DH takes aim at prescription direction by distance-selling pharmacies

Some distance-sellers receive majority of their prescriptions from a single general practice
Some distance-sellers receive majority of their prescriptions from a single general practice

The Department of Health and Social Care (DH) has recommended tightening the rules around distance-selling pharmacies after seeing “strong evidence” of prescription direction.

Evidence submitted for the statutory review into the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 “demonstrated sudden drops in the dispensing volume at bricks and mortar pharmacies following the opening of a distance-selling pharmacy located nearby”, the DH said.

This volume drop corresponded with a “spike in prescriptions at the new distance-selling pharmacy, the vast majority coming from a single general practice”, the DH added in the review published last month (March 29).

The DH recommended “consider[ing] how the rollout of the electronic prescription service and patient nomination processes could help mitigate prescription direction”.

Some distance-sellers only delivering locally

Under the current regulations, “distance-selling pharmacies must offer essential services to people based anywhere in England, but these services cannot be delivered face-to-face” and “must not expressly state or imply that the essential services provided at or from the premises are only available to persons in particular areas of England”, the DH said in its review.

However, an analysis of a “random sample of 32 distance-selling pharmacies” showed that five only advertised local delivery services, two did not have functional websites and one advertised face-to-face services at its registered premises.

Further analysis of prescription records between May 2016 and August 2017 showed that “an average of 6.7% of distance-selling pharmacies only dispensed prescriptions to locations within a distance of 10km from the patient”, the DH said.

In the review, the DH recommended changing the 2013 regulations to ensure distance-selling pharmacies “declare any vested or significant interests” and “require distance-selling contractors to maintain functional websites, which detail how their service can be accessed nationally”.

It also suggested NHS England set up a “complaints process” to report and investigate suspected breaches.

Allow 100-hour pharmacies to reduce opening times

The review also recommended allowing 100-hour pharmacies to reduce their total opening hours in certain circumstances after evidence submitted showed “a very low use of early and late-hour pharmaceutical services from this type of pharmacy, as well as data on the associated staffing costs”.

Other recommendations include a “more streamlined application process in the event of very minor and temporary relocations” of a pharmacy, so contractors do not have to go through the full application and appeals process, and allowing NHS England to “rescind breach or remedial notices” to make it easier for companies to gain contracts.

In the review, the DH repeated its claim that “clustering remains and in some areas there are more pharmacies than required to ensure access to NHS pharmaceutical services” – an allegation it has repeatedly used in the past to justify cuts to pharmacy funding in England.

“General thumbs up” to review

Lawyer Noel Wardle, partner at Charles Russell Speechlys LLP, said the review “gives a general thumbs up to the current market entry system in England”.

“The review has sensible conclusions and highlights issues that many of our clients have experienced over the last five years,” he added.

Mr Wardle said he “looks forward” to the consultations on the changes suggested in the review, which are expected over the coming months.

Malcolm Harrison, chief executive of the Company Chemists’ Association (CCA) – which represents Boots, Lloydspharmacy, Well, Rowlands and Superdrug, as well as the pharmacy arms of Morrisons, Tesco and Asda and was one of the stakeholders consulted as part of the review – said: “It is somewhat refreshing that the DH has effectively and consistently engaged with stakeholders throughout the review process.”

Prescription direction “is something our members have been concerned about for some time”, said Mr Harrison, who is “reassured” that this has been considered in the review.

The Pharmaceutical Services Negotiating Committee (PSNC) – also a stakeholder in the review process  – gave a “cautious welcome to the report” and said it will “review the recommendations with the DH”.

14 Comments
Question: 
What do you make of the recommendations?

Farhat Ahmed, Locum pharmacist

Why have the DH been allowed to waste valuable tax payers money to analyse any data leading to the suggestion that " 100 HOUR PHARMACIES REDUCE HOURS" Why is this idea even on the table it should be flushed down the toilet where it belongs by the PSNC. And to reiterate the thoughts on clustering, is there a section that analyses how many 100 HOUR contracts have been allowed to open in these areas. May be the DH should start reducing numbers of pharmacies by shutting down, initially, all 100 hour contracts that feel the need to reduce the hours, followed by the shutting down of 100 hour contracts in the areas where clustering is a problem. I am sure that all standard hour contracts in these areas would be abble to share a rota service for continuity of pharmacy service out of hours.

