Community pharmacy — clinical governance and the Centre for Pharmacy Postgraduate Education

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Clinical governance and the Centre for Pharmacy Postgraduate Education

Community pharmacy is increasingly being brought under the remit of the PCT. Clinical governance facilitators have undertaken baseline assessments in order to integrate community pharmacy into wider PCT clinical governance plans.

See Clinical governance in community pharmacy: guidelines on good practice for the NHS.

The Centre for Pharmacy Postgraduate Education (CPPE) has organised workshops on clinical governance for pharmacists and a national programme of induction training for the community pharmacy clinical governance facilitators has also been developed by CPPE, in collaboration with the Modernisation Agency clinical governance support team.

There may well be opportunities here for NHS influencers to further develop relationships with community pharmacists and local pharmaceutical services around clinical governance.

Office of Fair Trading recommendations

NHS influencers may be aware that in 2003 the Office of Fair Trading (OFT) re-examined the controls over the location of retail pharmacy services in England and its final published report suggested complete deregulation.

The Pharmaceutical Services Negotiating Committee (PSNC) commented that this would lead to a free-for-all that could destabilise primary care, as supermarkets would be able open pharmacies as and when they wanted to. This at the same time as a report from Boots on the results of a survey of 200 GPs suggesting that some 20 per cent of GP appointments are unnecessary and could have been dealt with by a pharmacist.

The government response

In the government’s initial response to both the OFT recommendations and a subsequent Health Select Committee report, ministers did not completely reject the proposals. The response basically said that it was not yet the time to move to a fully deregulated sector but that it intended to move cautiously in that direction, linked to the new pharmacist contract. See Response to the Health Select Committee report on the control of entry regulations and retail pharmacy services.

A consultation document then followed. Proposals to reform and modernise the NHS (Pharmaceutical Services) Regulations 1992 built on the government's initial response to the OFT report. The proposals included:

• a duty for PCTs to consider the impact on consumer choice when new pharmacies apply to dispense NHS prescriptions
• boosting patient choice and access by removing restrictions on:
  — pharmacies who locate in large shopping developments
  — pharmacies prepared to open for more than 100 hours a week
  — one stop primary care centres where pharmacists work with a number of other NHS services

The government’s final proposals, aimed at partial deregulation, were published in summer 2004 (see Wellard’s NHS news, August 2004). Under the new package of measures, patients will find new pharmacies easier to get to, open longer and offering a wider range of services locally following new rules to control the location of pharmacies. All 24-hour supermarkets will now have the right to sell prescription drugs and more late and all-night supermarkets will be allowed to offer pharmacy services. Supermarkets in large-scale shopping malls will also be entitled to licences to run pharmacies for the first time. Note that pharmacies set up by consortia establishing new one-stop primary care centres must offer a wide range of primary care and community-based services in addition to usual GP services, for instance dentistry, optometry, podiatry etc. Also the current regulatory system will be further reformed and modernised. See DH press release 2004/0310.

Sue Sharpe, PSNC chief executive, said that she welcomed the government’s changes to the control of entry regulations. She commented that these controls would help minimise damage to the present network and are more favourable than the threat of complete deregulation. The PSNC will review the impact in 2006 and monitor developments in the interim — see www.psnc.org.uk. The National Pharmaceutical Association (NPA) also generally welcomed the proposals. But John D'Arcy, NPA chief executive, commented:

‘We still have some concerns about the possible unpredictable impact of the exemptions. What we mustn’t have is “deregulation through the back door”. The opening of new pharmacies under the new exemptions could serve to suck business away from existing pharmacies. If this happens, existing pharmacies may be forced into reducing the level of services on offer. And in extreme cases, existing pharmacies may be forced into closure. There is no doubt that a reduction in services or closure will adversely affect local communities — in particular the higher users of pharmacy services: the elderly, infirm or mothers with young children. These are the groups that will face the greatest difficulty in getting to pharmacies located further afield’.