This is not confined to human health, as, particularly in rural areas, pharmacists can also provide agricultural, horticultural and veterinary products. All medicines must have a licence from the Medicines Control Agency, part of the Department of Health. Legislation controls the sale of drugs and medicines according to their classification as follows:-
The term "over the counter" (OTC) sales relates to sales in a registered pharmacy of all drugs and medicines other than prescription only medicines. Most non-prescription medicines are sold under resale price maintenance - whereby the manufacturers stipulate minimum retail prices. This arrangement, as with that for the sale of books under the Net Book Agreement, is exceptional among retail trades, with the dispensation for its continuation having been granted by the Restrictive Practices Court in the early 1970s. Most pharmacies also supply appliances. The supply and payment for appliances under the NHS are governed in the same way as the dispensing of drug prescriptions. 1.1 Professional bodies 1.1.1 The Pharmaceutical Services Negotiating Committee 1.1.2 The National Pharmaceutical Association The NPA has two sister organisations serving the local needs of its members in Scotland and Northern Ireland: The Scottish Pharmaceutical Federation and The Ulster Chemists Association respectively. 1.1.3 The Royal Pharmaceutical Society of Great Britain The Annual Register of Pharmaceutical Chemists provides an alphabetical listing of pharmaceutical chemists along with a register of premises listed in county/town order.
The pharmacist is paid monthly for NHS dispensing by the local Family Health Services Authority. Each month he sends prescription forms to an official Pricing Bureau which calculates the amounts due and notifies the Family Health Services Authority who pay the pharmacist. Payment is made at monthly intervals and the make-up of the payment is shown on a form FP34, or similar approved form. The calculation of the fees, etc. due as shown on the FP34 is not sent to the pharmacist until two months after the month to which it relates, but in England and Wales an interim payment of 80% of the amount due is sent one month earlier. Thus for prescriptions dispensed in January the pharmacist would receive 80% of the amount due on 1 March and the balance, together with the form FP34 on 1 April. In Scotland, the equivalent of the FHSA is called a Health Board, and the interim payment is normally 90% of the amount due. The system operating in Northern Ireland has the Central Services Agency carrying out the the functions performed by the Family Health Services Authorities and the Pricing Bureau. The statement issued to the pharmacist includes the individual details of each prescription. The Northern Ireland pharmacist holds a permanent advance of 90% of his average monthly NHS receipts. The advance is recalculated at intervals of six months and the average is based on the receipts for the previous six months. The payment made by the FHSA for NHS work includes the following:-
The pharmacist may also receive additional amounts in respect of rota services outside normal shop hours and emergency work. These elements are subject to annual adjustments, and recent revisions are described in some detail later in this note. The rates and conditions under which payment is made to the pharmacist by the NHS are set out in the "Drug Tariff" which is amended and published monthly. This sets out the amount the NHS will pay for each drug dispensed. The Drug Tariff also includes the changes in the terms and rates of the other elements making up the amount payable, each of which can be altered independently of the others. 2.1 Discount Deduction Scale The basis of this scale changed in 1983. Previous to the change it was related to the number of prescriptions dispensed each month. It is now related to the total wholesale value of the drugs dispensed each month (the Net Ingredient Cost). For example, for the period from 1 April 1986 to 30 April 1988, the deduction ranged from 1.96% (where the total Net Ingredient Cost for the month fell between £1 and £125, to a deduction of 9.46% (total month's Net Ingredient cost greater than £39,751). From 1 June 1987 the pharmacist has been able to avoid a deduction from the cost of certain drugs, known as Zero Discount or 'ZD' items. These are listed in the Drug Tariff and are generally preparations for which he is unlikely to have been able to obtain a discount from his supplier. 2.2 Dispensing Fee The basis of the standard fee changed on 1 April 1987. Before April 1987 the pharmacist received a flat fee per prescription ("script") dispensed. In England and Wales the rates were 40p at June 1981; 47p at September 1984; 60p at April 1985; and 63p at April 1986. From 1 April 1987 the fee was set on a graduated scale, initially at :-
From 1 September 1987 an additional 30p was payable per script where it included a drug on a list given in the Drug Tariff, and the amount of the drug dispensed was greater than the quantity specified on the list. It is estimated that between 10% and 12% of the prescriptions attracted this fee which is known as the threshold quantity fee or period of treatment fee. Additional fees are also payable where the prescription has to be specially prepared, dispensed outside normal hours, etc. Subsequent standard graduated dispensing fees have been as follows:
