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Jill Jesson and Neil de
Reybekill are working
with North East London Local Pharmaceutical Committee to provide
a combined impact assessment
of the South Ilford Polyclinic
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ARTICLE CONTENTS
• What Darzi says about pharmacy
• Pharmacies will have to compete
• Act now
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The Broad spectrum feature is
open to any reader. Contributions of around 1,100 words commenting
on topical issues
may be posted to Graeme Smith, managing editor, or
e-mailed to graeme.smith@pharmj.org.uk for consideration
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Healthcare professionals and their representatives are now regularly quoted criticising the polyclinics proposed in Lord Darzi’s recent report, “Our NHS, our future”.
Tony Stanton, representing London GPs, recently condemned these “huge, centralised polyclinics”, while Nick Bosanquet, professor of health policy at Imperial College London, decried “a complete lack of any sound evidence base for the polyclinic concept”.
Healthcare is big business and businessmen
will defend their patch, but how can local pharmacists defend their interests
and those of their patients?
Health minister Dawn Primarolo promised that the much anticipated pharmacy
White Paper would be aligned with the Darzi review. Rob Darracott, chief
executive of the the Company Chemist’s Association, has focused
on the positive and on the potential of Darzi to increase the chances
of pharmacy services being commissioned. By comparison, Hemant Patel,
President of the Royal Pharmaceutical Society, has called for impact
assessments to be undertaken before any polyclinics are introduced.
“Our NHS, our future” and another recent Darzi report, “A
framework for action — healthcare for London”, set out the
Government agenda. They propose the introduction of polyclinics, serving
up to 50,000 people as part of a new model of healthcare that falls somewhere
between the current GP practice and district general hospitals. These
would provide a greater range of services than currently offered and,
it is claimed, do so more effectively and efficiently
But we have been here before. In July 2000, we were promised 500 new
one-stop primary care centres by 2004 by “The NHS plan”,
yet where is the systematic evaluation of this initiative? In an evidence
based era, we need to know what impact, if any, this has had on health
targets and community cohesion before embarking on another massive institutional
change. What Darzi says about pharmacy
The focus of these reports is on NHS services provided by GPs and hospitals.
Local doctors are seen as working in inner-city, single-handed practices
of variable quality and community pharmacy is mentioned only in a
limited way. Lord Darzi clearly does not understand the pharmacy business
model,
the diversity of ownership within the sector or how patient use of
pharmacies differs from general practice.
His report covers three dimensions of community pharmacy:
• Championing healthy lifestyles: helping patients and those people
who are not ill to stay healthy
• Long-term care: working with patients who have long term needs, such
as smoking cessation, obesity management and medication management
• Supplying public needs: provision of over the counter medicines and
self care
support
Significantly, dispensing NHS prescriptions is not mentioned at all.
Pharmacies will have to compete
The report is critical of older, single-handed GP practices, so the
problem the Department of Health sets out to address lies with GP practice
shortcomings, not pharmacy. However, each polyclinic will include
a
pharmacy, open for 18 to 24 hours a day. The expectation in Redbridge
Primary Care Trust, where the first polyclinic is going ahead, is
that as many as 70 per cent of NHS prescriptions will be dispensed through
three polyclinic pharmacies.
The local health economy will not be able to support both the existing
network of community pharmacists and these in-house dispensing super-units.
The loss of NHS income will make local independent community pharmacies
economically unviable and only the rich multiples will have the resources
to bid for the pharmacy contract, serving 50,000 patients.
Historically, local doctors and pharmacists were co-located for good
reasons. Not only has there been a community of interest between the
professions, but there is also a commercial imperative. Without dispensing,
the only other source of NHS income is from the provision of enhanced
services, which is an aspect of community pharmacy that PCTs have been
lamentably slow to commission.
The carrot that is held out is that there may be opportunities for
pharmacists within polyclinics. New work, currently provided in a community
pharmacy,
includes supplementary prescribing, medicines use reviews and repeat
dispensing to patients with long-term chronic illness. But will these
services be commissioned outside the polyclinic? If not, community
pharmacists will be left competing with supermarkets to sell OTC medicines
and personal
care products.
At present, most people are never more than 10 minutes walk away from
a community pharmacy. This ease of access will be lost if the Darzi
reforms proceed unopposed. If we believe that the existing network
of neighbourhood
pharmacies is a good community health resource, then, as with post
offices and local schools, we need to speak up in their defence.
Although some new polyclinics may be attractive and offer a wider range
of services, for most patients they will entail added journey time
and greater effort to consult a GP and obtain a prescription. The local
neighbourhood
will lose a valuable healthcare resource and the public will no longer
have their GP and community pharmacy within easy access to home.
This all seems to fly in the face of sustainable communities and public
consultation, which are supposedly central goals of this government.
In particular, this severely detracts from patient choice in the NHS,
as it removes the option of personalised care with a local trusted professional. Act now
The rationale for changes in NHS healthcare provision is that they
must support improvements to care, increase patient choice and address
health
inequalities. There is clearly a mismatch between the Darzi proposal
and these policy intentions. The loss of local pharmacies, which
will be the inevitable result of the introduction of polyclinics, can
only
serve to limit patient choice and harm community well-being.
Under the Local Government and Public Involvement in Health Act 2007,
local authorities and healthcare trusts are required to inform, consult
and involve local people when they propose to change the way that local
healthcare is provided. This has not happened.
When Lord Darzi wrote his report, there were no polyclinics in London.
In Redbridge, builders are already on site and staff are being hired.
Surely it is time for community pharmacists to challenge this ill-considered
charge for change.
Local communities, local scrutiny committees and local pharmaceutical
committees need now to be working together to force PCTs to commission
full health, community and business impact assessments for each and
every proposed polyclinic so that the interests of vulnerable patients
and
communities can be protected. |
The
Pharmaceutical Journal