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”.