A chemist's shop for Benbecula?

by Dr Kate Dawson [viewed 5865 times]

There has been a local consultation run by a small company who intend to submit an application to the health board to open a pharmacy in Balivanich. This has had some local support, partly as there is an impression that this would be a chemist shop retailing shampoos, beauty products etcetera. The public were unaware that this would prevent the local surgery from dispensing. The initial consultation implied that the shop was mainly a retail chemists. However, the truth is somewhat different. The following are some useful points. WHAT IS A DISPENSING CHEMIST/PHARMACY? In the UK, chemist shops generally contain a pharmacy, where drugs are dispensed on prescriptions issued by prescribers. Chemist shops are generally not commercially viable without also running a pharmacy service. This is because the service is part of NHS services, and they are funded to ensure that the public have access to the medication they require. Boots is an example of a chain of dispensing chemists that include pharmacy services. Some supermarkets have also opened pharmacies on the premises, including Tesco. Some Superdrug shops do not have a pharmacyl. Pharmacists also provide other services, including advice about medications, medication reviews, advice to prescribers about reviews, smoking cessation, contraceptive advice, blood pressure reviews, methadone clinics, needle exchanges and general health checks. To do this they must have a confidential area within their premises. In the UK, a pharmacy must be open 6 days a week, and can only dispense medication when the pharmacist is on site. A small pharmacy must therefore have at least one full-time pharmacist, as well as a second pharmacist or a secure arrangement for a locum to step in for holidays, days off etcetera. Pharmacists have their own professional body and professional standards, and are regulated through these mechanisms. A new business also needs to have a pharmacy supervisor, who may be one of the pharmacists. In Gairloch, the GPs and practice manager set up their own pharmacy. They were able to protect their dispensary staff by redeploying them to the pharmacy or within the practice. They set up the new business in the face of possible predatory applications from outside the practice area. The practice income is much reduced, but service to patients have been protected where possible PUBLIC RIGHT OF ACCESS TO A PHARMACIST In Scottish law, members of the general public have a right of access to a pharmacist, and can seek advice from them as an alternative to phoning NHS24 or contacting their GP or A&E. A pharmacist who wishes to open a chemists/pharmacy must apply to the health board, who must then judge whether this is a valid and safe application. The health board must take into account this right of access, and whether such a service already exists in an area. CURRENT ARRANGEMENTS AND HOW THEY ARE FUNDED In remote and rural areas, where there is no pharmacy service, supply of medication and advice has been provided by General Practitioners, who have a contract with the health board to dispense medication. GP practices also provide advice on contraception, smoking cessation, advice about medication, medication reviews, blood pressure checks, and general health checks, plus a whole range of other services. Funding is organised on a per item basis: the more items that are dispensed, the more funding there is to run the dispensary. The practice also gets some funding for adhering to good prescribing principles. Generally, the funding from running a GP dispensary will pay for dispensing staff and GP time so that people have access to similar services even when there is no pharmacy. Pharmacists would also get a per-item dispensing fee. Historically, pharmacies have not been financially viable in remote areas, but advances in chronic disease management, improved survival of patients with multiple conditions, and more strategies to prevent illness; this is no longer always the case. The increase in the number of prescriptions being generated has made these businesses more viable. For Benbecula Medical Practice, the dispensary provides just enough funding for one GP and three part-time dispensers. CONSEQUENCES OF A PHARMACY AND CHEMIST OPENING LOCALLY If a pharmacist was to open a chemist/pharmacy locally, it would only be viable if this included a pharmacy. The practices in the neighbourhood would lose their dispensing contract and no longer be allowed to dispense any medication. Patients would be obliged to collect their paper prescriptions from the surgery, and then to collect their medication from the pharmacy. The pharmacists can arrange to undertake some of the transport issues, such as collecting repeat prescription forms from the practice, and delivering dispensed if required. If a delivery service is included, the new pharmacy would then need a business vehicle and driver. Benbecula Medical Practice would lose the income that pays for one GP and three dispensers, who would no longer be required. The practice would have six months to cease dispensing medication. GP income has already fallen significantly in the last 2 years, and it is highly unlikely that the practice in Griminish would be able to continue to afford to have four full-time GP partners. The proposal will also adversely affect the other two medical practices in the area. With three partners, it would become very onerous to manage the out-of-hours cover at the hospital, and the remaining GPs would have less time to continue to support and provide additional services, such as exercise tolerance tests, anaesthesia for local surgical lists, local dermatology clinics, involvement in health board committees et cetera. In addition, the increased workload and extended responsibility makes this a very difficult area to recruit GPs to work in. As a consequence of a pharmacy opening locally, there will be a reduction in the range and sustainability of existing medical services in all three practices. WILL THE PHARMACY BE VIABLE? We don’t know. If it opens, and we lose services, it would be difficult to re-instate these. The current dispensary staff are unlikely to be employed in the pharmacy as they are not trained as pharmacists or pharmacy assistants. Experience and information from elsewhere suggests that a population of 3000 patients would be enough to sustain a pharmacy business: this is the experience in Back in Stornoway, where a population of about this size sustains the business there. They employ a driver, and provide services to local nursing homes etc. The population of our practice is 2,300, including around 400 patients south of the Howmore river, reaching as far as Eriskay. For this application to have enough patients their ‘neighbourhood’ will need to be very large, possibly covering more than one practice area. Both practices would then stand to lose their dispensing. The total population of the three main islands is around 5,000, which would definitely be enough to sustain a pharmacy, but the distance for the promised delivery service to cover would be huge, covering from Berneray to Eriskay, including all the wee roads that go miles off to places like Cheesebay and North Glendale. In order to service these areas with a promised home delivery service, the staffing of the business will need to be substantial, or the promised benefits have been exaggerated. APPLICATION PROCESS The Western Isles Health Board have provided comprehensive details of the application process