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RxMargin · Dispensary margin review Prepared for partners · Period: Oct 2025 to Mar 2026

Ashcombe Medical Practice: where the dispensary is losing margin, line by line.

Practice
Ashcombe Medical Practice
ODS (fictional)
A99921
List size
8,400
Dispensing
88%
System
EMIS Web
£57,200
in recoverable margin identified across six months, before any change to prescribing.
§ 01

Snapshot

A single month, reconciled. Every figure below is traced back to dispensing data, the Drug Tariff and your remittances.

Monthly contribution
£28,400
Feb 2026 · fees + rebates ▼ £1,300 vs Jan
Reimbursement (net)
£61,200
after 11.2% clawback
Dispensing fees
£19,800
8,940 items @ blended fee
NHS rebates
£8,600
below scheme rate
Items dispensed
8,940
Feb 2026 (FP34)
6-month contribution
≈ £172k
Oct 2025 to Mar 2026
§ 02

Contribution, month by month

A line that made money in October can turn. The dip in February is concession-driven, and recoverable.

Monthly dispensary contribution
Contribution (£000)6-mo average
40 30 20 10 concession dip OctNovDec JanFebMar
§ 03

The drug-level ledger

Net cost versus what you were actually reimbursed, line by line, so loss-making and over-tariff items stop hiding inside the average. Click a column to sort; filter by flag.

Drug-level margin, February 2026 All lines Losses Over-tariff Concession
Item Items Net cost Reimbursed Margin £ Margin % Flag
Total, 16 lines shown8,940£42,180£61,200,
Illustrative figures for a fictional practice. A real review covers every dispensed line, reconciled against the Drug Tariff Part VIIIA, monthly concessions and your wholesaler invoices.
§ 04

Where the money moves

Net margin by therapeutic class. Two classes carry the practice; two are losing money.

Cardiovascular+£4,120
CNS / mental health+£2,980
Endocrine (incl. GLP-1)−£1,840
Gastro-intestinal+£2,150
Vitamins / OTC (over-tariff)+£1,410
Specials & shortages−£2,510
§ 05

Recoverable margin, prioritised

A ranked list of what to do, with the value at stake. None of it requires changing what you prescribe.

Loss
£2,100 /mo

Rebate below scheme rate

Wholesaler rebate running ~13% against a ~25% achievable rate. The single biggest lever, a procurement conversation, not a clinical one.

Loss
£1,850 /mo

Genuine shortage losses

Lines bought above reimbursement during shortages. ≈ £11,100 over six months versus what the Tariff paid back.

At risk
£1,600 /mo

Concession-dependent margin

≈ £19k a year of contribution that evaporates if specific price concessions are withdrawn. Worth watching and hedging.

At risk
£3,200 /6mo

Procurement anomalies

A cheaper same-month source existed on several lines. Ordering discipline, not concessions, quick to fix.

§ 06

What lands in your portal

Every review ships these, finished, audited and ready to act on. Open the samples below (fictional data).

§ 07

Looking ahead: the next 12 to 36 months

A review looks back; this looks forward. Ashcombe is fictional, so the local-growth figures here are illustrative. The 2026/27 contract and QOF facts are real and apply to any English practice. Every projected figure shows its working and a range.

1. Local growth and an ageing list (illustrative)

Ashcombe sits on the edge of a growing market town with an allocated urban extension. A real review would model your own local plan, household size and registration share; the figures below are illustrative for a fictional practice.

new patients = dwellings occupied x 2.3 people x share registering here
Low+ about 90slower build-out, about 60% register
Central+ about 180urban extension over roughly five years, about 65% register
High+ about 280faster build-out plus windfall sites, about 70% register

About 1% to 3% of an 8,400 list over five years. The larger pressure is ageing, not headcount: in an older list, demand and complexity per patient climb faster than the headcount does.

2. Contract income, 2026/27

The 2026/27 contract was imposed from 1 April 2026. The Global Sum rose from £123.34 to £130.07 per weighted patient, an increase of £6.73.

Global Sum uplift = weighted list x £6.73
Indicative uplift: 8,400 x £6.73, using the raw list as a stand-in for the weighted listabout £56,500/yr
New practice-level GP reimbursement scheme, about £4.57 per adjusted patient, to claimabout £38,000/yr

Offsets to weigh: the dispensing fee per item fell for April to September 2026, with an October uplift expected but not yet published; National Living Wage rose to £12.71 an hour with employer NI at 15% and no Employment Allowance. The weighted list is not known here, so the uplift is indicative. Net effect: a modest capitation gain, not a windfall.

3. QOF changes to prepare for

QOF rose to 582 points at £227.95 a point, mostly a list-size effect, with no income protection this year. For a high achiever the risk is in the changed indicators. QOF maths uses the contractor population index, about 10,295, not the registered list.

CHOL003cholesterol points cut 38 to 20; about £4,100 at risk. Model the loss.
DM037 (new)all eight diabetes care processes, all-or-nothing per patient. Audit completeness.
HF009 (new)four-pillar therapy in HFrEF. Run a heart-failure medication review.
AF006upper threshold raised 90% to 95%. Push anticoagulation toward 95%.
OB004, OB005obesity indicators replace the retired weight-management service. Check the pathway and coding.

These are planning estimates based on published sources, not guarantees, and should be reviewed as figures are confirmed.

This is a fictional practice. Yours would be real.

Send us a period of data and we'll show you where your dispensary is losing margin, and what it is worth to fix.