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Rural areas: updated regulations should improve pharmaceutical access
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Doctors’ practices that hold a dispensing contract can provide
a valuable service for patients in rural areas and their surgeries are
often located in areas where it is not financially viable for a community
pharmacy to operate.
However, in rural areas that do have a community pharmacy the subject
of dispensing doctors can be a sensitive one, with tensions created either
from the business competition of GPs who dispense, or the lingering threat
that others may apply to do so.
According to Stephen Lutener, head of regulation at the Pharmaceutical
Services Negotiating Committee, the updated NHS
(Pharmaceutical Services) Regulations 2005 for England (PJ, 2 April, p386) close some loopholes
that have previously fuelled tensions between the two professions (see
Panel).
Updated rural regulations
The regulations have been standardised so
that pharmacy contractors already on a PCT’s pharmaceutical list must satisfy the “prejudice
test” (that the new service would not prejudice the provision
of local medical or pharmaceutical services) as would any new
applicant. All applications from GPs must now also pass this
test.
New regulations include that applications from GPs will be refused
if their surgery is within 1.6km of a pharmacy and that PCTs should
notify pharmacists and doctors of rural applications and give them
the right of appeal.
If a pharmacy opens in an area with fewer than 2,750 patients on
its medical lists, patients living within 1.6km of the pharmacy
will now not necessarily switch to receive dispensing services
from the
pharmacy but may continue to receive them from their doctor if
they wish to do so.
The full amended regulations can be accessed here |
He says: “The main principles of the new regulations are
the result of the agreement between the PSNC, the General Practitioners
Committee
and the Dispensing Doctors Association. We believe that the 2005 regulations
will improve access to rural patients to pharmaceutical services, remove
the points of tension between the two professions, encourage a better
service to patients and tidy up certain administrative procedures in
the 1992 regulations.”
However, pharmacy contractors in Wales are still waiting to hear how
their rural regulations may change.
Mr Lutener says: “We are disappointed that the regulations applying
in Wales were not also amended at the same time, as this creates uncertainty
for pharmacy contractors in Wales, and a disparity in the arrangements
at the border between England and Wales.”
Adrian Tebby, director of a group of community pharmacies in the Welsh
Marches region, is concerned that this issue is addressed as soon as
possible in Wales. “Recent events show that there are still GPs
who are willing to jeopardise the provision of pharmaceutical services
in their area by applying to dispense from surgeries within small towns
that do have a pharmacy,” he says.
Mr Tebby describes a pharmacy just over the border in Wales serving a
small town with a population that has recently increased to about 3,000
following a new housing development at one end of the town. The local
surgery has just applied to the local health group for a dispensing contract.
He questions the motivation of the doctors in making the application. “The
town in which this practice is located is served excellently by a pharmacist
running his own business,” he says.
Mr Tebby points out that because of the linear layout of the town, most
patients have to drive from the development and past the pharmacy to
get to the surgery. The pharmacy therefore gains little protection from
the “one mile” rule (that GPs may only dispense to patients
who live more than one mile from a pharmacy). “The one mile rule
is a farce in this day and age,” he says. “Every patient
who lives further away than this from a pharmacy is judged to be fair
game for doctors’ unfair gain.”
He adds: “The money needed to keep a GP practice viable should
not be heavily dependent on the income from any dispensing they undertake.
This argument is really about securing proper funding for both pharmacies
and GP practices.”
Mr Tebby decribes the updated regulations as a mixed blessing. “Although
they are a bit of a trade off, they are a step in the right direction
and will make the existing network of pharmacies more stable in rural
areas in England. This is a positive step forward for England and, if
the Welsh Assembly Government adopts these regulations too, then hopefully
it will put an end to such situations in Wales.”
Peter Haydn Jones, chief executive of Community Pharmacy Wales, says: “Ministers
in Wales are well aware of the concerns for rural applications in Wales
and the impact that that will have on community pharmacy. In the short
term we are expecting a consultation on how the rural issue will be tackled.
We are working closely with WAG but as yet have no indication from them
about when the consultation will start.”
He says that the new community
pharmacy contract will provide pharmacy
with a stronger case when rural applications are being considered because
it shows how much more contractors do than just dispense.
However, it is not to be said that all pharmacists have troubled relationships
with dispensing GPs. Roger Pilsbury, superintendent pharmacist at Healthcare
Plus Pharmacy, explains how one of his pharmacies in Stocksfield, Northumberland,
has built up a good relationship with the local GP surgery, despite it
being a dispensing surgery located 100 yards away from the pharmacy.
“From a business perspective we would be better off if the surgery was
not dispensing,” he says, “But we live in the real world
where competition will always be a reality. We have tried to develop
the professional relationship and work with the surgery to provide new
services. This way we can try to secure funding from other streams such
as developing advanced services that we can present to the primary care
trust for funding.”
For example, Mr Pilsbury describes how a partnership has been established
between the dispensing doctor and the pharmacist to bid for funding for
a pharmacist-led dyspepsia clinic.
However, Mr Pilsbury says that because most of the patients registered
at the surgery live in Stocksfield itself, the surgery only dispenses
for the patients who live in outlying villages, which is about 10 per
cent. He admits that he might feel differently if he were to lose much
more business than that, but adds: “Dispensing doctors exist whether
it is right or wrong that they should have contracts. I do not see it
as a reason to prevent us from working closely together.” |
The
Pharmaceutical Journal