|  The current system controlling how pharmacy contracts in England
are awarded is “a legacy of the last century” which prevents
primary care trusts from commissioning services to meet local health
needs, health minister Andy Burnham said last week. And, launching the
Government’s latest report on the control of entry system, Mr Burnham
announced that a further
review would be undertaken (News, p63).
The current regime has led to a system in which the market remains largely
provider-led and primary care trusts have insufficient influence to commission
or exercise sufficient control over where services are provided to meet
greatest needs, he said.
“We consider it is open to further debate whether the control of
entry system remains a suitable vehicle to enable primary care trusts
to meet
their new roles and responsibilities for commissioning a patient-led
NHS. … We shall review what action is needed to allow primary care
trusts to have more powers to commission as is necessary to secure adequate
service provision to meet local health needs,” he added.
No major overhaul
This review will not, however, lead to a drastic overhaul of control
of entry, Mr Burnham stressed. “It would not be prudent to propose
further major changes to the current system, either in terms of moving
towards greater deregulation or imposing tighter restrictions,” he
said.
Steve Lutener, head of regulation at the Pharmaceutical Services Negotiating
Committee, believes that the decision to avoid drastic changes is sensible.
“The minister emphasises that it would ‘not be prudent’ to
make changes to the control of entry system at the moment,” he
says. “I would agree with that. We don’t want to see any
changes to the system which could undermine the pharmacy network we already
have.
“Nonetheless, he said they need some means of managing the availability
of pharmaceutical services in their area and PSNC will be taking part
in the new review.”
John D’Arcy, chief executive of the National Pharmacy Association,
agrees that it is too early to judge the impact of the revised control
of entry provisions: “I’m pleased to see that there won’t
be any changes rushed through. The minister’s announcement of another
review is, in a way, a neat political sidestep in terms of not making
any drastic changes in response to the report, but still recognising
that changes may be needed further down the line.” Impact of reforms
The Government’s report shows that where new pharmacies opened
under the revised control of entry regulations access has been increased,
Mr Lutener says, but that they do so where there is already good access,
so patients have not seen a great widening of access in areas of poor
provision.
“What PCTs say is that they need to commission services in deprived areas
with poor provision of pharmacies, but financial constraints are limiting
their ability to do that because pharmacies opening under the exemptions
are drawing funds that PCTs say they would otherwise be able to spend
on enhanced services,” he says.
“We are concerned that PCTs have not been able to maximise the opportunities
that the pharmacy contractual framework provides, in that the overall
levels of enhanced service commissioning has been low,” he adds.
Mr D’Arcy agrees that PCTs need to be given a greater role in managing
the supply of services. “We would want to see PCTs putting pharmaceutical
needs assessments at the centre of their plans for controlling provision
of services in their areas.”
There also needs to be a balance between consistency and flexibility
for PCTs to make their own decisions, he says. “I would want to
see the review focusing on PCTs and the tools that they will need to
be able to control the provision of services, rather than on consumer
choice or access. The review needs to ensure that any new system introduced
is easy to administer, to understand and for PCTs to control.”
The need to control entry is recognised in the report, by patients as
well as contractors and PCTs, Mr D’Arcy points out. “Many
patients seem to be concerned that if you open up the market in an uncontrolled
way, you will have areas with too many pharmacies and other areas with
too few,” he says.
The NPA also has concerns about the sustainability of pharmacies opened
under the exemptions in the new control of entry system, Mr D’Arcy
says. “If there is uncertainty about whether these pharmacies can
prove to be financially viable that will frustrate PCTs’ abilities
to plan the provision of pharmaceutical services. In the report there
is a suggestion, I think from a patient, that there could be an upper
limit on the number of 100-hour pharmacies that could open in a locality
and that is certainly something worth
considering.” Will the review make any difference?
There certainly seems to be a need to increase PCTs’ powers to
commission pharmaceutical services to secure adequate local provision.
What is less clear, Mr D’Arcy warns, is how much the new review
will be able to achieve. “We’ll have to wait and see whether
the new review will get anywhere. What the review will do is give pharmacy
an opportunity to comment on what we would like to see change in control
of entry
regulations.
“The review has to be completed by March, however, and what can be
achieved in such a short review will be limited,” he says. “Ultimately,
primary care trusts should be in the driving seat and they will be looking
forward to the next review. For our part we will be looking at what we
can do to help to provide a solution that’s good for community
pharmacy as well as patients and the public.”
Consideration of OTC prices
The Government’s report contains a comparison of over-the-counter
medicines’ prices across various outlets. And, in a written
ministerial statement about the report and the review, Mr Burnham
said that the 2005 amendments to the control of entry regulations
had had “no noticeable impact so far on the prices of OTC medicines”.
Mr D’Arcy thinks that the analysis of OTC medicines prices
was included to placate the Office of Fair Trading, which has argued
that entry to the pharmacy market should be completely deregulated.
“Pharmacy is increasingly in the business of health care and I was
concerned to see a price comparison of OTC and pharmacy medicines
in the report,” he says. “That has nothing to do with
the provision of NHS services and its inclusion in the report is
an unacceptable sop to the Office of Fair Trading. The Office of
Fair Trading has made its case for straightforward competition,
but pharmacy is now about providing health care in a way that complete
deregulation cannot support.” |
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The
Pharmaceutical Journal