The Pharmaceutical Journal Vol 264 No 7089 p483-486
March 25, 2000 Forum

Local Pharmaceutical Committee Representatives' Conference

Conference calls for PSNC to implement resolutions

Local pharmaceutical committees have called on the Pharmaceutical Services Negotiating Committee to demonstrate its respect for their conference by vigorously pursuing the objectives set by conference resolutions.
Successfully proposing a motion to that effect for the second time (PJ, March 7, 1998, p350), Mr GRAHAM PHILLIPS (West Hertfordshire) said that low morale among contractors was not solely caused by lack of recognition of their contribution to health care nor by inadequate pay. A contributory factor was that some of the profession's leaders thwarted its ambitions towards pharmaceutical care. By ignoring similar resolutions which were carried year after year, the PSNC acted as a morale-buster. Outlining a succession of resolutions which he said had not been implemented, Mr Phillips said: "The PSNC must act on conference motions so that our earnest ambitions for the future can be realised." How long did pharmacists want to have to survive in business by beating the discount scale and chasing prescriptions? What would happen when the discount scale really caught up?

PSNC should not be hog-tied

For Northumberland LPC, Mr ANDREW BOOTH said that the PSNC should not be hog-tied by an insistence that they followed resolutions to the letter. Flexibility should be allowed.
Mr ROBERT GARTSIDE (North Wales) said that negotiators should not be rigidly confined. They had a feel for what could be achieved. In his view, the motion amounted to a motion of no-confidence.
Responding to the debate, Mr PHILLIPS pointed out that there was a difference between flexibility and ignoring resolutions year after year.

Application fee

The conference agreed that applicants for new pharmacy contracts should have to pay a fee, which would be refunded if their applications succeeded.
Proposing, Mr GARETH SPURGIN (Birmingham) said that many applications were serial applications for sites with a history of rejection. The proposed fee would hinder such applications and release time for LPC members. The proposed fee was comparable to fees payable with town planning applications, but would be refundable. It would lead to applications which were well thought through and well presented.
Opposing, Mr KARL LEGG (Suffolk) said that the implication for rural areas, where villages were deprived of pharmaceutical services, would be to discourage applications which could often fail the test of prejudice to existing medical services. Applications in dispensing doctor areas should be encouraged, he said. The conference should not seek to restrict pharmacy ownership to those who could afford to lose what amounted to a deposit.

Dr HOPKIN MADDOCK (Cornwall and Isles of Scilly) opposed the return of the fee for successful applications. "I defend existing contractors," he said. "Why should an applicant get his money back if he beats me?' Barking and Havering LPC unsuccessfully called on contractors to stop co-operating with the Department of Health until it recognised their productivity gains over the past 10 years. Proposing, Mr JAY PATEL said that pharmacists should "blow the whistle" on drug wastage with local and national photocalls to show how much waste there was in a month. The proposed non co-operation would take the form of no longer colluding in the covering up of a national scandal. Supporting, Mr IMRAN KHAN (Redbridge and Waltham Forest) said that the difference between nurses and pharmacists was that nurses fought for what they wanted.

Hopkin Maddock: Why should be get his money back if he beats me?

PPA

Mr ROBERT DARRACOTT (West Surrey) proposed successfully that the PSNC should find out whether the Prescription Pricing Authority had the right to collect prescription charges from pharmacies if they had not been collected from patients. What would the Government do if pharmacies stopped collecting prescription charges, he asked.
A motion of no confidence in the PPA, also proposed by Mr Darracott, was withdrawn after debate showed that it had no support.
Mr Darracott said that he had no confidence in the ability of the PPA to do its job efficiently or effectively. No prescription bundles checked by the PSNC's National Prescription Research Centre were correctly priced. Over-payments were rare. The annual total underpayment amounted to £7.2m.
Speakers against the motion said that it was aimed at the wrong target. The PPA acted on instructions from the NHS Executive. PPA staff were efficient and hard-working and should not be alienated. They had no flexibility and worked strictly according to operating manuals.
West Hertfordshire and Redbridge and Waltham Forest LPCs unsuccessfully proposed that contractors should withdraw from the prescription charge exemption checking scheme from October 1. Proposing, Mr GARY BOORMAN (Redbridge and Waltham Forest LPC) said that the pharmacist-patient relationship had been destroyed for 2.5p. Pharmacists had been asked to swap their white coats for blue uniforms and whistles, he said. If GPs did not want to do these checks, why should pharmacists, he asked.
Mr GARY ELTON (West Hertfordshire) added that pharmacies had saved the Government £37m by carrying out these checks. At the same time, the PPA had taken to switching prescriptions from charge-
exempt to charge-paid bundles and refused to allow contractors to correct incomplete exemption declarations. The £12m added to the global sum for exemption checking was off-set by a loss of £8m from switching. Exemption checking was not a pharmaceutical care issue.
The motion was defeated even though no-one spoke against it.

