Applications to provide NHS Pharmaceutical Services. A Consultation on the Control of Entry Arrangements and Dispensing GP Practices

CONSULTATION PROPOSALS PART 1

CONTROL OF ENTRY (PHARMACY APPLICATIONS) AND DISPENSING GP PRACTICES

The stability of NHS services in remote, rural and island areas

1. The Scottish Government recognises the vital role that dispensing GP practices play in the dispensing and supply of medicines to patients in remote, rural and island communities. It is committed to ensuring that where patients have serious difficulty in obtaining (from a pharmacist) any drugs, medicines or appliances, required for their treatment that the dispensing GP practice will continue to fulfil this vital role.

2. The Scottish Government notes concerns that sometimes the impact of opening a community pharmacy in some rural communities could potentially impact on other NHS provided services or destabilise the overall disposition of NHS primary medical and pharmaceutical services. It is also aware of concerns about the impact on the viability of the dispensing GP practice and the staff it employs.

3. Whilst the income GP practices receive for dispensing is not intended to subsidise the delivery of primary medical services, the Scottish Government considers that in the circumstances it is reasonable that a degree of stability be provided for dispensing practices whilst the way ahead in the context of Prescription for Excellence is developed.

Areas of a 'prescribed description' and 'prescribed criteria'

4. Therefore, based on existing powers under Section 27(4)(d) of the NHS (Scotland) Act 1978, the Scottish Government proposes amending legislation that will introduce the designation of 'controlled remote, rural and island localities' for the purposes of considering pharmacy applications. These are areas that would be deemed by NHS Boards as rural in character taking account of the Scottish Government's Urban/Rural Classifications such as "remote small towns", "accessible rural", "remote rural", "very remote small towns" and "very remote rural"^[13]. These areas will usually have one or more dispensing GP practices and branch surgeries within the locality.

5. In a 'controlled remote, rural and island locality' the NHS Board Pharmacy Practices Committee (the PPC), in addition to the test of 'necessary or desirable' (the adequacy test), will need to consider whether the application to open a pharmacy in the locality would adversely impact on the provision of existing NHS services in the locality. This would be known as the 'Prejudice Test'.

6. In general, this means that nothing must be done which would compromise the ability of people to access existing NHS pharmaceutical services, dispensing services or primary medical services. Prejudice arises where the pharmaceutical services or primary medical services that people can rightly expect to be provided by the NHS would, in some respect, cease or otherwise be curtailed or withdrawn without the replacement of those services potentially affected.

7. If the NHS Board PPC concludes that the opening of a pharmacy would affect NHS provided or contracted services in this way, then the application would be rejected regardless of whether it would otherwise be necessary or desirable in order to secure the adequate provision of pharmaceutical services in the locality.

Proposal 1:

The Scottish Government proposes amending legislation that will introduce the designation of 'controlled remote, rural and island localities' for the purposes of considering pharmacy applications in these areas of Scotland and introducing a 'Prejudice Test' in addition to the test of 'necessary or desirable' (the adequacy test).

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8. Changes can occur that may affect the designation of an area as a 'controlled remote, rural and island locality'. This can happen where an urban area is expanding into the surrounding countryside, or where there has been a substantial development permitted in what may have been deemed a 'controlled remote, rural and island locality'. An example of this could be where a housing development has been built or is in the process of being built and the population of a village has increased or will increase as a consequence with increases in shopping, leisure and other facilities usually found in non-rural areas.

9. In addition NHS services need to be able to respond to changing healthcare needs and priorities both locally and nationally that may require some local NHS service reconfiguration to deliver appropriate and clinically effective service provision with available resources.

Proposal 2:

The Scottish Government proposes that the designation of an area as a 'controlled remote, rural and island locality' should be reviewed periodically by NHS Boards so that NHS provided or contracted services are responsive to population changes, and changing healthcare needs and priorities both locally and nationally. It is proposed that the review should be carried out at a minimum of every three years.

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10. It follows, therefore, that NHS Boards need to have the appropriate freedoms to discharge their statutory duty to secure and provide both the NHS pharmaceutical services and NHS primary medical services needed by their local communities.

11. The circumstances in which GP practices are required to dispense to their patients should also be kept under review by the NHS Board.

12. As discussed above, it is important that NHS services are responsive to population changes and changing healthcare needs and priorities both locally and nationally. It is therefore important that where the dispensing by a GP practice is necessary, it should be supplemented with pharmaceutical care provided by a qualified clinical pharmacist sourced by the NHS Board so that patients get the best possible outcomes from their medicines.

Proposal 3:

The Scottish Government is of the view that people living in remote, rural and island areas should have access to NHS pharmaceutical services and NHS primary medical services that are no less adequate than would be the case in other parts of Scotland.

Where the dispensing by a GP practice is necessary, it should be supplemented with pharmaceutical care provided by a qualified clinical pharmacist sourced by the NHS Board to ensure the person-centred, safe and effective use of the medicines. NHS Boards would be required to develop local plans sensitive to local circumstances to achieve this.

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