Earning Your Pharmacist An Honest Crust

May I tick your boxes?

As we may have mentioned before, Tyler is a major league drug user. And not all of them are for recreational purposes: he routinely ingests an amusing cocktail of prescription drugs to keep a lid on his wayward immune system.

So the other day he's visiting his local chemist to pick up the latest crateful, when he's accosted by the pharmacist (see here for previous pharmaceutical encounters). Would Tyler care to enter her consultation room for a quick word?

Consultation room?

"Yes, yes, it's a bit more private in there."

Private? Why private? Is she going to break bad news? Has there been some horrible mix-up? Has Tyler inadvertantly been taking those drugs they use to chemically castrate elephants? No wonder he's been feeling a little lacklustre of late.

"Mr Tyler, we've noticed that you've never had a medicines use review." The keen young pharmacist brandishes the form she's holding. "If I just run though this with you, we can make sure you're getting the right medication."

"But I already have an annual review with my GP, and I'm also under a consultant."

"Ah yes, but they look at your body - we look at your medicines. We can advise you on them."

"Hmm... well, OK."

"Fantastic! Now, these first pills, how do you take them?"

"I... er... swallow them."

"Fantastic!" She ticks a box. "And how often do you take them?"

"Well, once a day, like it says on the instructions."

"Fantastic!" She ticks another box. "And do you have any side effects?"

"No... otherwise I'd have gone back to my consultant."

"Fantastic!" Another box ticked.

I could go on, but you get the idea. By the end of my 3 minutes, she must have ticked a dozen boxes. And what advice did she have for me?

"Well, you seem to be taking all your medicines correctly, and there's nothing I can suggest in terms of lifestyle to help your condition."

So no advice.

Fantastic.

But what was really going on?

The pharmacist was earning herself - or at least her company - £28 from the NHS. Which for 5 minutes work isn't bad (£336 per hour). That's what she gets paid for conducting a Medicines Use Review (MUR) under a scheme set up by the NHS to make sure patients comply - yes, that is the word they use - with the instructions they've been given.

You can sort of understand how the commissars dreamed up the scheme. After all, they spend well over £8bn pa on prescription drugs in England alone, and that bill has doubled in ten years. The last thing they want is for we punters not to be taking them properly.

But is 5 minutes with Sharon ticking boxes in her consultation cupboard really going to help?

Seems unlikely. In fact from what Tyler saw, it looked more like money for old rope.

And what does the whole exercise cost us?

According to the official stats, the number of MURs is soaring. Between 2006-07 and 2007-08 MURs roughly doubled to over a million. Which at 28 quid a pop comes in at around £30m - a considerable sum in these straightened times. Especially when you remember that pharmacies in England and Wales already earn getting on for £1bn pa from the NHS just for dispensing fees (ie not including the cost of the drugs):

Which is presumably why the commissars have imposed a limit on how many MURs an individual pharmacy can conduct - 400 pa.

But how does that work exactly? Who decides which punters are going to get MURRED? Sharon told Tyler she could tell immediately he didn't really need a MUR because he wasn't a batty old lady. But she went ahead and did it anyway.

And come to that, isn't the whole shebang open to massive fraud? How can the commissars possibly tell that the MUR has actually taken place? Tyler signed nothing, and Sharon retained the tickbox form.

Oh, guess what - the whole shebang is open to massive fraud. And it turns out there is a massive fraud investigation underway. The NHS's own Counter Fraud Service (oh yes, the NHS needs one of its very own) is on the case, and has already discovered that the payment system was set up by a particularly unworldly four year old:

"Pharmacists declare to NHS Prescription Services how many MURs they have performed during the month when they send their monthly FP10s for processing, and they are paid £28 for each one. They do not submit MUR forms or disclose patient names in support of their declarations, although they do send GPs lists of patients whom they declare have received MURs."

There is no procedure for checking that the claims marry up with what the GPs have been told. Still less is there a procedure for checking whether the MURs have actually taken place. Fraud is almost certainly rife.

Needless to say, the pharmacists are squawking. It seems they don't want to be investigated, and they reckon the case cannot proceed because of "patient confidentiality concerns". So the entire investigation is now on hold while m'learned friend is consulted - no doubt at further considerable taxpayer expense.

Now, just imagine you're a pharmacist. You'd probably be knocking off as many of these £28 "consultations" as you could possibly manage, before the opportunity disappears. You'd also be ticking patient boxes like fury to get some kosher records on file ahead of Inspector Knacker's forthcoming visit.

Let's hope they still have time to make sure Tyler doesn't get any more of those elephant pills.