Sponsorship

The Pharmaceutical Services Negotiating Committee is to seek sponsorship from pharmaceutical companies and other organisations in order to fund an extension of the support it provides to local pharmaceutical committees.
A motion which urged the PSNC to seek such sponsorship was carried.
Proposing the motion, Mr MAYUR PATEL (Redbridge and Waltham Forest) said that sponsorship should be sought as an alternative to an increase on the levy paid by LPCs to the PSNC.
Mr MICHAEL KING (head of professional development and LPC services, PSNC) outlined some of the areas which the PSNC wanted to develop. These included additional support and guidance packages for LPCs, improved information technology and the PSNC website, display and exhibition materials for LPCs, funds for practice research, public relations, lobbying and legal challenges.
Mr King said that the PSNC had already had discussions with a commercial sponsorship company about raising funds. All sponsorship deals would be developed carefully so as to avoid possible conflicts of interest.
Mr KIRIT PATEL (chairman, communications and information subcommittee, PSNC) said that pharmacy contractors had been marginalised on major developments in the National Health Service, such as primary care groups and NHS Direct, because they were so poor. The PSNC needed to raise and spend "big money" to achieve its objectives.
Dr MADDOCK opposed the motion, saying that accepting such sponsorship would lower the PSNC's credibility with Members of Parliament and other opinion formers. He felt that there would be conflicts of interest between initiatives such as medicines management and a greater use of generic medicines and sponsorship by pharmaceutical companies.
"Local initiatives are one thing, but our national body doing it is another," Dr Maddock said.

Monitored dosage systems

Two linked motions on dispensing in monitored dosage systems, proposed by Worcestershire LPC, were carried by the conference. The first called for general medical practitioners to be allowed to specify on prescriptions that dispensing should take place in monitored dosage systems. The second called for a dispensing fee to be paid for each seven-day supply made in a monitored dosage system at the request of a GP. Proposing both motions, Ms PATRICIA ALESBURY said that the use of and payment for seven-day prescriptions was the crux of the motion and that new money should be sought for these payments. Opposing the motion, Mr ASH SONI (Lambeth, Southwark and Lewisham) said that he wanted to be paid a professional fee for providing professional services, such as supplying monitored dosage systems. He did not want to be paid through additional dispensing fees. Mrs MARION GARNER-PATEL (Brent and Harrow) said that the whole point of using monitored dosage systems was to provide pharmaceutical care to patients in the community. By keeping patients in their own homes pharmacists were saving social services large amounts of money and this money should be used to fund the service. She supported the motion.

Patricia Alesbury: GPs should be allowed to prescribe monitored dosage systems and we should be paid to supply them

Minimum repayments

Kensington, Chelsea and Westminster LPC, whose area includes a large number of pharmacy contractors with low dispensing volumes, proposed a motion calling for the PSNC to maintain the principle in its negotiations that contractors "should, at the very minimum, be repaid the cost price of every item dispensed on an NHS prescription". Proposing the motion, Mr TONY CARSON said that this subject was a real issue for small contractors. In Kensington, Chelsea and Westminster around half of contractors did not receive the professional allowance because of the small volume of prescriptions they dispensed and only one-third received the full allowance. Many of these contractors did not receive discounts from wholesalers or manufacturers because of their small purchasing volumes. They were forced to buy stock at prices above those quoted in the Drug Tariff, which assumed that discounts were available. "Any system which uses averages in its calculations means that some will win and some will lose - but it is always the same ones that lose," Mr Carson said. He added that the PSNC had a responsibility to all contractors. Any measure which affected a few would eventually affect them all. Seconding, Mr YOGIN PATEL (Kensington, Chelsea and Westminster) said that it was a basic principle of business that one should be repaid at least what one had paid out. Pharmacies did not sell other items for less than they had paid for them. Any system which forced contractors to sell at a loss was unfair. It had been said that pharmacies would not go bankrupt because of this process because they could support the losses through the profits on over-the-counter sales, but it was unfair to wait for such bankruptcies to occur to prove the point of his argument. The motion was carried.

