Decision details

As of April 2013, Local Authorities have responsibility for commissioning public health services as part of their duty to take steps to improve the health of people in their area. Public Health grant allocations made to Local Authorities are therefore designed to reflect the full costs of commissioning public health services, including any necessary costs relating to the prescribing of medications relevant to public health services.

Some Public Health services will involve the supply of medicines and appliances using NHS pharmacy services - these include: substance misuse, smoking cessation support and sexual health services, each of which involves the prescription of medications to service users.

Whilst the majority of medication costs are included within specialist Public Health commissioned service budgets, there will be some instances where individuals can only access certain medications outside of commissioned services (e.g. prescription only smoking medications); or where individuals choose to access support from their local primary care GP. Furthermore, there is a duty to ensure individuals can access support as widely as possible including via primary care sites.

Prescribing of public health relevant medications for patients in primary care settings will often occur on FP10 prescription forms which can be taken by the patient to a community pharmacist for dispensing. The use of these prescription forms allows patients to choose which pharmacy they obtain their medication from

Whilst the responsibility and funding for these public health services lies with Sandwell Public Health, costs associated with primary care prescribing of public health relevant medications are borne by Black Country Integrated Care Board (formerly Sandwell & West Birmingham Clinical Commissioning Group). These costs relate to payments to the community pharmacy where a prescription is dispensed and the cost of the prescription drugs themselves. As such, it is necessary to reimburse Black Country ICB for costs incurred due to public health medications.

Criteria that will be used to determine which medication costs will be reimbursed by Public Health are as follows:
• All drug and alcohol medication costs will be reimbursed
• Orlistat for obesity will not be reimbursed as it is a tier 3 weight management service which doesn’t fall within the remit of public health commissioned services.
• Emergency hormonal contraception costs will not be reimbursed as they are covered by the primary care GP contract. However, long acting contraceptive devices and appliances are not covered by this and are reimbursed by public health.
• Nicotine replacement therapy is not reimbursed as this is already purchased through the Public Health procured smoking cessation service. The cost of smoking related prescription only medications (e.g. Bupropion, Varenicline) will be reimbursed from the Public Health budget.
• Any of the above outlined costs in relation to primary care practices outside of the Sandwell borough border will not be reimbursed

Quarterly costs are routinely scrutinised for monitoring purposes and to ensure claims made are in line with the agreed criteria for reimbursement outlined in the paragraph and bullet points above.

(1) That the Director of Public Health approve to reimburse FP10 Public Health medication costs to the Black Country Integrated Care Board up to a maximum of £500,000 covering a period until 31st March 2034.

(2) That should the organisation administrating and managing the FP10 recharges change constitution or name, approval for the Director of Public Health to authorise and continue payment to any subsequently changed organisation /body who would continue to manage this element

Payment in relation to FP10 Public Health medication costs is not currently possible given the administrating body has changed from Sandwell & West Birmingham Clinical Commissioning Group (CCG) to Black Country Integrated Care Board (ICB). Existing approval related to these payments no longer stands as it explicitly stated that the reimbursement is to go to Sandwell & West Birmingham CCG (which no longer exists) and there is no provision within the existing approval for the Director to authorise payment to a different/subsequent body. There are therefore now outstanding invoices in need of payment.

Previous approval was secured for the Director of Public Health to make FP10 payments to the Sandwell & West Birmingham CCG covering the period until 31st March 2025 (see Appendix 1 previous approval report). It has now become necessary to revisit this agreement prior to the approved end date given the change in organisational name/constitution, and as part of this revisit to extend the period of payment in line with Director level approval limits up to a maximum of £500,000 covering the period until 31st March 2034 (annual charges approximately £40,000 to £50,000 per annum).

To not approve the reimbursement of Public Health related primary care medications. This would be contrary to the terms of the Public Health grant and would require that such costs be borne by the Black Country IBC instead who may not agree to this, and ultimately impact access to important medications.

An alternative option is for Sandwell Public Health to administrate and manage the scheme directly with the primary care providers. This option however would require additional staff to manage and administrate such an arrangement and it would create two schemes requiring GPs to retrieve funding from two different commissioners (the Council and the Black Country ICB) which would add complexity and deter engagement and the provision of public health services would be adversely impacted.