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www.gudanggrosiran.com Categories: fraud, nhs, simple shopper

Update On Welfare Fraud

The same old picture

The Department for Work and Pensions has just slipped out its annual estimate of welfare fraud (summary table above). Overall, it reckons overpayment due to fraud and error is now running at around £3bn pa, or 2.2% of benefits paid - an increase on last year's 2%.

That's bad enough, but as we've blogged before, some benefits are much more prone to fraud than the overall total suggests.

For example, Housing Benefit (annual cost £17bn) has a fraud and error rate of around 5%. And despite constant assurances of a crack-down, there has been virtually no improvement over time:

When we last had a good look at Housing Benefit, we discovered a highly expensive shambles, with the Simple Shopper paying way over the odds to canny private landlords.

And this week's revelation that in some areas an extraordinary 40% of households are now in receipt of housing benefit makes us even more concerned. When taxpayers are subsidising that much of the private rental market, rents are inevitably being inflated way beyond their true level. No wonder it's costing us so much.

Given our dire financial straits, the entire welfare system is heading for a serious pruning. A big reduction in fraud losses should be one of the benefits.

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www.gudanggrosiran.com Categories: dwp, fraud

Victims Of High Taxation

2am: 8 September 2009 - thieving scum help themselves from a shop in Huntingdon

The Village Postmaster and his family are still recovering from their 1am encounter with the robbers who smashed into their shop. Needless to say, the police have yet to apprehend anyone.

The gang were after cigarettes, and it turns out this was one of a huge number of such robberies taking place right across the country. Just in the last few months, small shopkeepers have been hit in Croydon, Oxfordshire, Glasgow, Sussex, Devon, Gloucestershire, Liverpool, Yorkshire, and back in Sussex again. AND THAT'S JUST THE FIRST PAGE FROM HUNDREDS OF GOOGLE RESULTS.

This is a massive crime wave.

WTF is going on?

The VP has already blogged his own highly plausible theory. Just like back in the eighteenth century, extraordinarily high taxes on tobacco have nurtured an extensive black market. And as before, this market has been supplied principally by smugglers bringing in untaxed stock from overseas.

It is a highly organised business. As described here, it has progressed way beyond a few amateurs loading up their white vans in Calais. Indeed, it is no longer driven by the difference in duty between the UK and our EU "partners", such differences having been largely eliminated (tax now accounts for 70-80% or more of the retail price right across the EU).

No, what's driving this is that organised criminal gangs have found ways of obtaining large quantities of cigarettes and tobacco without paying duty at all.

Of course, some is counterfeit. But much is the genuine article, manufactured and branded by the big international tobacco companies, and reportedly sourced from their legitimate factories in countries such as Ukraine. Here's a graphic summarising one estimate:

Obviously, the customs authorities all over the EU are working to clamp down, and over the last few years, HM Revenue and Customs have stepped up their efforts significantly. Quite right too.

But every success means that black market distributors in pub carparks and bootsales across the country find themselves short of product. So as the VP points out, the market has come up with a neat solution - stealing from legitimate suppliers here in the UK.

We've blogged the black market in tobacco before (eg here and here). Fundamentally, with tax now accounting for three-quarters of the price of cigarettes, even normally law abiding folk like the parson and the clerk can convince themselves such taxes are onerous and unnatural, and that it's reasonable to resort to the black market. After all, it isn't as if the black market is real crime, like murder or something.

We have moved beyond the realms of workable taxation. High taxes become the excuse for criminality.

And tobacco is such a great product for criminals. It's both light and high value (cf the mobile phones used in VAT carousel fraud). In one recent case, customs officers "found 74,000 cigarettes in the luggage of a Newcastle couple travelling from the Canary Islands". Something that easy to smuggle is very difficult to stop.

So what to do?

Well, since Tyler doesn't himself smoke, he strongly supports taxing smokers to buggery. Let 'em pay, says Tyler - less taxes for the rest of us to stump up.

But as we can see, that approach has opened the gates to a crimewave. And whatever the buyers of black market ciggies may tell themselves, it's not a victimless crimewave - just ask the VP and his family.

Worse, the black market in tobacco is just one part of Britain's burgeoning black economy. As we blogged here, most serious estimates have put the size of our black economy at 10% of GDP or more. But those estimates were made pre-recession and pre-Polish plumbers. Our guess is that it's now much bigger, and our forthcoming tax hikes will make it bigger still.

Which is very worrying.

High taxes fuel the black economy.

And the black economy fuels crime.

Yet another reason why Cam and Oz need to get a lot more serious about cutting spending rather than raising taxes yet further.

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www.gudanggrosiran.com Categories: crime, fraud, tax