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Parish Council
Notice Board
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The following is the Parish
Council's response :-
Pharmacy in England: Building on strengths –
delivering the future – proposals for legislative change
Consultation Questions
Response form
Please fill in and/or tick the appropriate response:
Name:
Stithians Parish Council
Contact address:
The Clerk, Stithians Parish Council, 18 Edward Street,
Tuckingmill, Camborne,
Postcode: TR14 8PA
E-mail:
stithianspc@aol.com
Information provided in response to this consultation,
including personal information, may be published or disclosed in
accordance with the access to information regimes (these are primarily the
Freedom of Information Act 2000 (FOIA), the Data Protection Act 1998 (DPA)
and the Environmental Information Regulations 2004).
If you want the information that you provide to be treated
as confidential, please be aware that, under the FOIA, there is a
statutory Code of Practice with which public authorities must comply and
which deals, amongst other things, with obligations of confidence. In view
of this, it would be helpful if you could explain to us why you regard the
information that you have provided to
be confidential. If we receive a request for disclosure of
the information we will take full account of your explanation, but we
cannot give an assurance that confidentiality can be maintained in all
circumstances. An automatic confidentiality disclaimer generated by your
IT system will not, of itself, be regarded as binding on the Department.
The Department will process your personal data in
accordance with the DPA and, in most circumstances, this will mean that
your personal data will not be disclosed to third parties.
Are you responding:
as a member of the public? Yes ( ) No ( )
as a health or social care professional? Yes ( ) No ( )
If yes, please indicate your area of work:
NHS ( )
Social Care ( )
Private Health ( )
Voluntary ( )
Regulatory Body ( )
Professional Body ( )
Education ( )
Union ( )
Pharmaceutical Industry/Company ( )
Trade Body ( )
Profession:
If a General Practitioner, are you a dispensing
doctor? Yes ( ) No ( )
on behalf of an organisation? Yes ( ) No ( )
If yes, please indicate your area of work:
NHS ( )
Social Care ( )
Private Health ( )
Voluntary ( )
Regulatory Body ( )
Professional Body ( )
Education ( )
Union ( )
Pharmaceutical Industry/Company ( )
Trade Body ( )
Other (please give details)
Parish Council representing the people of the Parish of
Stithians
Consultation Questions
CHAPTER 2: A stronger focus on commissioning for quality
which addresses local needs
Market entry based on Primary Care Trusts’ assessments of
local pharmaceutical needs – the Pharmaceutical Needs Assessment (PNA)
Questions for consultation
The Department proposes amending legislation to replace
the current market entry system based on the ‘necessary or expedient’ test
with one based on a PCT’s assessment of local pharmaceutical needs and to
introduce specific factors which a PCT would take into account in
determining applications.
Q1: Do you agree the current market entry system should
be changed to one based on pharmaceutical needs assessments (PNAs)?
Yes ( )
No ( X)
Unsure ( )
Comments:
Predictive modelling is a poor substitute for the
effective demand of patients. It is not sufficiently developed to cope
with local variations, how ever sophisticated the model is claimed to be.
Q2: What safeguards may be appropriate to ensure
transparent, fair and unbiased consideration of applications?
Comments: Only have to answer this if you agree with Q1
above
Q3: Do you agree that specific additional factors, as
identified in this Chapter, should also be introduced to help PCTs
determine applications?
Yes ( )
No ( X )
Unsure ( )
What further comments do you have on the range of
additional factors identified?
Treat all applicants equally on their merits. Do not let
PCT’s regulate they are not suitable for this purpose.
Q4: Should decisions be appealable and, if so, to whom?
Yes ( )
No (X)
Unsure ( )
If yes, to whom should they be appealable?
The courts.
Q5: Do you agree exceptions to this new system may be
necessary?
Yes ( )
No (X)
Unsure ( )
If yes, what might these exceptions be?
Make all applications the same so they have to clear the
same hurdles and pass the same hoops.
Q6: If introduced, do you agree such an approach should be
piloted and evaluated before introduction?
Yes ( )
No (X)
Unsure ( )
Comments:
This approach should not be introduced. It is not suitable
for ensuring that patient needs are best met at the best value for
patients and NHS.
