Many prescribing and dispensing practices have been, or are now in the process of, considering the merits of opening a community pharmacy on their surgery site. For dispensing practices, this provides a safeguard against another pharmacy opening on their patch.
In order to open a community pharmacy, doctors need to set up a body corporate and apply under the (amended) Pharmaceutical Services Regulations 2005.
However, the rules are in a state of flux and, in particular, the Health Bill 2009 is set to alter the playing field against the community pharmacy status quo and its incumbent pharmaceutical providers.
The proposed Health Bill, which was introduced into the House of Commons on 14 May, puts forward measures to improve the quality of NHS care, the performance of NHS services, and to improve public health.
It 'reforms current arrangements for pharmacies applying to provide NHS services and how performance meets required standards to ensure they are providing high quality services responsive to local needs.'
The Bill adopts the proposals in the Galbraith Report that PCTs must publish pharmaceutical needs assessments (PNAs). These will then become the yardstick for granting new community pharmacy and dispensing doctor NHS contracts. However, it is important to understand the background behind these changes.
In the recent Assura Appeals Court judgments one law lord criticised the difference between the law (Pharmaceutical Services Regulations 2005) and the DoH's intentions outlined in the accompanying guidance to the regulations for PCTs.
He emphasised the contradictions and commented: 'The result is that the chemist who gets there first is shielded not only from unnecessary or undesirable competition in dispensing but from commercial competition in relation to a significant proportion of its turnover.'
The judges' critical comments have undoubtedly influenced The Health Bill proposal.
Health bill section 26 subsections
The Health Bill was introduced into the House of Lords and was amended in Grand Committee on 18 March 2009; the bill proposes new arrangements for entry to the pharmaceutical list, in that they have removed the words 'may be granted' and substituted 'must be granted if the PCT is satisfied as mentioned in subsection (2A), and may otherwise be granted only if the PCT is satisfied as mentioned in subsection (2B).' (see box)
A recent test case in May proves the change in attitudes: Hadleigh Surgery in Suffolk successfully won (on appeal), consent for their body corporate, Mill Pharm Limited (based at their surgery) to join the pharmaceutical list of Suffolk PCT.
Like many contested pharmacy applications this went to an oral hearing of the National Health Services Litigation Authority (NHSLA) because the current providers (two branches of Boots) appealed against the PCT's decision to allow Mill Pharm Ltd to join the pharmaceutical list.
It is quite clear from this that the NHSLA is now persuaded of the merits of the proposals and of the philosophy outlined in the Health Bill.
As long as an application is robust and shows improvements over a monopolistic local provider, then the gateway is now open for more dispensing and prescribing practices to achieve consent for collocated community pharmacies on their sites.
- Nigel Morley is the managing director of Surelines Limited, a consultancy and training company specialising in the prescribing-dispensing interface. Email firstname.lastname@example.org; tel: 01004 859000
- Hadleigh were represented at the Litigation Authority Oral Hearing Appeal by Nigel Morley MRPharmS
- Health Bill 2009: www.dh.gov.uk/en/Publicationsandstatistics/Legislation/Actsandbills/DH_0 93280
- Pharmacy in England: building on strengths, delivering the future: www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publications PolicyAndGuidance/DH_083815
- NHS Employers Guidance on Pharmaceutical Needs Assessments: www.nhsemployers.org/PressReleases/2009/Pages/ NHS-Employers-launches-Pharmaceutical-Needs-Assessment-guidance.aspx
- Pharmacy White Paper: new obstacles facing dispensing practices: www.healthcarerepublic.com/practice/Management/883809/ Pharmacy-white-paper--New-obstacles-facing-dispensing-practices/
- Opening a pharmacy: your questions answered: www.healthcarerepublic.com/practice/PracticeFinance/892451/ Opening-pharmacy-questions-answered/