Dispensing Practices
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Cumbria Health and Well-being Scrutiny Committee Report on Dispensing Practices November 2008. Chairman of the Committee: Councillor A. P. Richardson Members of the Task and Finish Group that examined the consultation: Councillors: A. P. Richardson, Cumbria County Council (chairman) G Garrity, Copeland Borough Council H. Horne, Cumbria County Council J Hunter, Allerdale Borough Council J Jenkinson, South Lakeland District Council D. Richardson, Eden District Council J Riddle, Carlisle City Council Scrutiny Officer: Doug Scott. 1. Introduction 1.1 This report contains the findings and recommendations of the Cumbria Health and Well-being Scrutiny Committee on part of the Department of Health consultation on proposals for legislative change concerning Pharmacies in England. The specific section considered by the Committee was the chapter on “Dispensing by Doctors”. The consultation was issued on 27 August 2008 and runs to 20 November 2008. 1.2 The Committee had been alerted to concerns from some rural communities as well as from some G.P.’s about the effect on local primary care services of Government intentions to change the rules governing dispensing of medicines by G.P.’s. These changes had been trailed in a White Paper on pharmacy in England published in April 2008. 1.3 The White Paper announced Government policy to broaden the role of pharmacies including health promotion, support for self care, screening, and minor treatments. It referred to the Government’s intention is to “refocus commissioning away from dispensing services – important as these remain – to a system which rewards high quality and innovative pharmaceutical services”. 1.4 The Consultation Document referred to 4 options for change 1. No change. 2. Whilst continuing with current arrangements where GP dispensing applies in controlled localities, the existing specific distance criteria would be removed. 3. Instead of the distance between the patient’s home and the pharmacy, the determining factor should be a distance between the dispensing surgery and the nearest community pharmacy. Such a distance could be put at less than the current 1.6 km, for example, at 500 m or at 1000 m. 4. (A variation of Option 3). It would mean that a GP would not dispense where there is a pharmacy within 500 m or 1000 m of the GP practice and a second pharmacy within 1500 m. Those who are permitted to dispense may do so to all their registered patients regardless of the distance between their home 1.5 During one of the Task Group’s meetings however, it was noted that Cumbria NHS preferred an alternative “option 5”, in which the PCT would like to look in the round at the micro-health economy of an area, involving the LINk. 2. How the Scrutiny was Carried Out 2.1 Prior to the consultation, the Committee had been advised on concerns by the Seascale Practice (in Copeland) that the proposed changes might put into question the continuation of the branch surgery in Bootle. The Committee was then briefed by NHS Cumbria on the number of Practices potentially affected by the proposals – i.e. dispensing practices in which there was a pharmacy within a mile of the Practice. Detail is in Appendix 1. 2.2 As soon as the consultation was published, the Committee arranged an informal meeting involving scrutiny representatives from County and District Councils, and representatives from NHS Cumbria, to discuss what each party hoped to do in response to the consultation document. There were concerns that the proposals affected primary care services in several rural areas. It was agreed that there should be a scrutiny of the proposals in Cumbria, and that the Task Group should include the District Council representative from any of the Districts that were concerned about the issue. 2.3 The Task Group met witnesses from NHS Cumbria, from 3 of the General Practices who considered themselves affected, from Voluntary Action Cumbria, and also a spokesperson for pharmacists in Cumbria. Details are in Appendix 2. The Task Group also invited the General Practices affected by the proposals to provide comments on how services for patients might be affected by the proposals. A summary of responses received is in Appendix 3. 2 2.4 In addition, the Chairman of the Task Group attended the Seascale Neighbourhood Forum, which covers one of the rural areas potentially affected. 2.5 On 17 October 2008, the Chairman of the Task group attended a “Listening Event” in Newcastle organised by the Department of Health, and found that the majority of attendees were firmly in favour of option 1. 3. Findings 3.1 At present Cumbria has 31 General Practices that dispense to their patients, 17 of which would potentially lose their ability to dispense under the proposals. The majority of Practices affected are situated in market towns such as Keswick, however one of the main concerns raised by the Task Group was that a number of these larger Practices have branches in more rural areas. If the main Practice were to lose its ability to dispense so would the associated branches. This would therefore mean that patients in outlying areas would potentially have to travel some considerable distance to collect their prescriptions. 