2.3 On Cost Allowance The basis of the on cost allowance changed on 1 April 1987. Previously the allowance was a sliding percentage of the monthly Net Ingredient Cost, and reduced as the number of scripts dispensed each month rose. The percentage obtained by the average pharmacist was calculated to be 11.27% in 1983; 11.25% in 1984; 11.01% in 1985; and 10.9% in 1986. At 31 March 1987 the allowance varied from 19.7% of the Net Ingredient Cost where 1,000 or fewer prescriptions were dispensed, down to 8.4% where more than 5,000 were dispensed. At 1 April 1987 the allowance became a flat 5% of the monthly Net Ingredient Cost before discount deduction and it was further revised to 2.5% with effect from 1 November 1992. The on cost allowance was eliminated on 31 October 1993. 2.4 Basic Practice Allowance This was introduced on 1 July 1980 (£166.67 per month); increased on July 1981 (to £200 per month) and on 1/4/85 to £250 per month; and abolished on 1 April 1987. 2.5 Professional Allowance A Professional Allowance was introduced with effect from 1 November 1993 of £500 per month per contractor provided they:-
The professional allowance was increased to £720 per month from 1 August 1994. 2.6 Graduated Transitional Payment This was introduced with effect from 1 November 1993, amounting to £250 per month for dispensing 1,000 scripts per month rising to £499.50 per month for dispensing 1,499 scripts per month. With effect from 1 August 1994, these sums were increased to £375 and £574.60 respectively. 2.7 Essential Small Pharmacies Scheme At 1 May 1987 the conditions which a pharmacy had to meet to qualify for this allowance were, broadly that:-
The maximum number of prescriptions for ESPS entitlement has since increased as follows:
In addition, the qualifying distance from the nearest pharmacy was reduced to 1 kilometre with effect from 1 November 1993. In 1987/88 the allowance (paid monthly) was such a sum as to boost the pharmacist's actual earnings up to £24, 489 per annum, subject to a maximum of £1,275.75 monthly. The allowance (including sums already paid in the year) was withdrawn if the pharmacy dispensed over 16,000 prescriptions in the year. The annual target incomes for ESPS contractors from 1987/88 have been as follows:-
The basis of the other elements making up the NHS payment have varied as follows:- 2.8 Containers Allowance At 1 February 1987 3.8p per prescription dispensed (excluding bulk or oxygen scripts). This was increased to 6.5p per prescription with effect from 1 November 1992, and revised to 5.8p from 1 January 1994. 2.9 Rota Service Appendix 3 provides details of the rates of hourly rota payments which the FHSA may pay to contractors providing services outside normal opening times. 2.10 Payments by patients Prescription charges paid over by patients are deducted form the payments made to the pharmacist by the FHSA. The rates of the prescription charges are shown at Appendix 2. 2.11 Expensive Prescriptions Allowance All prescriptions with a net ingredient cost before discount greater than £50.00 attract a 1% expensive prescription allowance. 2.12 Payments in respect of pre-registration trainees This is an allowance payable to certain contractors in recognition of in-service training provided. The amount payable is currently (1994) £4,500 per annum. The payment was previously paid in one lump sum mid-way through the year - i.e. six months in advance and six months in arrears, but with effect from 1994, it is now paid on a monthy basis. Ê Ê 2.13 Advice to residential homes Where a pharmacist provides advice and regularly supplies drugs, etc. to a residential home, a payment may be claimable from the FHSA in respect of an initial visit to a home and an annual fee. A written agreement on the provision of advice must be obtained from the manager of the home, and the amounts payable by the FHSA are banded according to whether the home has more than 20 residents on its books. Pharmacists are normally limited to 5 such agreements, although the FHSA may accept agreements for a larger number of homes if an adequate service would not otherwise be provided. Amounts payable in recent years have been as follows:-
Generally speaking, there has been an overall decline in the levels of gross profit achievable in respect of NHS dispensing in recent years. Due to the way the system is structured, both before and after the changes on 1 April 1987, the GPR falls as dispensing turnover rises above the average (3500 scripts per month), and conversely rises as dispensing turnover falls below the average. In addition, in general, in rural areas doctors tend to prescribe more proprietary (i.e brand name) drugs and fewer generic - and cheaper - drugs than their urban colleagues. The value of individual "rural" prescriptions also tends to be greater than urban prescriptions because the rural script is likely to be for greater quantities - say three months supply as against one month. The overall effect is that rural pharmacies may tend to achieve lower GPRs than their urban counterparts because of the higher average value of prescriptions. A similar effect can arise where a pharmacist administers the supply of drugs to a nursing home, where cassettes of drugs may be supplied for the nursing staff to dispense over a period of, say, three months. In such a case, the issue of a three month cassette constitutes just one prescription. Such an eventuality may be in part, at least, redressed by the payment receivable from the FHSA for advice to a residential home. Indeed, a pharmacist providing advice of this nature to, say, five residential homes, each with more than 20 residents will be eligible for payment