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Letters to the Editor
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New Contract
Minor ailments should be an essential service
From Mr A. Spooner, MRPharmS
I note that the recently proposed amendments to the control of entry
regulations for England place a high priority on the desirability of
increased competition and choice. The local primary care trust will have
powers to administer this new regime and grant contracts where the criteria
are fulfilled.
There are many new developments in community pharmacy, especially under
the proposed new pharmacy contract and ad hoc pharmaceutical service
developments in England. These new services may fall under the essential,
enhanced or additional part of the new contract or could arise from the
extension of prescribing rights. It is noticeable that many of these
services may not be provided by all contractors for various reasons.
The reasons for the variation of ability to provide these services (and
obtain the funds that flow from them) seem many and varied. Minor ailments,
addiction, medicines management and other services are not currently
being proposed within the essential part of the new contract but as additional/enhanced
services. The ability of a pharmacist to get involved in these may be
highly dependent on factors out of his control, such as access to training
and funding. I understand that these will also be administered by PCTs.
It appears to me that there is scope for significant conflict of interest
arising from the introduction of these two new regimes. On the one hand
PCTs play a major role in deciding which contractors can enter into new
service provision so as to differentiate themselves and extend choice
and competition. They will then also determine new contract applications,
in part, on the criteria of extended choice and competition. I suspect
that this could lead to some rather difficult decisions where it might
be impossible for PCTs to demonstrate equity to existing and proposed
contractors. In my view, the solution to this potential problem might
lie with the inclusion of the maximum number of services within the essential
(if optional) part of any new contract — including minor ailment
services, etc. Without this, it could be wise to separate the powers
granted under the two regimes.
The non-inclusion of the minor ailment service within the core contract
was disappointing. In light of recent reports of the success of pilot
schemes in this area, illustrating not only a successful clinical, but
also financial model, is it too late to renew arguments for inclusion
of these in the essential part of the new contract?
Adrian Spooner
Solicitor and consultant,
London N3
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