Developing Community Pharmacy Payment Systems Gibraltar Health Authority
The Gibraltar Health Authority (GHA) Healthcare model is linked closely to the NHS Healthcare model in the UK. The GHA serves the health needs of its 32,000 resident population and approximately 10 million visitors each year, through the commissioning of primary care, secondary care and mental health services. The GHA spends approximately £11 million each year on medication; making it at £4.20 per capita (compared to £1.20 per capita in England) one of the highest spenders worldwide.
The GHA commissions 21 community pharmacies to serve its local and tourist population. Given the scale of the GHA, traditionally a manual processing model had been employed locally to process community pharmacy prescriptions. The equivalent NHS Prescription services model utilises high speed scanners and intelligent character recognition software. The GHA were keen to improve the timeliness and accuracy of their local system which had a mix of manual and digital processes. There was an opportunity to vastly improve productivity and accuracy.
Due to the complex nature of prescription processing and reimbursement calculation, the GHA required a team to develop a solution to resolve prescription processing delays, review the backlog and improve efficiency and accuracy.
Following an initial site visit to scope and develop a project solution, a project team led by MLCSU was established. The team had representation from subject matter experts from within medicines optimisation, business intelligence and wider stakeholders.
Stakeholders included the GHA Prescription and Pricing Advisory Unit (PPAU), GHA Executive team led by the Medical Director and Clinical Governance & Informatics lead, the EMIS system supplier, community pharmacy and hospital pharmacy.
MLCSU developed a bespoke SQL rules-based automated system for the processing of community pharmacy prescriptions to include national pricing and local adjustment for GHA formulary policy and professional fees. The solution was able to process prescriptions faster, more accurately and efficiently, in a consistent and transparent manner.
The MLCSU bespoke solution was sample-tested and piloted with a month’s data. Invoices generated were triangulated and validated for accuracy with two other methods. Validated results for one months data demonstrated:
- Unprocessed, the overall cost to the GHA for 78,059 individual items dispensed for the month would have been over £750,000.
- Corrections were made to 55,229 rows of data or 71% of the dataset, using the MLCSU automated solution reducing drug price reimbursement costs by 7%
- The bespoke solution generates invoicing schedules promptly with improved accuracy for payments to pharmacies.
MLCSU continues to support the GHA in utilising the automated solution for review of prescription payments. A separate project is in development to standardise the processing of prescription data, and to consider wider medicines optimisation strategies with wider stakeholders.
"The MLCSU Medicines team have provided co-ordination in managing a highly complex problem with a solution that is innovative and novel. We look forward to working with MLCSU in the future."
David Burke Responsible Officer, Clinical Governance Lead. GHA.