of £2,335 per annum at current rates for such service. On the other hand, the proximity to, for example, a drug rehabilitation centre can have a marked enhancing effect on a pharmacist's level of gross profit where he is required to dispense significant numbers of prescriptions on a daily basis. Appendix 1 sets out a series of "models" which enable a comparison of typical GPRs achieved by Pharmacists dispensing at the rate of 1500 and 3000 prescriptions per month respectively, and which also demonstrate the overall effect of markedly contrasting ingredient costs It is apparent that, in terms of gross profit rate at least, under the prevailing remuneration structure, the pharmacist dispensing a relatively low volume of prescriptions at lower than average ingredient cost has an advantage over the high volume/high ingredient cost outlet. An additional factor that can have a significant bearing on the GPR achieved by a low volume contractor is the possible entitlement to payments under the Essential Small Pharmacies Scheme. In such cases, the apparent GPR may well be considerably enhanced. Similarly, a contractor eligible for payment in respect of a pre-registration trainee will see a distortion from the anticipated ratio of ingredient costs to NHS income, unless such income is separately identified. All of the figures set out in the "models" do not, of course, provide the Inspector - or for that matter the pharmacist - with an account of the actual gross profit rate achieved. They are merely an interpretation of the assumptions applied by the Family Health Services Authority to quantify an approximation of the agreed level of remuneration due. For example, the level of discount applied to the ingredient cost may or may not be an accurate reflection of the level of discount obtained by the pharmacist. If, for whatever reason, the pharmacist is unable to obtain the discount percentage assumed in the FHSA calculations, his actual gross profit rate for NHS dispensing will be less than that calculated by the above means. The converse is of course true if he succeeds in obtaining a higher level of discount from his supplier(s). Similarly, the FHSA applies standard costings in respect of purchases of the drugs and medicines dispensed. It may be, however, that the pharmacist is able to supply a particular item for lesser costs through the use of "parallel" imported drugs, which are manufactured abroad rather than purchasing exclusively from UK manufacturers. In such cases, the gross profit margin actually achieved can be enhanced, and therefore higher than that reflected in the FHSA statements. Indeed, many of the leading wholesalers now provide their customers with the option of parallel imports, and the Department of Health's calculations of the discount to be clawed back from pharmacists reflect an assumed element of parallel imports whether they are purchased or not. On the other hand, the pharmacist may choose to dispense more expensive proprietary drugs in preference to the generic drugs on which the FHSA's costings are based, which will have an adverse effect on the margins. Pharmacists also dispense some private prescriptions. On these, in common with veterinary prescriptions, the pharmacist is free to decide the charge. The scales formerly recommended by the professional association involved a 50% mark-up plus a dispensing charge, which was increased if the drugs were made up by the pharmacist. However there is no longer a recommended scale for such charges.
In addition to their dispensing role within the NHS, the majority of local pharmacists also operate as retailers of a wide variety of goods, ranging from OTC medicines to toiletries, cosmetics, babycare products, etc. to pet and veterinary goods, confectionery and photographic goods. Indeed, many pharmacists shops have assumed the role of the traditional corner shop. More and more medicines are being made available without prescription, as the government encourages people to buy medicines for minor ailments rather than going to a GP for a prescription. In this way, the NHS saves the cost of the medicine and the GP's time. In many cases, it can also save the consumer money, as hundreds of medicines cost less over the counter than the prescription charge. The distinction drawn earlier between pharmacy medicines and general sales listed medicines remains important, even though the term 'OTC' covers both these classifications. As the range of pharmacy medicines increases, so too does the supervisory role of the phamacist in advising on and monitoring the products being consumed. As noted earlier, the majority of non-prescription medicines sold are governed by Resale Price Maintenance - in particular proprietary medicines. This control is seen as necessary for the protection of some of the smaller pharmacies against the large pharmacy and "drugstore" chains, and thereby to retain their accessibility for the public. In general, gross profits of between 25 and 33% appear typical for such goods. With regard to other items commonly sold by pharmacists, analyses from a number of sources show the following gross profit rates to be typical: -
The gross profit rate will obviously vary according to the product mix. Photographic development and printing services are generally directed through specialist developing agencies. Increasingly, however, in-store processing by means of photo labs has provided a more lucrative medium for photographic services, although the heavy capital outlay is a significant obstacle in many cases.
