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Health bill: 5 things you need to know

From GPs paying pharmacists to a dual licensing process, there are lots of things you need to know about the planned NHS reforms. Here the C+D team picks out five essentials for you

1. Pharmacy payment changes

Pharmacy will have several different paymasters. Dispensing costs are likely to be paid by GPs. According to the health bill’s co-ordinating document, although the “greatest benefit” lies with pharmaceutical services being commissioned by the NHS Commissioning Board, “GPs are responsible for generating the costs of dispensing medicines when they make prescribing decisions. Therefore, the costs of dispensing should fall to GP consortia.”

However, remuneration for pharmaceutical services will be determined by the NHS Commissioning Board, which will determine the amount paid for pharmaceutical services in each financial year.

Payment mechanisms could also be affected, as the government promised in its review of arms-length bodies to “commission a commercial review of the NHS Business Services Authority” with the possibility of private sector involvement or removing non-core duties from NHS BSA.

2. Pharmacy licences

In the new NHS, Monitor, the economic healthcare regulator, and the Care Quality Commission (CQC), which inspects providers against essential levels of safety and quality, will operate a joint licensing regime. Service providers will need a joint licence in order to provide health services.

In an impact assessment published alongside the health bill, the government promised the two bodies would be “jointly responsible for administering an integrated and streamlined registration and licensing regime, in order to minimise regulatory burden on providers”.

Monitor’s licence conditions might include requirements to report on costs, quality and volumes, or rules to protect patient choice by facilitating patient switching, while the CQC will provide assurance on the quality and safety of services being provided.

3. The national service tariff

In the new NHS, Monitor will publish a document known as the national tariff, which will specify services which can be provided by the NHS and detail how the prices paid for such services should be determined.

It will give a price, or maximum price, payable for the provision of each service. This doesn’t necessarily mean pharmacies will be paid the same as anyone else for offering a service, as the health bill states that different prices may be given “in relation to different descriptions of provider”.

Nor is the tariff final, as regulations have been proposed to allow some local modification to the process, but it does mean there should be national price guidelines for at least some services.

4. New home for PNAs

Full responsibility for developing and publishing pharmaceutical needs assessments (PNAs) will be transferred to local authorities in the new NHS.

The reason for the shift is because PNA requirements are viewed as “an integral element of the joint strategic needs assessments”, which are viewed as part of the public health service role of local government, specifically the Health and Wellbeing Boards due to be established.

For pharmacists, PNAs remain useful as they will continue to be used as a valuable resource by the NHS, providing a powerful summary of required services pharmacies can provide, and a compelling argument for commissioning through GP consortia.

5. GP engagement

Pharmacy organisations including the NPA have expressed concerns that GPs could use their new powers as consortia to commission services from themselves, rather than from other providers like pharmacy. The health bill includes a number of measures to try to limit this.

Firstly, GP consortia can be held to account by Monitor, which will ensure commissioning is operated on a competitive basis. The NHS Commissioning Board will conduct a performance assessment of each consortium every year, too, and will have powers to dissolve consortia, if needed.

Patients are next up, as a duty will be placed on consortia to engage with patients before making any commissioning decisions.

The consortia will also face scrutiny from the Health and Wellbeing Boards of local authorities. These boards will publish joint health and wellbeing strategies, which consortia will be required to take into account when commissioning.

Pharmacists can also do their bit and engage with GP consortia – reading their annual plans and reports may be a good start.

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