Agenda item

11.30 am

Alan Webb, PCT Director of Service Redesign, and Ginny Hope, Head of Primary Care Contracted Services will present a paper on PCT commissioning intentions for pharmaceutical services and the revised Control of Entry Regulations process which PCT’s are required to apply to new applications to open a new pharmacy in the PCT area. A paper which has been prepared for the Committee by Ginny Hope and Alan Webb is attached for information at JHO9.

The Chairman invited Jean Nunn Price and Mary Judge up to the table to comment on behalf of Oxfordshire LINk. Jean Nunn Price reassured the Committee that the LINk continued to challenge the PCT, where appropriate, with regard to the proposals. Indeed, both herself and Mary Judge had been involved in service changes over the last two years which had included carrying out a Pharmacy Survey (which had been presented to this Committee by the PCT’s Patient & Public Involvement Group) and sitting on a PNA Steering Group where challenges had been made on quantity outcomes, equity of location, opening times etc. Mary Judge commented that one of the issues from the survey had been the need for patients to have the appropriate facilities with which to discuss their needs privately.

Ginny Hope, Head of Primary Care Contracted Services, Oxfordshire PCT , introduced the paper (JHO9)  on PCT commissioning intentions for pharmaceutical services and the revised Control of Entry Regulations process, which PCTs were required to apply to new applications when opening a new pharmacy. A consultation on the Pharmaceutical Needs Assessment was required prior to submission to the Board.  The Committee were asked if they found the consultation process acceptable.

Prior to discussion on the above the Chairman invited Councillor Hilary Biles, local member for Chipping Norton, Dr Ahmed, Pharmacist, Shipton under Wychwood GP Surgery, Catherine Hitchins, spokesperson for the surgery’s Patient Involvement Group and Dr Nixon, senior GP partner, Shipton under Wychwood Surgery, up to the table. At the same time he advised that it was not within the remit for the Committee to be involved in individual applications for the development of new pharmacies, it being more strategic in nature. However, whilst the matter was not directly within the Committee’s sphere of activity, the PCT representatives had been advised that it may be raised at this meeting as an example of the complexities of planning pharmacy provision. It related to a recent decision of the PCT to give permission for the development of a new pharmacy in Shipton under Wychwood. At present, there was no pharmacy in the area, but the local GP surgery contained a dispensary. If the pharmacy were to be opened the, under current regulations relating to dispensing in rural areas, the surgery would lose the right to provide medicines to patients living within a 1.6km radius of the new pharmacy. They would still be able to dispense to any patients who were deemed to be in a rural area outside of the 1.6 km radius of the pharmacy. In this context the concept of a ‘rural area’ is one that has a population within 1 mile of the pharmacy amounting to more than 2750 people. Below 2750 was considered to be a ‘reserved area’ and the 1.6km regulation did not apply. The population of Shipton under Wychwood was 2,796.

Councillor Hilary Biles made the following points:

• The application affected 5k patients in what was a rural area;
• The PCTs decision meant the loss of a GP dispensing service to people living within 1.6kms of the surgery and a loss of income to the surgery;
• In her view the decision constituted a major service change and no consultation had taken place;
• She urged the PCT to look at current provision for patients living in the area, to conduct a patient survey and to reconsider their decision;
• She asked why the PNA had not been sent to district councils for their views;
• In her view the surgery’s pharmaceutical provision would far outweigh the benefits which a new, independent pharmacy would bring, for example, the current provision offered a needle exchange service. She added that any profits were ploughed back into services for the community; and
• The support that current pharmacy gave to members of the community served to avoid the need for patients to go into acute care.

Dr R.Ahmed, Pharmacist, addressed the Committee stating that the proposed change would directly affect his business. The Pharmacy had introduced a number of changes and were working together with the PCT as a team in order to bring about the changes in the best possible way.

Catherine Hitchins put forward the following points:

• She understood that it was the duty of the PCT to provide Health and Social Care to the local community and to respond to local demand. It was also their duty to make the service accessible to residents;
• Currently, both able bodied and disabled residents had ease of access to the service. The surgery reorders medicines for collection at 8.15am or at 6.30pm each day. There was no closure for lunch. This helped to cut down on transport problems for older people or for young mothers in an area which has sparse public transport facilities;
• No discussion had taken place within the Parish and District Council and the local Patient Involvement Group. Furthermore those living outside the designated area had been ignored;
• The whole community and in particular the Local Patient Involvement Group, were gravely concerned at the potential loss of the facilities offered at the surgery; and
• The Patient Involvement Group were also concerned at the lack of attention given by the PCT to the views expressed by the public.

Dr Nixon commented as follows:

• There is a large proportion of high priority groups served by the current Pharmacy, which include older people and young mothers;
• The Pharmacy undertakes risk assessments on medicines and also gives health advice;
• The service given is confidential and staff often have a personal knowledge of the patients;
• The Pharmacy offers exceptional access to patients covering a 25 mile distance;
• He expressed his confidence that the service it gives results in lower referral rates;
• The Pharmacy also offers enhanced diabetic care.

At this juncture, Alan Webb and Ginny Hope informed the Committee that the application was not subject to appeal with the PCT, rather, to an independent organisation, namely the NHS Litigation Authority – Family Health Services Appeal Unit. The PCT was therefore unable to comment on individual applications. The DoH PNA regulations were due to come into force on 24 May 2010 and the PCT was thus bound by the current regulations. They pointed out that any decisions made by PCTs were subject to a strict formal process to accord with a Statutory Instrument, Pharmaceutical Regulations 2005. These also determined regulations for rural surgeries. They added that although dispensing income at GP practices had to be separate from GMS; in practice there were links, but they were not co-dependent.

In response to a question seeking information on whether there were regulations enforcing who to consult on applications, Ginny Hope responded that there was a requirement to notify interested organisations about applications. As a matter of course, notifications were sent to parish and town councils, to the LINk and other representatives of the public. Unsolicited responses were received from members of the public and these were taken into account when the PCT made their decisions.

Following a further question and answer session and discussion with regard to the PNA process and consultation, the Committee AGREED to:

(a)               thank Jean Nunn-Price, Mary Judge of the Stewardship Group, Oxfordshire LINk, Dr R. Ahmed, Pharmacist, Shipton under Wychwood, Ginny Hope, Head of Primary Care, Contracted Services and Alan Webb, Director of Service Redesign, Oxfordshire PCT for attending the meeting;

(b)               thank Councillor Hilary Biles, Catherine Hitchins, Patient Involvement Group spokesperson and Dr Nixon, senior partner of Shipton under Wychwood surgery for addressing the Committee;

(c)               note that the Committee had no remit to intervene in the appeal process with regard to individual applications to set up a pharmacy; and

(d)               note the project plan for the Pharmaceutical Needs Assessment process and consultation.