Drawbacks of 100-hour pharmacy rules recognised by Government

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The Pharmaceutical Journal
Vol 280 No 7497 p423
12 April 2008

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White Paper “Pharmacy in England — building on strengths, delivering the future”

Drawbacks of 100-hour pharmacy rules recognised by Government

Significant drawbacks to market-entry exemptions for 100-hour pharmacies are recognised in the new pharmacy White Paper, which incorporates the Government’s response to Anne Galbraith’s review of contractual arrangements. Both the White Paper and the Galbraith report were published last week.

The White Paper acknowledges that 100-hour pharmacies have improved access in some areas but it also recognises the concerns of independent pharmacies that are subject to increased competition and those of primary care trusts, which are unable to plan strategically or to commission further clinical services because of the costs arising from each new pharmacy.

Four options are identified, which the Government will consult on this summer:

• Introducing a distance restriction on new 100-hour pharmacies of 1.6km or 2km from existing 100-hour pharmacies

• Imposing a requirement on new applicants to justify a need for the 100-hour pharmacy

• Contracting successful applicants using local pharmaceutical services contracts so PCTs can avoid the fixed costs they currently incur from surplus provision

• Strengthening the requirements for the specific services a 100-hour pharmacy provides, for example, linking applications to developments outlined in the White Paper

The Government favours combining the first and last options since policy on exemptions to market entry would then be aligned with national priorities identified in Lord Darzi’s interim review.

The White Paper says that PCTs’ commissioning skills need to be strengthened before they can take on full responsibility for commissioning — one of the options suggested in the Galbraith report (see Panel below). This suggests that, as PCT commissioning evolves, control of entry regulations could eventually be replaced with contracting mechanisms that are based on safety, quality and outcomes.

The Galbraith report

The Galbraith report identifies a need to strengthen primary care trusts’ commissioning roles to stimulate competition and to ensure that future contractual arrangements are founded on the quality of services to be provided rather than on market entry.

The report recommends that PCTs should undertake more rigorous pharmaceutical needs assessments and that they should be able to terminate contracts when pharmacies perform poorly.

The report concludes that neither further moves to more advanced or essential services nor simple deregulation would meet these objectives.

It identifies two possible options:

•complete devolution of contracting responsibilities to PCTs

•introduction of the concept of “any willing provider” for the provision of essential services, with more contestability for enhanced services

The Government believes that commissioning in the future must foster a shift away from the dispensing service to more clinically focused pharmaceutical services.

To achieve this long-term strategic direction, commissioning must meet local needs and link to practice-based commissioning; arrangements for contracting and payment mechanisms for such services must be revised; and high quality and safety in the delivery of services must be ensured.

Immediate improvements that can be made to ensure high quality and safety of services include setting more robust standards for essential and advanced services and harmonising accreditation standards for similar enhanced services.

The White Paper also proposes introducing financial incentives and penalties as well as more effective sanctions to address poor performance.