Health and Social Care Bill

Memorandum submitted by Lloydspharmacy (HS 96)

Briefing on key clauses in the Health and Social Care Bill 2011

About Lloydspharmacy

Lloydspharmacy is a leading community pharmacy operator with over 1,600 pharmacies across the UK. Our trusted staff, working at the heart of local communities, serves over 2 million people each week and 90% of our business is directly related to healthcare. With strong relationships with patients and vast experience of front-line health service delivery, community pharmacy plays a vital role in the health of the nation.

Summary

1. This briefing sets out Lloydspharmacy’s position on the Health and Social Care Bill. We welcome the broad thrust of the bill, but believe that further attention is required to improve the legislation in order to deliver an enhanced patient-centred service with improved clinical and public health outcomes, together with greater efficiency. In particular, there are four areas we believe deserve particular attention:

· The National Commissioning Board

· Commissioning Consortia

· Licensing, competition, and pricing

· Health and Wellbeing Boards

The National Commissioning Board

2. Clause 5 establishes the National Commissioning Board, and Clause 11 sets out the power for the Secretary of State to require the National Commissioning Board to commission certain services. Pharmacy is not explicitly mentioned in any of these clauses.

3. Lloydspharmacy believes that the National Commissioning Board and its committees must draw upon appropriate expert advice. This will inform and enable good commissioning decisions, and enable the Board to benefit from existing expertise in the health service. We welcome the discussions that have occurred in Committee on this point, and welcome all parties’ views that pharmacists, alongside other healthcare professionals, should assist the Board. We believe that as the Committee considers further aspects of the formation and the powers of the National Commissioning Board, due regard must be given to the need for the Board to consult expert advice.

4. This is particularly important for community pharmacy, as the Board will be responsible for the Community Pharmacy Contract – an agreement with a funding budget of £2,486m [1] (2010/2011) and which affects millions of patients every day.

Commissioning Consortia

5. Lloydspharmacy believe that the creation of GP Consortia affords the possibility of better-integrated care for patients.

6. Around 12% of the total NHS expenditure in England is spent on medicines, equating to around £10bn [2] . Effective use of medicines plays a crucial role in meeting the QIPP agenda, and it is essential that experts in medicines are represented on commissioning bodies.

7. Community pharmacists also bring a unique frontline perspective. Their expertise and understanding of the local pharmacy environment will be crucial for effective GP commissioning.

8. As Pharmacy Voice [3] has noted, community pharmacists see many patients who are not registered with GPs – and it is vital that the interests of this group are considered if public health outcomes are to be maximised.

9. As such, while we note the Committee’s discussions on the clauses and schedules establishing consortia, we believe that to make better-integrated care a reality, relevant healthcare professions should have appropriate representation on the boards of GP Consortia, including community pharmacists.

Licensing, competition, and pricing

10. As the Royal Pharmaceutical Society [4] (and others) have argued, it is essential that a transparent and level playing field exists for providers to compete to deliver services in the new NHS. We believe that NHS services should be delivered by a broad range of providers, with the most appropriate and cost effective resource utilised, not only to draw on expertise but also to deliver additional capacity.

11. We agree with the principle of licensing for providers, as set out in Clause 74 - so that commissioners have confidence in the legitimacy of an organisation delivering services on behalf of the NHS.

12. Lloydspharmacy welcome Clause 56, outlining Monitor’s requirement to ensure it does not impose unnecessary regulatory burdens. Pharmacy is already a highly regulated profession, and this is an important clause for ensuring that it can make a contribution to health outcomes – licensing arrangements should not deter valuable healthcare providers.

Health and Wellbeing Boards

13. Clauses 178-183 establish Health and Wellbeing Boards. Lloydspharmacy agree with the establishment of the Boards, and believe that they can bring healthcare decisions closer to patients.

14. We agree with the membership of the Boards, as representation from different parts of social and health care will improve the quality of local decision-making.

15. With around 10,000 pharmacies in England, community pharmacies provide frequent opportunities to engage with target populations. Initiatives such as the Health Living Pharmacy model, where pharmacies in one area agree to support and implement public health programmes, shows the potential to use existing infrastructure and expertise to improve public health.

16. As with GP Consortia, we believe that it is important that the leadership of these organisations includes representatives of pharmacies. We believe that there are further opportunities for providers to be represented by existing groups - such as local pharmaceutical committees.

17. As such, we welcome Clause 179’s Duty to Encourage Integrated Working. We would add that Clause 178.2 should include a statutory duty to include a representative of healthcare professionals, including pharmacists, to support effective public health provision particularly in the development of Pharmaceutical Needs Assessments (Clause 190).

March 2011