 

Dave Downham, Manager

Maybe the DH should shut down a standard hours pharmacy thus keeping the 100 hours pharmacy allowing greater access to the public? I'm sure that all standard hour contracts in these areas would be abble to pick up the slack.

 

(Yes, I am stirring)

Brian Austen, Senior Management

The DH are favouring 100 hour contractors by suggesting such a change. If it does happen the value of the 100 hour pharmacies would go up overnight after slashing their operating costs. This could possibly be interpreted as a breach of competition rules. Why not remove the standard hours minimum of 40 hours, its the same logic. Why have any restrictions on hours at all. Pharmacy Needs Assessments country-wide and Health and Wellbeing Boards would be undermined. The contract application process would also be undermined. You might as well remove all regulation and make it free-market. Maybe that is the overall intention. If an internet pharmacy met the application standards then it should only be affected if it operates contrary to the Regulations, as has always been the case. This makes me wonder whether the intention is to put all independent internet pharmacies out of business to leave the field open to P2U and the large multiples. Reducing hours for 100 hour contracts would also be very beneficial to the many GPs that own 100 hour pharmacies as well as supermarkets, etc. Huge conflict of interest in my opinion buried in this somewhere. Once again Independent Pharmacy is under attack!

Mi Wa, Community pharmacist

I know of a surgery owned pharmacy who would benefit massively if they were allowed to reduce their 100 hours, but who would be in trouble if prescription direction was clamped down on.

Now there's a conflict in itself.  You might know it Mr Austen as you set it up for them!

PAUL watson, Pharmacy owner/ Proprietor

I trust the cautious welcome the PSNC has given does not stretch to include any acceptance of allowing a reduction in the "100 hour" contract provision.  

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

When is a 100 hour Pharmacy, not a 100 hour Pharmacy?

A Hussain, Senior Management

Prescription direction requires a complicit GP surgery.  Stop them and you stop the problem at source.  Also reducing the hours for 100-hour contracts will be challenged surely if it ever came into force.  You get a free contract and then turn it into a valuable asset due to legislation rather than it proving its worth as a business.

Adam Hall, Community pharmacist

Prescription direction, by its definition, is by the GP - a pharmacy can "suggest" a practice sends their prescriptions to them but it requires the GP to actually carry out the act - for the usual fee, I am sure

Julia Bailey, Information Technology

As many of the 100 hour contracts would never have been awarded if they did not commit to extended opening to allow them to now reduce hours where there is other local pharmacy provision would be wrong!

Dave Downham, Manager

...but the contract has changed out of recognition over the last few years. (NHS England insisted the word "cuts" was removed from the local PNA and replaced with "reductions") so is it not fair to consider reducing opening hours?

A Hussain, Senior Management

Fair point but if I'd known the cuts were coming and were going to be so savage I might not have bought my standard hours contract.  Can I get a refund?

paul lisbon, GP

A GP surgery that gives pharmacy space to the multiples because they can pay more in my view is the same principle as prescription direction, because the DoH just stood there and did nothing its all coming to haunt them. 

Adam Hall, Community pharmacist

That is a double-edged argument - yes, large multiples may have historically offered more but, equally, greed from the GPs - allegedly along with threats (real or implied) of allowing a competitor in to take your existing business - has also fuelled this

Harvey Northwood, Pharmacy owner/ Proprietor

I thought the whole part of allowing the opening of 100 hours pharmacies WAS to provide early or late hour pharmaceutical services? Even "low" use is use! If contractors were prepared to apply for and open 100 hours pharmacies, then surely they knew the financial implications.  Perhaps the big supermarkets now realsie that operating 100 hour pharmacy within a store and only dispensing 3,000 items is not so much a loss leader but finacial suicide! Rather than reduce the opening hours, porbably a better idea to close down the contract. 

 

 

 

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