“Move or lose” contract threat in Scottish proposals
More consultation unlikely in England and Wales
A similar consultation process over new contract
proposals is unlikely in England and Wales. Sue Sharpe, chief
executive of the
Pharmaceutical
Services Negotiating Committee, said that the NHS Confederation
was involved in contract negotiations as a proxy for NHS organisations
and, through them, for patients. She said: “So far as I know,
there are no further plans for formal consultation with others.” |
Scottish community pharmacies that are too near to each other are to be encouraged to relocate to areas of under-provision or risk losing their NHS contracts. This proposal follows the rejection in Scotland of the Office of Fair Trading's proposals to overhaul control of entry regulations.
The plans are set out in a consultation paper on modernising NHS community
pharmacy in Scotland. The aim is to introduce the new contract during
2005–06, but with some of its elements being phased in later this
year.
The Scottish Executive Health Department (SEHD) and the Scottish Pharmaceutical
General Council (SPGC) have already agreed an outline framework for the
new contract. Core pharmaceutical services — a chronic medication
service, a minor ailments service, an acute medication service and a
public health service — will be centrally negotiated and remunerated.
Additional services and their remuneration will be subject to local negotiation.
All pharmacies in Scotland will provide the core services, with greater
emphasis than hitherto being given to clinical management of individual
patients’ conditions.
Legislation to enable the core services is expected to cover such matters
as quality of service, clinical practice standards, staff training and
qualifications (there will be a statutory requirement for CPD measured
by designated clinical competencies) and premises standards.
As part of the implementation, NHS boards will be required to draw up
pharmaceutical care services plans (PCSPs) that identify areas of over-
and under-provision. Pharmacies that meet the objectives identified in
the plans will get new contracts. Pharmacies in areas of over-provision
will get time-limited holding contracts. Health boards will be allowed
to incentivise change that results in a match between service provision
and PCSPs. Boards will be able to provide support, including financial
assistance, to enable contractors to merge or move to areas of under-provision.
Where there is under-provision of services, NHS boards will be allowed
to provide services using their own staff or contractors if they are
unable to attract pharmacies to the area. New contract applications will
be tested against PCSPs — the current test of necessity and desirability
will be dropped — but new applicants will only be successful if
no pharmacy with a holding contract is willing to move.
Under-provision is to be defined as the complete absence of a pharmacy,
insufficient pharmacies or the absence of any locally required services.
Frank Owens: Challenge is to improve services and not damage the
network |
SPGC chairman Frank Owens said: “We will seek clarification
from the Scottish Executive of what it means by time-limited holding
contracts
and how it expects them to work.”
More generally, he said: “These proposals, if adopted, will, facilitate
implementation of the new pharmacy contract, thereby providing the opportunity
to deliver a range of new services as detailed in the Scottish Executive’s
strategy for pharmacy.”
He said that although the Scottish Executive had rejected proposals from
the Office of Fair Trading to deregulate pharmacy totally, Scottish ministers
had made it clear that they would take the opportunity to examine how
the existing regulatory framework might be improved.
“It is clear that the Scottish Executive’s position remains
unchanged — the
current network of community pharmacies continues to enjoy significant
support,” Mr Owens said. “In all of this, the challenge is
how we improve the quality and range of services, both clinical and supply,
putting in place the necessary drivers to deliver the new contract and,
at the same time, ensuring the existing network on which we are looking
to build for the future is not endangered.”
To facilitate NHS disciplinary proceedings, all pharmacists providing
pharmaceutical services in Scotland will have to be named on NHS board
pharmaceutical lists, whether they are contractors, employees or locums.
Locums will be able to be included in multiple lists through a single
application. To gain entry to the list, pharmacists will have to declare
their fitness to practise and give, as yet unspecified, undertakings
and consents.
The consultation paper also sets out proposals intended to facilitate
mail-order and internet pharmacy from both existing pharmacies and new
mail-order/internet-only pharmacies by allowing NHS boards to pay contractors
based outside their own areas who provide services to patients who live
within that board’s boundaries.
The proposals are open for consultation until 1 June. The consultation
paper is available here |
The
Pharmaceutical Journal