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Georgina Craig is head of communications at the
Company Chemists' Association
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Primary care policy and service development, with the focus on improved
access and choice, and the shift from hospital to community are increasingly
as much about where services are provided as they are about what services
are provided. Community pharmacy has always prided itself on its high
street location, which makes it easy for patients to reach. But there
are forces at work that will drive changes in the location of pharmacies — and
perhaps not all for the good.
One-stop centres
Traditionally, the rule of thumb has been that pharmacies do well when
they are close to GP surgeries. Perhaps this is one of the reasons
why the Government is so focused on there being pharmacies in every
one-stop primary care centre,1 of which there will be 750 by 2008.
As well as more altruistic goals, like convenience, the Government
knows that it can subsidise the building of these centres by charging
community pharmacy and other contractors premium rents for space
in them. Early experience from NHS Local Improvement Finance Trust projects
has seen one pharmacy contractor being played off against another
by
private sector partners and primary care trusts alike. This is despite
local pharmaceutical committees and pharmacy owners being willing
to talk about service models like consortia, which will enable the continuation
of a pharmacy service on the high street alongside that in the one-stop
centre.
Ironically, with the introduction of the new general medical services
(GMS) and new pharmaceutical services (PhS) contracts, one-stop pharmacies
may find themselves with little dispensing to do and thus unable to
meet premium rents. A recent survey of PCTs in England2 found that
80 per
cent were already commissioning, planned or wanted to commission a
community pharmacy-based minor ailments service. With estimates that
up to 30 per
cent of GP workload consists of minor ailments that could be treated
under such schemes, and GPs keen to reassign this work to community
pharmacy, if such schemes become widespread, one-stop centres will
see significant
falls in people presenting for treatment of acute self-limiting illnesses.
When repeat dispensing is in place as an essential service within PhS,
this, too, will change the way people access the pharmacy service.
Once they no longer need to visit the surgery to collect their prescription
every month, people will choose to access a dispensing service in a
place
convenient to their home or work. Studies of repeat dispensing confirm
that under such schemes prescriptions migrate away from pharmacies
close to surgeries. With 70 per cent of NHS prescriptions classed as
repeats,
and estimates that as many as 80 per cent of these could be dispensed
under the new arrangements, a large proportion of current health centre
pharmacy business may disappear overnight.
However, both these changes will take time to bed down, and developing
a technology infrastructure that supports information exchange between
pharmacies and general practice is an important prerequisite.
In the meantime, the inevitable freeing of control of entry is likely
to destabilise the existing pharmacy network. The question is, who
will be the winners and who the losers?
Gaps in service and regeneration
A barely acknowledged fact is that despite the existing controls to
entry, there are already pharmacy deserts within the UK. Often in areas
of
deprivation and rural areas, the local population does not have access
to the pharmacy service they deserve because the business case for
a pharmacy in their neighbourhood cannot be made. The essential pharmacy
scheme has not plugged these gaps. In some areas, PCTs are exploring
the use of local pharmaceutical services (LPS) pilots to support pharmacies
that would otherwise be non-viable, and this is perhaps one of the
most positive uses of LPS to date.
But there is another facet to this agenda that is yet to be fully explored
by pharmacy and the NHS — the link with regeneration and neighbourhood
renewal.
The Welsh pharmacy strategy consultation paper3 was the first to make
this important link. It quoted the Department of Health’s own research,
which shows that there are three essential businesses needed to make
a business community flourish — a general practice, a pharmacy
and a source of cash (usually a post office). If any one of these businesses
closes, it will have an impact on the local business economy. Ironically,
in its rush to relocate GPs to more central premises, the NHS may inadvertently
be destabilising the local economy that is so important to public health
in its broader context. “Tackling health inequalities: a plan for
action”4 acknowledges this and encourages the NHS to act as a good
corporate citizen when planning its estate and service provision so as
to support neighbourhood renewal.
But in neighbourhoods where there is no pharmacy — or the viability
of an existing business is threatened due to a GP surgery
relocating to a new one-stop centre — there is a case to be made
to both the NHS and the local authority for support to develop and sustain
a successful pharmacy business on grounds of regeneration alone. The
model pharmacies in Scotland, funded by generic primary care premises
improvement budgets, signal what such pharmacies might look like and
how they could contribute to health improvement and increase footfall
for their retail neighbours. With suites of consulting rooms where visiting
health and social care professionals can run outreach clinics, pharmacy-based
provision of drug misuse services, alongside minor ailments and repeat
dispensing schemes, these pharmacies would, in effect, become the general
practice of old, allowing GPs to concentrate on a more challenging case
mix.
Cracking this nut will require pharmacy to engage with new partners,
most notably local government, but unlike its experience with primary
care organisations, community pharmacy may find it is pushing at an open
door. Local authorities understand the importance of the business side
of pharmacy, and that, in its own way, the pharmacy as a business contributes
to public health by providing employment and supporting other retailers.
This, and local government’s increasing engagement with the NHS
agenda, bodes well for community pharmacy in the future.
Conclusion
There is not a pharmacy organisation that does not see continuation
of an extensive pharmacy network that provides access to all as an important
feature of the service. There are a number of threats to that network
in the current policy environment. The challenge in 2004 will be to
look beyond these threats to the opportunity community pharmacy has
to contribute to public health in its broader context, in partnership
with both the NHS and a new and increasingly vocal ally in health matters — the
local authority.
References
1. Department of Health. Pharmacy in the future: implementing the NHS
Plan. A programme for pharmacy in the NHS. London: Department of
Health; 2000.
2. Celino G, Blenkinsopp A, Dhalle M, Gray N. National survey of
community pharmacy development. Keele: Westar Health, London and
Keele University;
2003.
3. Welsh Assembly Government. Remedies for success, a strategy for
pharmacy in Wales: a consultation document. Cardiff: Welsh Assembly
Government;
2002.
4. Department of Health. Tackling health inequalities: a programme
for action. London: Department of Health; 2003. |
The Pharmaceutical Journal