Reform—but with a planned
provision of pharmacy services
51. Many witnesses argued that this debate should
not be seen simply as a choice between the current system or
total deregulation. None of our evidence suggested that that the
current system of controlled entry was perfect. Sue Sharpe (PSNC)
contended that the NHS gets the "best value within a planned
service" as opposed to an "increase in the numbers of
pharmacies in unplanned localities,"[60]
and summed up the argument:
it is very important not to characterise this as
a debate between deregulation and the status quo. We have made
proposals for change, proposals for improvement in the planning
systems that operate under a revised scheme, and I think it is
really important to identify the key issue here which is: do we
have a planned pharmacy service or do we have an unplanned service
that comes from deregulation? I do not think any of my colleagues
here are supporters of the status quo.[61]
52. Mr D'Arcy of the NPA added that:
in moving forward we should be building on what we
have got, recognising deficiencies, and dealing with those on
the basis of health need in particular in the needy groups—the
mothers with young children, the elderly, the infirm—particularly
vulnerable groups—and building a modern, high-quality pharmacy
service, which is flexible and adaptable and is actually patient-focused.[62]
53. Mr D'Arcy further argued that the Government's
aim should be to "develop proposals that will give PCTs and
primary care organisations throughout the UK greater flexibility
in meeting local needs, that is something we are all supportive
of and in essence deregulation is not necessary to achieve that."[63]
54. Most of those from whom we took evidence expressed
support not only for reforms of the current system, but also for
a model in which a national framework guarantees a degree of uniformity
of standards but which is nonetheless sufficiently flexible to
enable Primary Care Trusts to plan and tailor the provision of
pharmacy services to the specific needs of their area.[64]
However in their oral evidence to us, the OFT argued that the
current system of regulation is only a negative planning tool
in the sense that it allows PCTs to decide that there should
not be a new pharmacy in a particular location, but that
it does not allow them to decide that there should be one
in a particular place.[65]
The relationship between the regulatory
reform and the remuneration system for pharmacy services
55. Several witnesses and submissions to the Committee
mentioned the fact that reform of pharmacy provision and, in particular,
the objective of increasing pharmacy involvement in primary care
might be facilitated through changes to the system of remuneration
of pharmacies. For example, ASDA argued that pharmacies could
be paid on the basis of services other than just prescriptions:
Other services that could reasonably be linked to
payment to encourage the pharmacy market to lift service standards
include: the provision of emergency services; extended opening
hours; repeat dispensing; supplementary prescribing; provision
of private consulting rooms; sums for provision of methadone;
blood pressure testing; diagnostic testing such as of cholesterol
and diabetes; warfarin clinics; smoking cessation; emergency hormonal
contraception (EHC); bone density testing; head lice management;
asthma clinics; tests for drug addiction; flu vaccinations; time
spent with GPs auditing high use patients' medication records;
home delivery. It may be that some of these services would be
valued more highly than others and remunerated accordingly.[66]
60 Q37 Back
61
Q40 Back
62
Q117 Back
63
Q51 Back
64
Q117; Q159 Back
65
Q57 Back
66
Ev 33 Back