Tony Carson: The same people always lose in an averagin system

LPC constitution

A motion from North and Mid Hampshire LPC calling for LPC constitutions to be altered to take account of the development of primary care groups and primary care trusts (PCTs) was defeated after the debate side-tracked into consideration of geographical boundaries. Mr MICHAEL HOLDEN, proposing, was in no doubt that although LPCs currently only negotiated locally for non-core pharmaceutical services they would soon be negotiating core remuneration. Contractors could even find themselves having to tender for services to PCTs. Mr HEMANT PATEL (PSNC member) said that he did not understand what representatives were being asked to vote for because the motion was non-specific. The National Health Service should be allowed to develop before constitutions were changed. Mrs GARNER-PATEL said that the necessary flexibility was already available through local development groups. The LPC framework did not need to be changed. Responding, Mr HOLDEN said that LPCs had to anticipate NHS reorganisation, not wait for it. The motion was not about geography. It was a question of whether pharmacists wanted one-stop health centres or high street pharmacies. There was heated debate about two further motions on changes to the LPC constitution to allow flexibility over the appointment of pharmacists to serve on the committees. The first, proposed by Wakefield LPC, called for a working party to be established to reconsider and amend the model constitution for LPCs so as to allow more flexibility in appointments.

Representatives vote unsuccessfully for Wakefield LPC's motion on the LPC constitution

Proposing, Mr PETER WALKER said that the balance of multiple and independent ownership had been changing for many years and was now out of kilter with the rules laid down by the current constitution. His LPC had had difficult in filling vacancies because of, for example, the small number of Co-operative pharmacies in its area. There was a need to change the representation on LPCs and to increase the number of employee representatives. "The current constitution was implemented before primary care groups or trusts were thought of. It needs an overhaul," he said. Mr PHILIP BOOTH (East Riding) opposed the motion, saying that LPCs represented contractors, not employees. Mr BARRY PRENTICE (North and Mid Hampshire) said that LPCs with smaller numbers of contractors in their areas had smaller pools from which to draw, accentuated by changes in multiple ownership. He wanted to see guidance which would allow representatives of primary care groups or trusts to be included. Mr HEMANT PATEL felt that the definition of the problem was good but the proposed solution was poor. "By opening the door we could let the wolves in," Mr Patel argued. [Mr Patel later clarified this remark to say that he was not referring to employee pharmacists as "wolves".] Summing up, Mr WALKER said that a working party was needed to look at the issue in the cold light of day and to come back to the conference next year with some proposals. The motion was narrowly defeated.

Peter Walker: LPC constitution no longer reflects the balance between multiples and independents

The third motion on LPC constitutions was proposed by North and Mid Hampshire LPC. It called for amendments to be made to allow greater flexibility for co-option of pharmacists when LPCs had been unable to fill casual vacancies from the appropriate category.
Proposing, Mr PRENTICE said that a more flexible approach to co-option was needed to allow for a broad mix of skills to be maintained on LPCs and to increase contacts with PCGs. These would help make the LPCs more effective in carrying out their statutory consultative duties.

A short-term solution

Seconding, Mr HOLDEN said that the proposals in the motion were a short-term solution to the problem. The implication of voting against the motion was that many LPCs would no longer be able to function.
Mr HEMANT PATEL said that he opposed this motion for the same reasons as the previous one. He felt that it was up to LPC secretaries to educate and pursuade pharmacists to join the committees. He saw no reason why observers could not be invited to LPC meetings.
Mr KEITH SWAN (Lincolnshire) said that in Lincolnshire, a large rural area, there was around 60 per cent multiple ownership and the LPC had vacancies for both contractors and employees. The motion was necessary for the LPC to function usefully.
Mr SHAILESH AMIN (Croydon) opposed the motion, suggesting that pharmacy development groups were a better forum in which to push forward pharmacy's agenda.
Ms MARGARET AVON (Avon) said that there were 12 PCGs in her area. The LPC did not have enough contractors on it to have one on each of the PCG pharmacy forums which had been established. Some early volunteers had been lost due to the time commitment involved and the LPC now wanted to co-opt interested pharmacists.
The motion was carried.

A motion from Birmingham LPC calling for LPC members to sign confidentiality clauses in relation to the information they acquired through LPC work was accepted by the meeting. Proposing the motion, Mr SPURGIN said that LPC members had to be seen to act in a "whiter than white" way. LPCs had to keep their house in order on a voluntary basis or legal sanctions would be applied. The conference carried a motion calling for the right of LPC representatives to question the applicant or appellant at oral hearings of the Family Health Services Appeals Authority to be reinstated.

Gareth Spurgin: LPC members must be whiter than white or there will be legal sanctions

FHSAA appeals rights

Proposing the motion, Mr PHILIP GILBERT (North Derbyshire) told the conference that this right had been withdrawn without consultation by the authority's chief executive in July, 1999. The reason given was that it was necessary in order to speed up the proceedings. He had written to the chief executive twice about the matter but his requests had been rejected out of hand.
A motion calling for the PSNC to appoint an independent chairman for future LPC conferences was rejected by the meeting.
The last motion of the day, from East Surrey LPC, calling for LPC secretaries to participate in the PSNC's networking conference was carried without debate.