Adequate powers to tackle poor performance
Questions for consultation
The Department proposes introducing legislation to create
an explicit power which enables PCTs to take action against listed
contractors on the grounds of the inadequate quality of their services.
Q7: Do you think we should introduce explicit criteria of
quality to govern market exit?
Yes ( )
No ( )
Unsure (X)
Comments:
Quality of what? What is poor performance? Is it
service provision to patients or the returns to shareholders? Define high
quality services as being good value available where and when needed by
patients at economic cost. Shipman was not a pharmacist so referring to
him is scaremongering! What about surgeons whose performance is not
monitored or evaluated even after the Bristol case how many years ago?
Q8: Do you consider existing legislative powers under
‘fitness to practise’ are adequate or not?
Yes (X)
No ( )
Unsure ( )
If not, what quality criteria might be used?
You could look at number and get profile of deaths per
1000 patients per annum?
Q9: Do you agree that PCTs should have the ability to
issue remedial action notices with the consequence of de-listing if issues
are not addressed satisfactorily within a set timescale or to withhold
payments for contractors who do not perform to accepted quality and
standards?
Yes ( )
No (x)
Unsure ( )
Comments:
Who are PCT’s to judge? Let any cases be referred to their
professional bodies if there is a problem. See the General Pharmaceutical
Council.
Q10: If introduced, do you agree there should be an
independent appeals mechanism?
Yes ( )
No (X)
Unsure ( )
Comments:
To the courts. Don’t waste time and cost with quasi
judicial arrangements which get referred to the courts anyway in the end.
Q11: Are there other factors the Department needs to
consider?
Other factors:
Is it worth spending £1,2 million to save £1,4 million?
No. The costs will over run and the benefits under perform. Don’t do this.
Let market forces do a better job. See following replies.
CHAPTER 3: Community pharmacies and pharmacists
Market entry arrangements for community pharmacies open
at least 100 hours per week
Questions for consultation
The Department proposes that 100 hours per week pharmacy
applications should, pending longer-term reforms, in future remain exempt
from the current control of entry test but, if approved, be subject to
locally negotiated, directly held Local Pharmaceutical Services (LPS)
contracts.
Q12: Do you agree we should we introduce direct LPS
contracting arrangements for pharmacies wishing to open 100 hours per
week?
Yes ( )
No (X)
Unsure ( )
Comments:
Treat all applications alike. No exceptions.
Q13: Do you agree safeguards are needed and, if so, what
might these comprise (for example these could be expressed in terms of
services, prices, standards, quality)?
Yes (X)
No ( )
Unsure ( )
Comments:
100 hours a week pharmacies are no substitute for a GP
surgery or A&E unit. The people who staff 100 hour pharmacies at non
standard hours are the least able or experienced seeking to make money by
what ever means.
Q14: Is it sensible that such pharmacies are required to
provide a minimum specified level of service such as minor ailment schemes
or services out of hours as identified or is this best left to local
decisions and negotiations?
Minimum specified level of service ( )
Left to local decisions/negotiations ( )
Unsure ( X)
Are there other factors to consider?
A pharmacy is a pharmacy not a GP or A&E. Don’t try to get
‘tick box’ service provision on the cheap
Introducing ‘supplementary list’ requirements for
individual pharmacists, taking account of the need to comply with the
Safeguarding Vulnerable Groups Act 2006
Questions for consultation
The Department proposes to introduce regulations to create
supplementary lists to enable PCTs to exercise comparable powers in
respect of individual pharmacists who assist a pharmacy contractor in the
provision of services, as they do with those on the ‘main’ pharmaceutical
list and invites views on extending these requirements to pharmacy
technicians. From April 2009, a two-year pilot NCAS service will be
extended to include pharmacists.
The requirements of the Safeguarding Vulnerable Groups Act
2006 will be rolled out from October 2009. Pharmacists and other pharmacy
and appliance contractor staff whose roles involve providing advice,
assistance, guidance and/or medical treatment will be subject to Criminal
Records Bureau checks and Independent Safeguarding Authority registration.
Q15: Do you agree the introduction of ‘supplementary
lists’ for individual pharmacists which would cover both employed and
self-employed pharmacists?