All chemists must trade with wholesalers as they form the distribution network for National Health Service drugs and appliances and offer a delivery service at least daily, and often several times a day due to the variable demand for prescription drugs. These wholesalers also supply toiletries, haircare products, cosmetics, etc. using the same service. There are three major Chemist Wholesale organisations - Vestric, a wholly owned subsidiary of AAH Holdings; Unichem, up until recently a co-operative organisation owned by its chemist members, but latterly a PLC following flotation on the Stock Exchange; and Numark, a group of independent wholesalers providing a central office for buying and marketing services to its chemist customers. A number of the Numark wholesalers have been taken over in recent years, and the group is currently seeking to to sell its operation to its retail pharmacist members. It is envisaged that it may become incorporated as an Industrial and Provident Society. Most chemists will trade with at least two of the wholesalers to ensure prescription drugs availability at short notice, and also to take advantage of special deals and services offered from time to time by the competing wholesalers. The three major wholesalers trade nationally and competition is fierce between them and against a few totally independent wholesalers trading purely on price and offering little in the way of additional services. A further source of supply comes from the drugs and appliances manufacturers, some of whom maintain sales forces calling directly on the pharmacists, and also offer direct delivery, thereby by-passing the wholesaler. In other cases, the manufacturer may drum up business by means of its representatives calling on pharmacists, but placing any consequent orders through a wholesaler with whom the pharmacist already has an account, thereby avoiding the need to bill the individual pharmacist directly. 5.1 Discounts receivable Due to the competition between the wholesalers, a pharmacist should be able to obtain, a discount for prompt payment (within 30 days), and a reduction of possibly 8 -10% - depending on the volume of his orders - on most of his "ethical" (drug and surgical appliances) purchases. The main wholesalers who dominate the market give a combined volume and settlement discount once a certain threshold has been reached. Below the threshold, no discount is achieved. If payment is not made within the specified period, then a significant part of the discount is taken away. The wholesaler may also offer a further discount on goods purchased through an electronic or computerised ordering system. It should be noted that the discount clawback scale operated by the Department of Health aims to recover the discount received by contractors from their wholesalers. Retrospective discounts, paid once yearly according to the pharmacist's total purchases over the year may also be a feature. Discounts on other "over the counter" lines are less common, apart from prompt settlement. 5.2 Wholesalers' finance schemes All of the larger wholesalers operate varying kinds of finance schemes. These may comprise: -
Drugs, medicines or other goods are for the most part standard-rated when purchased, but are zero rated if they are prescribed by a doctor or dentist for a patient and are dispensed by a registered pharmacist. Otherwise their supply attracts VAT at the standard rate. Disposable nappies, baby food and some other food products are zero rated both on purchase and on re-sale. A retail pharmacy must use one of the nine Customs And Excise retail schemes. Scheme F is the simplest to use and requires gross takings figures for standard rate and zero rate goods to be separated at the point of sale - e.g. by coded cash tills. Under Scheme B takings are not separated at the point of sale between VAT rates. To arrive at the total takings of zero-rated goods, the purchase invoices details of these items must be listed and uplifted to the retail selling prices. Under Scheme D sales are apportioned in the same ratio as purchases at each tax rate. Scheme B limits zero-rated sales to 50% or below of total turnover including VAT. The National Pharmaceutical Association has, however, negotiated a concession whereby a pharmacist can disregard their prescription income when calculating whether their zero-rated outputs are below the 50%. Schemes B and D are based on relating the value of purchases at the various rates to takings. They assume that any particular item is bought and sold by the retailer at the same rate. This is true for pharmacists except for goods supplied on prescription. Drugs, medicines and appliances supplied against doctors' and dentists' prescriptions are zero-rated under Group 14 of Scheme 4 of the Finance Act 1972. For the most part they are standard rated when purchased. There are a few exceptions, such as gluten free bread and other foods which are zero-rated when purchased and dispensed. The schemes' calculations are made in the usual way as per VAT leaflet 727 to arrive at a notional output tax figure. To overcome the problem of overstated standard rate sales under Schemes B and D a special adjustment is required. The gross takings will include the NHS cheque less any exempt items such as rota fees plus NHS levies and private prescriptions. In Scotland and Northern Ireland, doctors' stock orders must also be deducted. The VAT fraction (currently 7/47) is applied to the total NHS income (i.e. cheque, NHS levies and private prescriptions). This gives the notional tax applied to the zero-rated prescriptions. This is then deducted from the total output tax caculated under the scheme.
