Review of the Distribution of Healthy Start Vitamins Through Community Pharmacies

2. Background

2.1 Healthy Start Vitamins

Healthy Start is a UK-wide scheme run by the Department of Health. Eligible families must already be in receipt of the appropriate benefits (confirmed by HMRC Tax Credits or the Department of Work and Pensions). Eligible families must apply to the Healthy Start scheme to receive the vitamins. Once accepted onto the scheme families receive vouchers for fresh and frozen milk, fruit and vegetables and, infant formula milk every 4 weeks and coupons for vitamins every eight weeks. The review was concerned only with the distribution of vitamins and drops.

Women's vitamin (tablets) contain:

• Folic acid: reducing the chance of the baby having spina bidifa
• Vitamin C: helping to maintain healthy tissue in the body
• Vitamin D: helping to absorb calcium to support bone development

Children's vitamins (drops) contain:

• Vitamin A: for growth, vision on dim light and healthy skin
• Vitamin C: helping to maintain healthy tissue in the body
• Vitamin D: for strong bones and teeth

2.2 National Trial Scheme Aim

Prior to the national trial of distributing vitamins through community pharmacies a number of issues had been identified as barriers to the existing distribution system via NHS Scotland. There were difficulties for families and health professionals in accessing vitamins; problems with wholesale supply of vitamins; and lack of effective distribution systems which could, combined with a limited shelf life, mean that wholesalers would be left with out of date stock. Distribution methods were complex and several mark up costs were incurred.

Scottish Government therefore initiated a trial scheme consisting of a national remuneration and reimbursement framework for community pharmacies to enable them to distribute Healthy Start Vitamins to improve uptake in Scotland. The national trial scheme commenced in May 2013, initially for one year. This was extended for a further year until May 2015. Community pharmacies were invited on voluntary basis to participate in the scheme in 2013-14 and then reapply to take part in 2014-15.

2.3 National Trial Scheme Overview

Each participating community pharmacy received a £200 remuneration fee for each year they were involved in the pilot. Participation in the scheme was conducted in line with specification and terms and conditions set down in the letters issued by Scottish Government for both years, and to help ensure all community pharmacy staff were aware of and understood the procedures for reimbursement. In addition, community pharmacies were reimbursed the cost price for the vitamins which they dispensed through the Healthy Start scheme. The reimbursement system operated as follows:

1. Community pharmacies would receive the Healthy Start Scheme coupon from the beneficiary.
2. The pharmacist would then endorse the coupon with their details and hand writes a separate prescription (CPUS form) detailing the type of vitamins provided^[1].
3. The pharmacist would then send the coupon together with the CPUS from to NHS National Services Scotland, Practitioner Services Division (PSD) for reimbursement.
4. PSD recharge these costs out to NHS Boards quarterly basis.

Community pharmacies ordered supplies of vitamin tablets and drops from three main wholesalers operating in Scotland as part of the pilot. Community pharmacies were allowed to sell Healthy Start vitamins to non-beneficiaries at a pre-agreed price. Community pharmacies could return any out of date stock to wholesalers for reimbursement.

During the trial scheme NHS Boards could continue to supply Healthy Start vitamins directly to eligible pregnant and breastfeeding women and children aged under 4. Some NHS Boards submitted reimbursement claims from distribution through the NHS directly to the Scottish Government. Other NHS Boards never made any claims but met the cost of providing Healthy Start vitamins and drops through their own budgets. This cost was in some cases covered by Scottish Government as part of Maternal and Infant Nutrition Framework monies.

The data on reimbursement to community pharmacies was collected centrally by NHS NSS Practitioner Services Division and provided to Scottish Government on a 3 month retrospective basis. Scottish Government also collect data on reimbursement claims direct from some NHS Boards on a monthly basis for the arrangement of a quarterly payment. Data on NHS Boards who met the cost from their own budgets (not claiming re-imbursement via Scottish Government) was only captured by the NHS Board and has not been shared.