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MODERNISING NHS COMMUNITY PHARMACY IN SCOTLAND

SECTION 3: PLANNING & PROVISION OF PHARMACEUTICAL CARE SERVICES

The Policy Intention

3.1 To improve the planning process for establishing and securing Pharmaceutical Care Services (PCS) by ensuring that service provision is based on locally identified care needs and that patients have convenient access to a full range of services.

The Need for Change

3.2 Paragraphs 13 to 15 of Section 1 provide an outline of the current arrangements by which persons or businesses secure a NHS contract to provide pharmaceutical services. These are generally referred to as the ‘control of entry’ arrangements, i.e. control of entry to pharmaceutical lists. The system is re-active on the part of the Board, i.e. the steps to establish a pharmacy contractor are initiated by potential contractors rather than by the Board actively planning and securing the services. The result is that there are instances where, particularly in rural, remote and deprived areas, patients do not have either complete or ready access to a full range of pharmaceutical services. There is, therefore, a need to place the arrangements for securing community pharmacy services onto a more pro-active footing.

The Proposals

3.3 The intention is to place a statutory duty on NHS Boards to provide or secure the provision of pharmaceutical care services that they consider necessary to meet all reasonable needs of persons in the Board’s area.

3.4 Boards would be required to publish, and thereafter keep under review, their plans for where and what pharmaceutical care services (PCS) are to be provided in their area. Amongst other things, the PCS Plan should state where the Board considers there to be over or under provision of pharmaceutical services. In determining or reviewing the plan a Board would be required to consult with appropriate professional and patient representatives as well as with the general public.

3.5 The PCS Plan would cover service provision under both national and local contracts (see 1.8). For national contract requirements, Boards would be responsible for ensuring that its resident population has convenient access (in terms of location and opening times) to the Core Services described in Section 2.4, i.e. Chronic Medication Service, Minor Ailments Services, Acute Dispensing Service and Public Health Services. The provision of Additional Pharmaceutical Services, i.e. locally negotiated ‘directed services’, would reflect local service needs as identified in the Board’s PCS Plan.

3.6 In both cases it is proposed that the required services are provided through individual PCS Plan contracts.

3.7 It is proposed to replace the current ‘necessary and desirable’ test for control of entry to pharmaceutical lists (see 1.14) with a more objective assessment for determining where PCS are to be located or delivered. The introduction of arrangements that result in an agreed area PCS Plan (PCSP) would provide the measure against which future applications for entry to a pharmaceutical list should be assessed.

3.8 Once the proposed new arrangements are in place, pharmacies providing services that match the needs plan would be granted a ‘new’ PCSP contract and continue to operate as they did previously.

3.9 In the case of over provision, it is proposed that the pharmacies in question will, for a set period of time, be granted a ‘holding’ PCSP contract and that Boards will be granted powers to incentivise change that would result in a match between service provision and the PCSP. Under the proposed arrangements, Boards would be able to provide assistance (including financial assistance) that could, for example, enable contractors to combine forces or to move to a location where a service deficiency has been identified.

3.10 It is thought that under provision will fall into three main categories, i.e.

• complete absence of national contract cover;
• insufficient national contract cover, e.g. where recent housing developments have placed a strain on existing service provision;
• absence of one or more locally required services, e.g. methadone or out of hours services.

3.11 In all cases, Boards would be required to take steps to secure the services in question through a ‘new’ PCSP contract or, where they are unable to place such a contract, by arranging the service provision themselves.

3.12 It is proposed that the first step would be for the Board to offer the sought after service to pharmacy contractors with a ‘holding’ PCSP contract. This could be on either an individual or consortium basis with the Board able to facilitate the process through the incentive and assistance arrangements outlined above.

3.13 Thereafter, other eligible persons or businesses would be able to apply for the new PCSP contract. In the case of national contract (Core Services) provision, the fees and allowances payable will be those centrally negotiated but the intention is that Boards will be able to pay additional sums where, for example, a more enhanced service is offered by the proposed provider. Contracts for local services would be negotiated in the same way as at present and Boards would be able to add such services to the specification for a Core Services PCSP contract.

3.14 The proposal is that new PCSP contracts for Core Services and/or local services are advertised with applications, in a prescribed format, to be submitted by a set date. Determination by the Board would include measurement against the PCS Plan, consideration of any service enhancements offered and the proposed timeframe for establishing the service.

3.15 Where the above processes fail to secure the required service the Board would be required to arrange the provision itself. For example, the service could be provided by Board employed staff or pharmacy contractors located elsewhere in either their own or another Board area.

3.16 It is envisaged that all PCSP contracts will be subject to periodic review by the Board against its PCS Plan, which itself should be subject to periodic review.

3.17 The holders of all PCSP contracts would be subject to the same provider requirements as currently exist for community pharmacy contractors. The service will have to be provided from authorised premises, delivered by or under the direct supervision of a registered pharmacist with the contractor being listed on the Board’s pharmaceutical list. The same terms and conditions of service will apply with additional or more specific terms being set where appropriate.

Questions

• Do these proposals offer a comprehensive way of ensuring patients have convenient access to a range of pharmaceutical care services that takes account of their care and access needs?
• Are there alternative models for fulfilling the policy intention for patients?

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