The requirement for a qualified pharmacist to be in attendance for the dispensing of drugs and medicines means that there is always going to be a demand for locum pharmacists to cover for holiday periods and days off. Depending on the precise terms of their engagement, the appointment of a locum may give rise to consideration of the appropriate schedule of charge. The NPA has produced a standard Locum Pharmacist Agreement form, which may be prima facie evidenceof a locum's self-employed status, although this does not, of course, diminish the Inspector's right to satisfy himself that the terms of such a form are an accurate reflection of the relatioship between the owner of the business and the locum concerned. There is no set scale of remuneration for locums. Each contract is likely to be the result of individual negotiations. However, the following are typical hourly rates that were payable in the years 1991/92 and 1993/94:-
In some cases some expenses incurred by the locum may also be paid.
In common with many retail outlets, pharmacists are making increased use of computers, which, in many cases, constitute an integral part of their accounting procedures. The use of electronic tills facilitating bar code reading and electronic point of sale (EPoS) technology are a common feature with retailers generally, which can enable, inter alia, automised pricing, cash control systems and stock control and re-ordering. Pharmacists may additionally use computers for a number of other purposes, with systems tailor-made for their particular needs. In particular, patient medication records (PMR) giving a catalogue of all medications dispensed to patients, and computerised labelling systems may well be in operation. In addition, there are on-line systems that enable the pharmacist to access up to date drug information.
The overall gross profit rate of a pharmacist can vary considerably. As indicated earlier, there are a number of factors that can give rise to significant variations in margins. Much will depend on the mix of sales, and the respective proportions of NHS and other sales. Broadly, a higher than normal proportion of NHS trade will produce a lower overall rate of gross profit, and vice versa. As a very broad generalisation, NHS sales typically account for approximately 70% of a medium sized pharmacist's turnover, whereas the percentage will be lower for branches of large groups who sell "own label" OTC products. The majority of retail chemists comprise two fundamentally separate elements -
The location of the shop may give some indication of the likely level of NHS work, and the extent of other products likely to be sold. A shop in a high class city shopping area stocking a wide range of toiletries and cosmetics and/or electrical and photographic goods can be expected to achieve a better than average rate of gross profit than a pharmacist whose location is fundamentally determined by its service to a doctor's surgery in what is otherwise a mainly residential area. The effect of competition, not just from other pharmacists, but also, especially in a rural area, from General Practices dispensing their own practitioners' prescriptions should not be overlooked. A further factor that can be affected by the sales mix of the shop is the wages bill, where, in crude terms, the higher the percentage of OTC turnover, the higher the wage percentage will be. In cases where the dispensing pharmacist is the proprietor/tress, and where the NHS business forms a high percentage of the total turnover, the wage bill is likely to be relatively low. Compared to the conventional High Street retailer, the accounts of a pharmacist can be expected to reflect a higher than average level of debtors due to :
a) The payment arrangements of the FHSA in respect of the NHS prescription work; and b) The likelihood of VAT repayments arising on goods purchsed at standard rate, and sold, under prescription, at zero rate. By its nature, there are limitations to the extent that the profitability of the former can be influenced by the pharmacist. With the latter, however, a number of options exist, depending on the facilities available and the range of products that is to be offered. Ancillary services such as pregnancy testing, blood pressure and cholesterol measuring may be made available, along with other health advisory services to maximise the value of the pharmacists' training and knowledge. This may be further extended by undertaking home visits, in particular, for example, to local residential rest and nursing homes and to the disabled.
Thanks are due in particular to the Pharmaceutical Services Negotiating Committee, the National Pharmaceutical Association and the Royal Pharmaceutical Society for their assistance in the preparation of this note.
Comparison of anticipated gross profit rates for pharmacists dispensing 1500 and 3000 prescriptions per month at average, high and low ingredient costs.
With lump sum payments of 5.63p per Rx
With lump sum payments of 16.47p per Rx.
With lump sum payments of 3.54p per Rx
Summary
Prescription charges applicable since April 1979
Glossary Ethical General sales listed (GSL) Generic Over the counter (OTC) Parallel imports Prescription only (POM) Proprietory Semi-ethical |
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