involved. From the end of the time that The Proposers have undertaken their public consultation they have 20 working days to make a formal application to the Board. This includes their own report on their own consultation process. Their consultation ends on the 28th June. Once that application is made the Board inform the relevant Committees and parties and they then have a 60 day consultation period. This will include consulting with the general public by way of letters to patients on the affected surgery’s lists, public meetings and any other means they feel is appropriate. They must also inform the Area Medical Committee and the Area Pharmaceutical Committee within seven days. After that period, a panel selected by WIHB holds a formal hearing where they take on board all the comments and feedback they have received and make a decision. They are not allowed to consider the impact the new Community Pharmacy will have on the Medical Practices affected, or health services or the impact on local business. The panel must decide if it is felt to be required or desirable to our community to have this service. Because of the principle that everyone has a right of access to a pharmacy, they may deem the application desirable on these grounds, particularly if there is no pharmacist in the area at the time of application. The application that has to be submitted is quite detailed and it is up to the Proposers to describe the catchment area they are intending to serve in that application. Until that is submitted we do not know if this proposal is for Benbecula only or for a wider area. The panel must also consider whether the application is secure, with adequate provision, for example in terms of finance, a realistic and viable business plan, and suitable premises. If approved, the new pharmacy has six months in which to start trading. CURRENT APPLICATION The current application has been made by a company registered in Montrose at the start of last year. They have not yet had to submit any accounts to Companies’ House. Although the company originally had two directors, one resigned last September. The remaining director is Mr Mohammed Khalil Jamil. He was not present at the meeting in Balivanich. He is currently working as a locum pharmacist in the Western Isles Hospital. Name & Registered Office: LOCAL PHARMACIES LIMITED 182 HIGH STREET MONTROSE ANGUS UNITED KINGDOM DD10 8PH Company No. SC413871 He appears to have left his previous company in 2009/2010 Medina Medicals Ltd 26b Blairs Road Letham Forfar Angus DD8 2PE Company No. SC365052 Anyone can look up details of the companies on the Companies House website. The company seems to be planning to open the pharmacy with the support from a pharmacy manager from Boots in Stornoway, and two pharmacists. They are not trading elsewhere at present. The company director, who was not present, has been involved in opening a pharmacy elsewhere, but is no longer involved in that venture. We have no further details, but a bit of research should reveal the name of the company, and what happened to his involvement. The impression is that the business initially failed, and was bought out by another company. The representatives of the company stated at a public meeting that it was up to the Western Isles Health Board to decide the neighbourhood affected by their application, and how many patients this would affect. However, this was not true, and the applicants have tried to mislead the public during their own consultation and a public meeting. It is up to the company making the application to set out the neighbourhood that they intend to serve, and thence the number of patients affected. The neighbourhood could include all of the Uists and Benbecula. At the Benbecula community council meeting, the representatives of the company making the application did not provide answers to questions on the neighbourhood that their application covers, on how many patients their application will affect, the business interests or previous experience of their director, or how they plan to ensure the continuity of their business. The director named at Companies’ House was not present. FUTURE APPLICATIONS If the current application is turned down, there is nothing to stop them re-applying, or from another company spotting the opportunity and applying instead. In many instances, companies have appealed and reapplied repeatedly, until a decision in their favour is reached. CAN BENBECULA MEDICAL PRACTICE OPEN A PHARMACY? It is possible for the practice to consider whether it should open a pharmacy itself. However this could still lead to the dispensers being redundant, as their qualifications are not suitable for dispensing in a pharmacy. The funding that currently allows us to have four GPs would then need to cover the employment of a pharmacist, and the need to employ cover when the pharmacist is off. The result would still be a drop in GP numbers and problems with sustainability of the out-of-hours service, staffing the hospital, and other additional services. WHAT HAS HAPPENED ELSEWHERE? In Gairloch, the GPs and practice manager set up their own pharmacy. As a result, patients in the further parts of the practice need to travel to collect their prescriptions, as their branch surgery can no longer dispense medication. The GPs have retained control over the supply of medication and advice to their practice area. They undertook this step in the face of the possibility of applications from an external pharmacy. The practice income is down, and the service to patients is diminished. In Cumbrae, a pharmacy set up in Millport, in the face of fierce public opposition. The two long-term GPs retired as their business was no longer viable, and the posts remain vacant. The health board have been forced to supply a series of locums to provide medical cover at great expense, and the population are no longer served by a regular GP. Killin in Stirlingshire has also been targeted, with a consequent threat to the overall provision of services undertaken by GPs in the area. The only two practices in Scotland who have successfully retained dispensing status are Drymen and Aberfoyle. In the last year, around 20 practices lost their dispensaries in Scotland, out of a total of 130. In England and Wales, small practices are protected against these closures. HOW AND WHEN SHOULD THE PUBLIC MAKE THEIR VIEWS KNOWN It is generally better to make your feelings known individually, rather than signing a petition, which would only be taken as one piece of evidence. The time to make your point is during the sixty days that the board is consulting with the public. The board do not have to take into account the views of local businesses or local GP practices. If you wish, and if you believe that a pharmacy would destabilise existing medical services, please copy the enclosed letter, and send it to the Health board as well as the company proposing a local pharmacy. You can adapt this as you wish. If you wish to contact local MPs and MSPs to let them know your views, please do so. There is currently a debate in the Scottish Parliament concerning rural dispensing practices being closed by pharmacies. You are also free to debate these issues on Twitter, Facebook and other social media sites. The practice is also seeking support from the Royal College of General Practitioners and The Dispensing Doctors Association. A draft letter will be available during the 60 day consultation period which you can download to send away to make your voice heard. Visit the Uist Pharmacy FB page for more updates