Yes ( )
No (X)
Unsure ( )
If not, can you suggest ways in which all pharmacists in
England can be brought into the systems for tackling concerns about NHS
performance locally which apply to other primary healthcare
professionals?:
Refer to their professional body Gen Pharmacy Council.
Q16: Without a ‘supplementary list’, how
might the new NCAS pharmacy service operate for
locums?
Comments:
Check qualifications and that they have passed the
Vulnerable Groups check.
Q17: Should this framework extend to pharmacy technicians?
Yes ( )
No ( X )
Unsure ( )
Comments:
Check qualifications and that they have passed the
Vulnerable Groups check
Q18: Do you agree that, in addition to pharmacists, other
people working in community pharmacy such as pharmacy technicians and
others who provide advice, assistance, guidance and/or medical treatment
need to be ISA-registered?
Yes (X)
No ( )
Unsure ( )
If yes, who are they?:
All who give guidance and advice to patients.
Q19: How might self-employed pharmacists
best be brought within the remit of ISA registration? For example, would
it be appropriate to require this as part of a self-employed pharmacist’s
inclusion on a PCT supplementary list?
Comments:
Check qualifications and that they pass the Vulnerable
Persons requirements.
CHAPTER 4: Dispensing by doctors
Market entry: revisions to the current regulatory
criteria
Questions for consultation
The Department has identified four possible options to
reform the current arrangements regarding dispensing by doctors.
Q20: Is the Department right in believing that there are
inequities and anomalies within the current procedures under which
patients can obtain their medicines and appliances directly from their
surgery rather than from a community pharmacist?
Yes (X)
No ( )
Unsure ( )
Comments:
Yes, but the proposals do not address the inequalities and
anomalies.
Q21: Have you any personal experience of any such
inequities and anomalies? If so, please briefly set them out.
Personal experience:
Dr advises that certain medicines available more cheaply
from pharmacies as P medicines but does not have ability to supply them.
Q22: Do you believe that having a local choice between two
or more local dispensers when having a prescription dispensed is important
to you? Could you quantify how important this is for you on a scale of 1 -
5 where 1 is exceptionally important and 5 is of no importance (please
tick one).
1 (X) 2 ( ) 3 ( ) 4 ( ) 5 ( )
Q23: Is it right for the Department to publish a national
set of rules setting out when a doctor can provide dispensing services or
should the local NHS, for example your PCT, consulting with others, have
more say?
National rules (X)
More local discretion ( )
Comments:
The rules should OBLIGE all rural GP’s to dispense
at all their branch and main surgeries.
Q24: Do you agree that the four options set out in this
consultation document relating to dispensing by GPs are appropriate
options for consideration?
Yes ( )
No (X)
Unsure ( )
Are there any others that should be considered?:
REQUIRE all rural GP’s to dispense and ALLOW ALL
to dispense if they choose urban and rural. It is called a level playing
field. Make sure the Dr hands the patient the prescription (this is not
always the case - sometimes they pop up off the printer in the
office/dispensary) and allow patients to choose to take it to the in house
dispensary or any other they think they can get a better deal from. This
is patient choice not some dull business about which hospital to have an
operation patients are not qualified to judge the difference between.
Q25: If you have a preference between Options 1-4, which
is your preferred option and why?
Option 1 (X) Option 3 ( )
Option 2 ( ) Option 4 ( )
Why is this your preferred Option?:
If not what is recommended above then the least bad is the
status quo. Prefer what stated in previous answer.
Q26: If there were to be change, what issues do you
believe the Department should take into account when implementing any new
system?
Issues to take into account for implementation: Service
provision and choice by patients. Give the patient the prescription and
allow them to choose where to get it filled. Allow all GP’s urban and
rural to dispense want to. Require all rural ones to dispense. GP’s
subsidise the dispensing by providing qualified supervised staff to
support the dispensing. Make sure that a practice is not judged rural or
urban on where its main surgery is. Judge each surgery on its
circumstances branch or main. Many bigger practices have a main surgery
and one or more rural branch surgeries.
Q27: Are there other factors to take into
account - for example, how well do these options or your preferred
option link to the proposals below for a common regulatory route for all
applications?
Other factors?:
Look not only at the main surgery and whether that is
rural or urban. Look at each surgery, main or branch on its own
circumstances.