3.2 Issues of accessibility both in terms of cost and availability of transport are crucial. People who can’t easily drive and as such rely on friends, local schemes or public transport may be disadvantaged by the additional cost of accessing this service if rural branch practices are no longer able to dispense. Instead of making a single journey to the doctors they may be required to make either an extended journey or a second one. 3.3 The Task Group are concerned that the proposals and policy are more appropriate to urban areas rather than rural communities. A key issue for rural communities is the erosion of rural services, and whilst the Group acknowledge that it is not always appropriate to keep all services in all areas, they strongly feel that consideration needs to be given to the needs and issues facing each locality. 3.4 Examples of good practice have been highlighted during this review, for example extended opening hours and the service provided to individual communities. The task group are concerned that this good practice should not be funded purely as a result of income from dispensing, and as such encourage NHS Cumbria to look at how such schemes could be delivered across Cumbria ensuring equity of service for all communities. 3.5 Continuing to improve and develop communications between pharmacies, NHS Cumbria and General Practices is key to enabling closer working, and the delivery of benefits for communities across Cumbria, with examples of best practice being shared and developed. 3 Examples of this may include investigating pharmacies ability to deliver to some rural areas. 3.6 Whilst the focus of this review has primarily been on the impact on communities of the potential reduction in dispensing General Practices, the Task Group welcomed the proposed wider role for pharmacies in communities. 4. Recommendations R1 That the County Council responds to the consultation supporting Cumbria NHS’ proposed Option 5, whereby Cumbria NHS be enabled to determine the communities where General Practice dispensing is appropriate based on the Pharmaceutical Needs Assessment and Joint Strategic Needs Assessment. R2 That if Option 5 were to be successfully taken forward, Cabinet encourages Cumbria NHS to adopt a flexible approach to reviewing dispensing Practices in Cumbria, taking into account local circumstances and need. 4 Appendix 1 The location, list size and parliamentary constituencies of the dispensing practices affected by the proposed changes Locality Practice Town List Constituency size MP Allerdale Derwent Cockermouth 6609 Tony Cunningham House Castlehead Keswick 6077 Tony Cunningham Medical Practice Solway Workington 5701 Tony Cunningham Health Ser. Carlisle Brampton Brampton 14866 David Maclean Medical Practice Dalston Dalston 5249 Eric Martlew Medical Group Warwick Carlisle 2229 Eric Martlew Square Copeland Seascale Seascale 5857 Jamie Reed Health Centre Trinity House Whitehaven 2280 Jamie Reed Eden Alston Alston 2390 David Maclean Medical Practice Upper Eden Kirkby Stephen 6710 David Maclean Medical Practice South Lakes Lunesdale Kirkby-in- 5978 Tim Farron Surgery Furness Stoneleigh Milnthorpe 6851 “ Surgery James Kendal 15257 “ Cochrane Practice Station Kendal 12172 “ House Surgery Sedbergh Sedbergh 3585 “ Health Centre St Mary’s Windermere 6324 “ Surgery 108135 5 Appendix 2 Meetings from the Task Group Date Purpose of meeting Witnesses 2 October meeting of the Task Group Dr B. Walker, GP, Seascale 2008 to hear from witnesses Ms B. Cole, Practice Manager, Brampton Dr. I. Mitchell, Chairman, Cumbria PEC Ms A. Loudon, Head of Medicine Management, NHS Cumbria 17 October Dept of Health Listening 2008 Event, Newcastle, attended by Cllr A. P. Richardson 23 October Meeting of the Task Group Dr W. Lumb, G.P., Sedbergh 2008 to hear from further Mr R. Roberts, Director, Voluntary Action witnesses and draw Cumbria together conclusions Ms A. Loudon Ms C Mcguire and Mr M Staintham, Local Pharmacy representatives 6 Appendix 3 Possible effect of loss of GP Dispensing Rights Information provided by individual General Practices potentially under threat (i.e. dispensing practices less than 1 mile from a pharmacy) Practice Location Size Possible threat to services (Patients) Derwent House Cockermouth 6609 Reduce patient choice for patients from rural areas. Reduce convenience for patients getting their medication at the surgery and having to walk or drive to the nearest chemist instead Practice cannot reinvest its profits from the dispensary, e.g. on additional doctor or nurse time or upgrades to premises and equipment Castlehead Keswick 6077 More difficult for patients to collect medicines (poor parking outside pharmacies) Loss of the Practice’s delivery service to outlying areas Solway, Workington 5701 Reduced patient choice for patients from (400 rural areas.