As we begin a new year, my mind has been casting back and thinking of the issues we faced over the last one: huge numbers of contract applications, complicated tendering schemes, medicine shortages, changes to the methadone payment, payment problems via the PCT/PPD to name just a few...and I've been wondering what's in store for us this year??
 
Well, by the time you read this, contractors will be coming to terms with reduced remuneration caused by category M reductions in October last year - and even if we accept the rationale for this, it's difficult to bear...
 
The PCTs shut up shop at the end of March; so in April we expect the CCGs and the new Commissioning Board with its local area teams to open for business. We also expect the health and wellbeing boards of the local authority to take up the public health agenda. Pharmacy services will be commissioned from these new entities, but they will take time to find their feet - so don't hold your breath for any new services for a while...
 
So, in conclusion,  I think next year will be an enormous challenge for contractors - but rest assured that your LPC members will pick up the baton and run on your behalf wherever we can to obtain the best deal we can for community pharmacy and to look after the interests of contractors. 
 
On another note,
I hope that the interim financial arrangements that are currently in force will be replaced by a considered financial settlement that is fair to contractors - based on the cost of service enquiry and the numbers of contracts. Pharmacy has suffered over the last few years partly because of the fact that the financial package that funds community pharmacy (formally known as the global sum) - whilst increasing slowly with costs - is based on historic numbers of pharmacies (~10,000) and not the almost 13,000 pharmacies we have today. So although the overall sums involved have increased in line with inflation, the fact that there are so many more contracts now means we all have a smaller slice of the cake...
 
A friend of mine, and past Secretary of our Committee, once said "If the Government want pharmacy to deliver as we know it can, then the DOH needs to remember that -  you get nowt for nowt and precious little for sixpence!"
 
Happy New Year everyone!

Most of the LPC executive team attended a very useful workshop recently in Leeds, led by Steve Lutener from the PSNC, on the recent changes that have been made to the legislation, and guidance, under which market entry and exit can occur.
 
Thinking about market entry, we were told all about the new market entry regulations based on the pharmaceutical needs assessment (PNA), for both routine applications and Excepted applications (change of ownership, minor relocation, or distant selling), and the associated guidance issued by the DOH to help implement the regulations.
 
We considered, and discussed, examples to ensure that we will be better prepared for contract applications made under the new regulations - given that the LPC is recognised as the official body representing contractors in the PCT area.
 
On receiving an application, the PCT must determine whether granting it would meet a current need for pharmaceutical services and must consider whether to invite other applications. If it does this, the PCT can defer the application and consider all of them together. The PCT can refuse the application for a variety of reasons including "if it considers that to grant the application would lead to an undesirable increase in the availability of essential services."
 
The regulations place a number of obligations on applicants and the PCTs - and hopefully will make market entry a more sensible process and so it's all change with applications - the necessary/desirability clauses have gone.
 
Thinking about market exit, we also considered the sanctions that  PCTs (or successor) bodies can make on existing contractors...
 
Regulation 69 states that, if there is a dispute, there is a requirement to attempt local resolution first - unless the PCT is satisfied that it is appropriate to move further at once due to the severity of the dispute (perhaps the pharmacy premises have not been open during core hours, or to protect the safety of the public or to protect revenue of the PCT etc.).
 
If this is not achieved then regulation 70 allows for a remedial notice to be issued by the PCT and regulation 71 provides for abreach notice to be issued. If the dispute relates to a failure to provide, or failure to provide at a reasonable standard, a service that the contractor is required to provide, then the PCT can withhold part, or all, of the remuneration due to the contractor (according to guidelines).
 
In essence, then, these are financial penalties (fines?) which will be applied to contractors in certain instances for failure to carry out obligations under the contractual framework, such as audits, patient questionnaires etc. or perhaps failure to provide an enhanced service to a reasonable standard!
 
Failure to improve or carry out remedial action may, as an ultimate sanction, lead to removal of the contractor from the PCT pharmaceutical list...
 

I was interested to read about the removal of the 100 hour contract exemption this week, and I'm sure it will be much welcomed by many worried contractors...This exemption was brought in a few years ago and led to a massive number of these contract applications...Perhaps some have been warranted in certain circumstances; but the vast majority have been seen as unjustified by many leading to problems for existing contractors. Certainly the LPC has spent a considerable sum of contractor's money addressing these applications - and has been worried about the destabilising effect large numbers of new contracts have on the existing contractor network. 
 
The removal of the exemption was achieved through amendments to the regulations, such that, new market entrants will be judged on a new market entry test based on the pharmaceutical needs assessment (PNA).
 
The LPC is looking forward to working with the PCT via the PNA to plan pharmacy openings, and new services, where they will bring real benefit to patients...