Changes to the provision of domiciliary oxygen
- 1/4 of people in the UK die of respiratory disease
- COPD was the sixth leading cause of death world-wide and is expected to be the third leading cause of death in 2020
- In England and Wales there is no provision for oxygen therapy that enables patient mobility out of the house.
The current situation - RCP findings
In 1999 on the request of the Department of Health, the Royal College of Physicians published a report that highlighted:
- the provision of oxygen therapy is highly inconsistent across the country
- ambulatory oxygen should be much more widely prescribed
- respiratory consultants should prescribe oxygen rather than GPs
- a lack of any any organised follow-up and monitoring arrangements was observed
Current provision of Oxygen Therapy
If a patient requires oxygen therapy the following procedure must be followed:
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Currently only home based oxygen therapy is precribable on the drug tariff using an FP10. Concentrators are supplied by contractors on geogrpahically exclusive contracts. Cylinders are distributed via Pharmacies, with no exclusive contracts.
Some key points from a Department of Health announcement made in July 2003, concerning the new contracts for supplying oxygen to the homecare market.
- Only 1 “oxygen contractor” per area (England and Wales have been divided into 11 areas) will supply all modalities of oxygen direct to patients home (not via community pharmacists)
- Prescribing of long-term or ambulatory oxygen therapy will be transferred from General Practitioners to hospital-based Respiratory Consultants - The FP10 will no longer be used
- There will be an increased scope for the provision of ambulatory oxygen systems
- The funding for the total supply of domiciliary oxygen will be devolved to Primary Care Trust (PCT) level
- PCT’s will be responsible for the changeover arrangements and the establishment of local respiratory teams to assess & monitor patients
- This is a major change, currently programmed to start 1 October 2005.
The consultant will dictate the flow and duration of the therapy for both home-based and ambulatory needs. This will determine the “patient category” and the oxygen contractor will then decide upon the modality of supply i.e. concentrator, cylinder, or liquid.
- The oxygen is the treatment/drug, not the cylinder, concentrator or liquid system.
- Adopting this approach, and not precribing on an equipment-specific basis, will enable the patient to benefit from any advances in technology.
A fixed daily rate will be charged, being dependent on the patient category. Examples:
- A patient who requires just 15 hours of Long Term Oxygen Therapy (LTOT) at home, may fall into category X - and the oxygen contractor may supply this category with an oxygen concentrator or a large cylinder. The cost of this service may for example, be £3 per day.
- A patient who requires 15 hours a day of LTOT, but is mobile enough to leave the house for 2 hours a day with ambulatory oxygen may fall into category Y - this category may be supplied primarily by an oxygen concentrator for home-based use, but then also include lightweight cylinders and a conserving device for ambulatory use. The cost of this service may be for example, £5 per day.
The timeline for the changes:
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After July 2005 a 6 month transition period will exist during which the incoming and outgoing contractors will both be supplying oxygen to patients PCTs will need to manage significant change during this period to ensure uninterrupted oxygen supply to patients
The changes will have several effects on Primary care:
- GP's will need more support from respiratory departments and oxygen contractors to assess all patients and transfer their therapy to new suppliers.
- Budgets for provision of ALL oxygen will be devolved to PCTs, with payment via the PPA.
- This is obviously going to require a great deal of interface between the PCTs (especially pharmacists) and the oxygen Contractors.
- Contractors will be accountable to the individual PCTs. The PCTs may require a representative for the contract region.
It is BOC Medical’s intention to hold meetings and roadshows with all PCTs in any areas that we are awarded, starting early 2005 in order to work together to make this transition period as smooth as possible
Finally, whatever the outcome of the tenders, BOC Medical is committed to providing a professional oxygen therapy service to community pharmacists right up to the start of the new arrangements. However, we will only succeed in providing uninterrupted service to patients with the help and co-operation of PCTs and pharmacists.
For more information on BOC Medical's provision of care and equipment for domiciliary oxygen homecare use:
- Download this more complete Guide to the changes presentation
- Contact our product manager Victoria Rylott, by e-mail
- Or leave a message with our Vitalair team on 0800 515 661
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