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Graham Phillips is a community pharmacist in Hertfordshire
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How balanced is the “balanced package of measures” offered
to pharmacy by the Department of Health in England in response to the
Office of Fair Trading report on control of entry?
As far as I am concerned the “package” is no more than a
staging post towards total deregulation because it proposes “to
move cautiously in the direction recommended by the OFT”. It also
appears to suggest that the only major barrier to total deregulation
is the current shortage of pharmacists — a position that will improve
over the next three years and implying that total deregulation will follow
at the next review.
Supporting the new NHS agenda
Like many community pharmacists I have spent much of the past five years
working to support the new NHS agenda. I was closely involved with
my (then) primary care group (PCG) as prescribing lead — a post
normally reserved for general practitioners.
At the time of my appointment, the PCG was predicting a 15 per cent (£200,000)
overspend against our prescribing budget, with a worsening position.
Working collaboratively with local GPs, we were able to bring the overspend
down to 5 per cent by the end of the first year and into balance by the
end of the second.
At this point we merged with a neighbouring PCG to form St Albans and
Harpenden Primary Care Trust. Again, I inherited a significant and worsening
prescribing overspend. I retained my position as prescribing lead, but
was also appointed to the professional executive committee and to the
board.
I was able to help persuade the PCT to invest in prescribing advice and
supported the appointment of an additional two prescribing advisers.
We have recently been declared a three star trust, our prescribing quality
is among the highest in the country and we actually underspent our prescribing
budget last year.
During this period I have spent a great deal of time away from the pharmacy,
working at the PCT. I have benefited from some degree of security in
that limitation of contracts has meant I have not had to look over my
shoulder all the time for so-called “leap-froggers” opening
between my pharmacy and the GP surgeries. I have also been able to work
collaboratively with all the other local community pharmacies in a way
that would have been rendered impossible by a “dog-eat-dog” deregulated
scenario.
I have now given up all my PCT positions entirely in order to do the
best I can to secure my own future. This is to a large extent a direct
result of the uncertainties brought about by the OFT report.
So why does the “balanced package of measures” concern me
and what do I think the implications are for the future?
1. Exemption for opening of 100 hours or more. I have two concerns:
First, it will prove impossible to police the 100-hours, and, second,
100-hours is an arbitrary figure and therefore a moveable feast (100
hours, then 80 hours, etc).
This policy plays directly into the hands of supermarket pharmacies that
certainly do not offer the local commitment or added value of the smaller,
independent ones. (I know of pharmacy contracts being taken over by supermarkets
which have then stopped existing services, such as oxygen delivery, 24-hour
on call services and needle-exchange schemes for drug misusers.)
2. Consortiums in one stop primary care centres. The definition of either
a primary care centre or a consortium is unclear. It will be practically
impossible to define both of these in such a way as to avoid undermining
the fragile controls on entry that are proposed. This will lead to great
uncertainty and will inhibit investment, and it is likely
to destroy any collaboration between
pharmacies.
3. Pharmacy online. One local general practice has been encouraging
patients to use an e-pharmacy by means of a handout. The handout also
suggests that the local pharmacy will be happy to answer any questions
that may arise on prescriptions that the e-pharmacy has dispensed and
delivered. Surely professionalism cannot reasonably be expected to extend
to commercial suicide!
4. Shopping developments over 15,000 square metres. As ever the devil
is in the detail. One would reasonably assume that this exemption applies
to large out-of-town shopping centres. However, included in this list
is a shopping area in St Albans. This is simply a refurbished area of
shops within the old-established centre of the city. The area houses
two doctors’ surgeries with a pharmacy next door. There is a large
Boots across the road on the high street and there are three further
pharmacies within five to 10 minutes walk. In addition, there are two
supermarket pharmacies both within a five-minute drive — hardly
a lack of choice or competition.
In my view these proposals will destabilise the network of existing
pharmacies in the town and have a knock on effect on local pharmacies
serving communities on the outskirts of St Albans who rely upon the receipt
of prescriptions from the town centre surgeries for their survival. Not
only will this destroy business confidence and any chance of investment
towards the Department of Health “vision” for pharmacy, but
also there is no possibility of these pharmacies being able to co-operate
and work together in the future towards providing PCT-wide roles.
So now, having spent five years working with the PCT in part towards
developing the potential for such collaboration, I am left with the feeling
that my time has been wantonly wasted by one Government policy cutting
across another.
Supporters of small businesses
The Department of Trade and Industry, which sponsors the OFT, is supposedly
a supporter of small businesses. From this standpoint another concern
is the ripple effect. Deregulation will lead to loss of small local
pharmacies such as my own in a village, thereby hastening so-called “ghost-town-Britain”.
The village has already lost its banks and other local amenities: for
example there is nowhere to buy fresh fruit in the village and the
post office struggles to survive. If the OFT proposals are adopted,
then loss of pharmacies will lead to further erosion of local shopping
parades which, significantly, serve the most vulnerable communities.
The Government must not forget that community pharmacy reflects an outstandingly
successful public/private partnership. Each of the 12,500 community pharmacies
have invested an average of £330,000 of private capital to fund
a public service. The continued uncertainty renders any form of business
planning impossible and the DoH “vision” for pharmacy is
dead in the water.
To my mind, the Government has played a cynical political game in response
to our well-fought campaign against deregulation. It made soothing noises
to “draw the campaign sting”, it has allowed time to pass
so we risk losing momentum and it now proposes a classic political fudge
that is the worst of all worlds.
The NHS will be the main battleground for the next general election.
We have not yet done enough to convince senior Labour politicians that
damaging the community pharmacy network is not the way to win votes.
Our campaign, both public and political, must continue apace. Community
pharmacy must not snatch defeat from the jaws of victory. |
