The Pharmaceutical Journal Vol 267 No 7176 p774
1 December 2001

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What will new disciplinary and control powers for health authorities mean?

Changes to National Health Service disciplinary procedures, coupled with proposed controls over who can provide NHS services, whether as contractor or contractor's employee, are being overtaken by changes to the structure of the NHS. The changes are intended to make it possible for the NHS to act against errant professionals without waiting for professional or criminal proceedings. Michael Thompson tries to find a way through the maze

What the future holds for community pharmacy and for pharmacists providing National Health Service community pharmacy services is becoming increasingly confused. Changes and proposed changes are being put forward thick and fast, so that each proposal comes forward before it has become clear when and how the previous one has been implemented.

An example of this is the NHS Reform and Health Professions Bill (PJ, 17 November, p701, and 24 November, p735), which is to abolish a tier of NHS management which was to implement new disciplinary and control arrangements for community pharmacists. It is not immediately obvious from the Bill whether the new strategic health authorities will taken on this role, which was to have been performed by existing health authorities, or whether it will be taken on by primary care trusts, which are expected to take responsibility for pharmacy contracts at some point in the future.

The new control arrangements are outlined in the Health and Social Care Act 2001, which was enacted shortly before the general election (PJ, 19 May, p667). It gives the Secretary of State for Health power to set grounds on which health authorities may, or must, refuse contract applications. It also provides for health authorities to be allowed to set conditions for continued inclusion in the list of contractors and to vary the terms of service.

Health authorities may also be allowed to keep lists, to be called supplemental lists, of people who are allowed to work on NHS services provided by pharmacy contractors. HAs would be able to set conditions for inclusion in these lists and to strike people off if they are considered to be unsuitable. This power could be used to make it impossible for people convicted of certain offences, eg, murder and NHS fraud, to work on the provision of NHS pharmaceutical services. It could also be used against people considered to be unsuitable for other, as yet unspecified, reasons.

There has been, and still is, an assumption that responsibility for these lists will transfer to primary care trusts and that these will form into ad hoc groups so that one PCT runs the system for a number of others. This assumption is tempered by belief that a system that is operated at the level of individual PCTs will be too complicated.

Kevin Hayward, who heads a pharmacy development group in south west Devon, says: "What worries me if PCTs administer the lists is what are the criteria for entry to the lists going to be. It could become very complicated if one PCT wants different validation from another for entry to its list."

Mr Hayward believes that the situation cannot be left to resolve itself over time. He says that the profession should take the lead and start to drive towards a solution on its own terms.

"We need to ask the questions now," he says. "I want pharmacy to drive it forwards, rather than have it imposed. We need to maintain our own lists and set our own criteria. This isn't something that many people have thought about yet because it's not a very high priority. It could have a drastic effect if we get it wrong."

Currently, the Department of Health is understood to be intending to turn its attention to pharmacy supplementary lists in about three months.

Sue Sharpe, chief executive of the Pharmaceutical Services Negotiating Committee, says that it not yet clear how the Department intends to approach the issue.

"What concerned us about this a number of months ago was to ensure that all lists are interchangeable. We really cannot cope with a system that includes a great deal of bureaucracy," she said.

This is important because of the mobility of staff working for pharmacy multiples and because of the large numbers of locums who can be expected to work across many PCT boundaries.

John D'Arcy, chief executive of the National Pharmaceutical Association, says that the idea of quality controls over contractors and their staff is unarguable. His concern, however, is with what the detailed proposals might say. Whether the details apply nationally or are locally determined is important because that will determine whether standards vary from one area to the next. If local variation is allowed, locums could find themselves on one list, but not on another, with consequent disruption to the distribution of manpower and services.

"As a principle, quality is OK," says Mr D'Arcy. "but we really do need to examine the detail. There needs to be national guidance on it. We need to see that it is workable and that there is no duplication."

One change to controls over NHS contracts for community pharmaceutical, medical, dental and optical services that has already been completed is to the existing disciplinary arrangements for contractors and the appeals mechanism. However, it remains unclear whether the powers of current health authorities will be transferred upwards to the new strategic health authorities, or downwards to PCTs.

From 1 December, health authorities have the power to suspend and remove contractors from their NHS lists on grounds of inefficiency, fraud or unsuitability. Until now there has been no power to suspend any contractor, and removal from the list, a slow process, was reserved for the NHS Tribunal and usually only took place after a successful prosecution for a serious offence. Appeals were to the Secretary of State. The tribunal has now been abolished and it is HAs who will take decisions to remove or suspend contractors. Appeals are to the Family Health Services Appeals Authority.

A significant difference between a health authority decision and an FHSAA decision is in the breadth of its effect. Health authority decisions to remove contractors only apply within individual HA boundaries and there is nothing to stop anyone seeking to join another HA's list. FHSAA decisions can be restricted to one or more health authorities or can be effective throughout England and Wales.