| Christopher Icha
|
Pharmacies opened under the “100 hours” exemption from control-of-entry
regulations in England have proved contentious. Concerns have been raised
about their effect on current patient care and on investment in future
services.
But they have also been seen as providing a much-needed opportunity
to open pharmacies in new locations, to improve patient access and to
use the extended hours to provide new services.
This autumn a White
Paper will consider the proposals made in Anne
Galbraith’s
review of pharmaceutical contractual arrangements (PJ, 4 August
2007, p118). The Galbraith review was born out of the Department of Health’s
review of the control-of-entry changes introduced in April 2005, the
most controversial of which has been to allow pharmacies opening for
100 hours a week to be exempt from the condition that they be “necessary
and desirable” (or “necessary
and expedient”, in the
new wording [PJ, 18 November 2006, p596]).
The DoH’s review acknowledged concerns that pharmacies opening
under this exemption reduce PCTs’ funds, as PCTs pay for essential
services, and limit their ability to fund enhanced services and plan
service provision. The DoH also heard a number of worries about the impact
of the 100-hour pharmacies on existing contractors.
For instance, existing
pharmacies may find it increasingly difficult to find locum staff, especially
during holiday periods. They may be forced out of business, reducing
choice for patients. Their business certainty may decrease, and with
it their incentives to invest in new services for patients.
The Pharmaceutical Services Negotiating Committee and the All-Party Pharmacy
Group have also expressed concerns about abuses of the exemption by pharmacies
failing to provide what would normally be thought of as a full range
of services for the whole 100 hours, and the APPG called for an urgent
review of the exemption.
“If it cannot be effectively monitored
so that the 100-hour rule is adhered to, with full pharmacy service available
throughout, the exemption should cease,” the APPG said in its report
on the future of pharmacy.
Nonetheless, the potential for 100-hour pharmacies to increase patient
access and improve service provision needs to be considered. The DoH
says that exempt pharmacies provide proportionally more enhanced services
than other pharmacies and it believes that they have improved accessibility
for patients, especially during weekends and evenings, when they have
opened near GP surgeries or other locations that patients find convenient,
although evidence for this is not easily found. The Company Chemists’ Association
believes that pharmacies opened under the new criteria have given patients
access to pharmacies in locations that “reflect the changes in
shopping patterns that have taken place in the past decade”.
In addition, the 100-hour exemption is seen by many pharmacists keen
to open their own pharmacy as their only option. For instance, Ben Marks
is a pharmacist who may wish to open a pharmacy under the 100-hour exemption.
He says: “The problems facing someone wanting to own a pharmacy,
and especially young pharmacists like myself, are that goodwill values
have risen vastly in the past 10 to 15 years or so, due to lack of supply
with increasingly high demand for premises.”
He adds: “A 100-hour pharmacy has comparatively low set-up costs
compared to purchasing an established pharmacy … [and] allows you
to improve patient care in various ways. Extended hours would allow people
who work to drop their prescriptions off on their way out in the mornings,
and collect them when they come back.”
He says his main concerns about running a 100-hour pharmacy are finding
locum pharmacists willing to work late and the security of staff. “Most
places where a 100-hour pharmacy would be viable are probably not the
safest places to walk around at night,” he comments. However, Mr
Marks says that other pharmacists he has spoken to have been wary of
opening 100-hour pharmacies because of their fears over high operational
costs — opening for 100 hours may consume much or all of the profit.
Mohammed Athaif, who opened a 100-hour pharmacy in the Hall Green area
of Birmingham last November, comments: “If I could have opened
a pharmacy with a normal contract I would have done, but I would still
have wanted to be open later.”
He believes an 80-hour contract would have been ideal. “I think
100 hours is too much, really. Some of the hours are just not needed
and we feel we are only there for the sake of being open for the full
100 hours.
So far, though, some of the potential difficulties with opening for 100
hours have not arisen, he says. “We have all the shifts covered
at the moment and have a few pharmacists on the books from locum agencies,
so we’ve not had trouble finding staff for the hours yet, but that
may pose a problem in the future. The pharmacy is on a main road and
we’ve not had many problems in terms of security when the pharmacy
is open late.”
The extra hours have meant that the pharmacy staff have been able to
focus on medicines use reviews and spend more time on them. The pharmacy
has also taken on other services, such as smoking cessation. In addition,
Mr Athaif thinks that opening for the extra hours has made the pharmacy
more accessible for a wide range of people.
“Talking to a few of
the other pharmacists who’ve opened 100-hour pharmacies locally,
I think we have quite a good mix of people coming in at different times,” he
says. “We have working people, non-working people, young people
and older people.”
Keith Sykes opened a pharmacy in Hull under the 100-hour exemption at
the beginning of the year. He also believes that using the exemption
was the only possible way he and his partner could have opened the pharmacy. “There
are already three pharmacies locally so we just wouldn’t have been
able to get an application approved unless we went for the 100-hour exemption,” he
says.
The pharmacy has been well received locally and is offering all the extra
services that the primary care trust has commissioned from it, including
a substance misuse service, minor ailments, emergency hormonal contraception
and smoking cessation, Mr Sykes says.
“We’ve also put our
hands up to do other services as they become available — so we’re
looking to do chlamydia testing and needle exchange as soon as the primary
care trust begins to offer them.” He adds: “We are currently
doing OK financially … but we didn’t start the pharmacy to
chase money.”
Discussion over the impact of the 100-hour exemption is unlikely to go
away anytime soon. Although the Office of Fair Trading is continuing
discussions with the DoH and pressing for control-of-entry regulations
to be scrapped, the Government has promised to shy away from a major
overhaul of the control-of-entry system (PJ, 20 January
2007, p63).
But, given the criticism levelled at the exemption, the Government
may be unlikely
to leave the 100-hour criteria entirely as they are. |
The
Pharmaceutical Journal