Pharmacy In England: Proposals For Legislative Change - National Pharmacy Association Response

Main Category: Pharmacy / Pharmacist
Article Date: 21 Nov 2008 - 1:00 PDT

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The NPA has submitted its response to this consultation, commenting on the five key proposals.
John Turk, NPA Chief Executive, commented: "Overall, we believe that any legislative changes to underpin the Pharmacy in England White Paper must balance stability with opportunity, while minimising administrative burdens on contractors."

A summary of the NPA recommendations follows and the full response can be downloaded from http://www.npa.co.uk:

PCT powers in relation to pharmacy 'poor performance'

- PCTs should approach matters of poor performance in a fair, supportive and consistent manner. To this end, procedures and criteria for judging improvement should be set out in national regulations.

- There must be an independent appeals mechanism, with contractors having the right to have appeals heard before any sanctions are applied. It should be noted that the livelihoods of the contractor and their staff would be put into the hands of PCT staff under the Department of Health proposals, and there must be safeguards against inadequate PCT processes or conduct.

- For as long as a pharmacy remains on the pharmaceutical list, we do not accept that the withholding of payments for core services should be amongst the sanctions available to PCTs should that pharmacy not perform to accepted quality standards. Instead, PCT imposed measures should be developmental and supported.

- There should be a timetable for investment, before any new sanction and reward structure is implemented, giving all contractors adequate time to attain any new baseline of quality defined by DH and to prepare to meet the new expectations more generally.

- We are concerned about the lack of detail in respect of Quality Accounts and would need to see a thorough cost-benefit analysis of this proposal before we can support its application to pharmacy.

Control of Entry, including 100 hour pharmacies

- NPA supports a process that will place a 'necessary or expedient' judgment at its heart, with PCTs clearly setting out what additional provision it wishes to secure and then stimulating that provision. The Government has indicated that most exemptions will eventually give way to PCT control of market entry, on the basis of robust pharmaceutical needs assessments (PNAs). We agree that exemptions should be removed and replaced by a reformed process of managed entry based on mapped need.

- We are concerned, though, that no timetable has been laid out, notably in respect of the 100 hour exemption. The pharmacy network needs to be allowed to stabilise so that contractors can prepare to take up the White Paper's challenges, confident that any new investment in premises and staff will not be undermined.

- There should be a moratorium on new 100 hour applications, pending new arrangements. If there are insurmountable legal barriers to a moratorium, we believe that applicants should be obliged to satisfy the PCT that there is justification for a 100 hour pharmacy application (i.e. the Second Option in the consultation document).

- PNAs must be robust enough to give a clear description of currently unmet need and to inform appeals. To this end, they should be developed by up-skilled staff in consultation with local pharmacy contractors and regularly updated.

Supplementary Pharmaceutical lists

- The NPA cautions the Government against cumulative regulatory burden that could gradually choke pharmacists' ability to engage with PCTs to expand and improve services. Any increased burden of regulation that could be generated by proposals for PCT-held supplementary lists would raise costs for our members and duplicate the work already carried out by the RPSGB inspectorate and GPhC in the future.

- Until such time as the scope for administrative duplication and the bureaucracy inherent in local lists can be eliminated, we oppose the proposal to establish supplementary pharmaceutical lists. With this in mind, it would seem sensible to wait for the new GPhC to establish before there is any further active consideration of this matter.

Rural dispensing

- Our starting position is that as many people as possible should have the opportunity to benefit from the provision of a full community pharmacy service. We acknowledge, however, that in places where a full community pharmacy service is unsustainable, dispensing from doctor practices may be a pragmatic solution.

- In the absence of testing of the full impact of these proposals, we feel confined at this point in time to support Option 1, namely that the current distance criterion remains. This will ensure that people in rural areas are able to enjoy at least the current level of pharmacy service. It will also prevent a period of uncertainty affecting investment that would occur if other options were selected.

OTC sales by dispensing doctors

- The Department proposes to allow, when there is no convenient alternative, dispensing doctors to supply over the counter medicines to all of their patients. We question whether the effort to implement a 'solution' would be proportionate to the issue it is seeking to address.

- For a number of our members, this proposal could impinge on their business viability. Any retreat of community pharmacy provision would be a significant loss to the communities that pharmacists serve.

Source
Geraldine Clark
Press Manager
National Pharmacy Association Ltd
Mallinson House, 38-42 St Peter's St, St Albans AL1 3NP
http://www.npa.co.uk