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Pharmacy white paper - New obstacles facing dispensing practices

Dispensing practices must be involved in developing pharmaceutical needs assessments, writes Dr Lisa Silver.

Photograph: Baber Williams
Photograph: Baber Williams

The consultation on the Pharmacy White Paper, containing its proposals for legislative changes for pharmacy, closed in November 2008.

On 16 December, minister of state for care services Phil Hope announced that the contentious proposals for dispensing doctors would be dropped. Unfortunately this is not the end of the story.

The next big hurdle will be pharmaceutical needs assessments (PNAs), which, according to the DoH's response to the consultation, will form the basis of the 'market entry system' for providers of pharmaceutical services, set to replace the current control of entry process.

NHS Employers produced its guidance on pharmaceutical needs assessments as part of World Class Commissioning in January 2009. In future, the DoH wants PCTs to deliver pharmaceutical services in accordance with PNAs.

By 'pharmaceutical services' - not to be confused with 'pharmacy services' - the guidance is referring to the provision of services such as the supply of medicines and advice, support for health and well-being and better medicines taking.

This could include services provided by community pharmacies, dispensing doctors, appliance contractors and others, including the acute sector.

The PNAs will be offshoots of the joint strategic needs assessments (JSNAs), developed by trusts in 2008. These are designed to consider local service requirements, for example, services for the obese, the elderly or children; and existing local transport networks.

My local PCT is, I believe, ahead of the game when it comes to PNAs.

At the time of writing, it has already held two meetings on PNAs, inviting dispensing doctors, commissioning leads, pharmacists, members of the public, and hospital prescribing leads to determine how pharmaceutical services will be delivered in the future.

As part of the process, we have established a joint LMC and Local Pharmaceutical Committee (LPC) liaison group, which is meeting quarterly.

This means GPs and pharmacists are negotiating with the PCT from a united standpoint, avoiding tripartite negotiations with each party pulling in its own individual direction.

This can only be a good thing and I would urge all dispensing GPs to find out what is happening in their own area, to ensure there is dispensing practice representation on the development of local PNAs.

If there isn't, GPs could find that services are commissioned from groups other than dispensing practices.

At our January PNA workshop, six representatives were from dispensing practices, so were able were able to contribute their detailed knowledge of how pharmaceutical services should be developed to benefit dispensing patients.

Issues to explore include whether dispensing GPs will be able to bid for the enhanced services due to be rolled-out to pharmacies, as detailed in the White Paper.

The PNA guidance covers
  • Why and how PNAs should be integrated into PCTs' existing business and commissioning cycles.
  • How PNAs fit within the World Class Commissioning framework.
  • The key pointers on how to write a PNA.
  • How robust PNAs can be used to inform and sustain decisions on applications to provide services, and for workforce development.
  • How PNAs can be used to support the provision of existing pharmaceutical services and extend the services that are provided by pharmacies.
  • Specific criteria and indicators of performance levels for the world class commissioning competencies particularly relevant for PNAs.

In my area, some 100,000 patients are served by GP dispensers and one could argue these patients will be denied the enhanced services offered by pharmacies, since dispensing practices are not being commissioned to provide them.

For example, are PCTs ensuring that both dispensing and non-dispensing patients have access to the vascular screening enhanced service, due to be rolled-out from April 2009? It is a national initiative and there must be equity for patients and practices.

Differing practice types
In addition, it must be ensured that PCTs do make simple comparisons between dispensing and non-dispensing practices without taking into consideration the differences between practice types.

Practices facing a review of their right to dispense must receive an accurate assessment of their pharmaceutical needs.

If their prescribing is greater than that of a non-dispensing practice, the local PCT must clarify issues such as the dispensing practice's number of mobility-impaired patients, because this clearly impacts on prescribing.

Access to OTC preparations for patients of rural practices should also be considered. Prescriptions for these items may be justified when the alternative is to put patients through long journeys to purchase them.

The key message is that PNAs must not be ignored. GPs should be involved and let their practice managers know, so that when emails about the assessments arrive from the PCT they are not simply deleted and forgotten.

  • Dr Lisa Silver is a dispensing GP in Oxfordshire


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