Issue 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.