In limbo
Out-of-hours medication services in England, as well as general out-of-hours medical cover, are in something of a limbo. There is still no sign of a review of medication services, expected from the Department of Health about a year ago (p603).
The lack of a clear way forward is further compounded by the fact that
at the end of September, general practitioner practices had to let their
primary care trusts know whether or not they intended to continue to
provide out-of-hours cover under the terms of their new contract. Although
the provision of out-of-hours services does not become the responsibility
of PCTs until April, the longer the delay in defining who can provide
what service, the less organised services are likely to be.
This situation has the potential to cause the most problems in rural
areas, where patients have much less chance to use the type of out-of-hours
emergency centres that have become popular in urban areas in recent years.
In fact, as a correspondent in this week’s issue points out (p614),
the pharmacy network in rural areas may be under as much threat as the
post office network and if that is threatened, health provision for people
in rural areas looks set to deteriorate to a point of no return.
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Do not recreate the generics problem
Plans by the Department of Health to change the way pharmacists in England and Wales are reimbursed for generic medicines could provoke severe shortages, bringing back all the stress pharmacists and their patients experienced in 1999, the British Association of Pharmaceutical Wholesalers is warning this week (see p605).
The DoH was stung in 1999 when generics prices started to rise rapidly after
many years of falling prices — falls that resulted mainly from the competitive
purchasing arrangements of pharmacists. The Department is trying to exert more
control over generics prices but is finding it hard to strike a balance between
restraining price increases and seeing the benefits of a dynamic free market
for unbranded pharmaceuticals.
The money made by pharmacists on generics purchases has played an important,
but until recently unspoken, part in keeping community pharmacy going. This looks
set to be acknowledged in the new pharmacy contracts being negotiated. The Government
must tread carefully if it is to avoid recreating the problem it set out to solve.
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