A common regulatory route for all applications
Questions for consultation
The Department proposes to amend the 2005 Regulations (and
associated primary medical legislation) to introduce a single regulatory
route to authorise dispensing by doctors for patients in rural areas.
Q28: Do you agree:
- the proposal to align the regulatory route for dispensing doctor
applications with those of pharmacies and appliance contractors?
Yes ( )
No (X)
Unsure ( )
Comments:
Require all rural GP’s to dispense and allow all GP’s
rural or urban to dispense if they choose. Practices are not homogenous so
treat according to their circumstances.
- dispensing by doctors should, as now, apply to those patients who
live in designated rural areas?
Yes (X)
No ( )
Unsure ( )
Comments:
Yes, but hand the prescription to the patient to decide
whether to get filled at the surgery or elsewhere.
- the approval of doctors’ dispensing premises should continue?
Yes (X)
No ( )
Unsure ( )
Comments:
Yes as long as all other contractors have the same
requirement.
- the ‘serious difficulty’ rule should be retained to enable a PCT to
authorise dispensing for any patient who has serious difficulty getting
to a pharmacy?
Yes (X)
No ( )
Unsure ( )
Comments:
Define serious difficulty as physical disability or being
>1km or >£1 bus journey of less than two hour frequency from the nearest
pharmacy.
Q29: Are there other factors which need to be taken into
consideration?
Other factors:
GP’s subsidise the pharmacy function by providing
skilled, experienced and supervised staff over and above the minimum
provision required in pharmacies or supermarket service providers.
The sale of over the counter medicines by dispensing
doctors
Questions for consultation
The Department proposes to allow, when there is no
convenient alternative, dispensing doctors to supply over the counter
medicines to all of their patients, subject to the MHRA’s review and
forthcoming informal consultation on the current medicines legislation.
Q30: Do you believe that it would be beneficial for
patients and consumers if dispensing doctors were able to sell general
sale list (GSL) medicines to their patients where there is no convenient
alternative?
Yes (X)
No ( )
Unsure ( )
Comments:
OK where convenient is defined as <1km or <100 hours a
week.
Q31: Do you believe that it would be beneficial for
patients and consumers if dispensing doctors were able to sell pharmacy
(P) medicines to their patients where there is no convenient alternative?
Yes (X)
No ( )
Unsure ( )
Comments:
OK where convenient is defined as <1km or <100 hours a
week.
Q32: How might the term ‘convenient alternative’ best be
defined? For example, should a distance limit of, say 500 m, be set, or
should this be left to local determination?
Comments:
Convenient is defined as <1km or <100 hours a week.
Q33: If dispensing doctors were to sell P medicines, do
you agree there should be safety provisions regarding such supply - for
example, similar or equivalent to those that govern the sale and supply of
P medicines through pharmacies?
Yes ( )
No (X)
Unsure ( )
Comments:
Dispensing GP’s have the safeguards required for
Prescription Only Medicines already, what more do you need?
Q34: Are there any risks not identified here in permitting
a dispensing practice to make a profit from selling medicines to their
patients?
Yes ( )
No (X)
Unsure ( )
If yes, what are the risks not identified?:
Do dispensing GP’s or pharmacies make a profit on
Prescription Only Medicines? NO change so allow it.
CHAPTER 5: Dispensing Appliance Contractors
Market entry for dispensing appliance contractors
Questions for consultation
The Department proposes that applications from appliance
contractors should in future be subject to an exemption from the
‘necessary or expedient’ test.
Q35: Should we introduce a specific exemption for
applications from dispensing appliance contractors?
Yes ( )
No (X)
Unsure ( )
Comments:
Q36: What specific requirements might be set out in the
regulations such as the types, standards and the quality of services to be
provided?
Yes ( )
No ( )
Unsure ( )
If yes, what might these be?
Goods must be of the required specification and be
economic
Question is wrongly worded! You can’t answer yes or no to
this question! That is why I didn’t put any yes or no
Q37: What safeguards might be appropriate to ensure the
NHS has a reasonable and proportionate control over any increases in costs
through new dispensing appliance contractor premises?
What safeguards might be appropriate?
Same as for pharmacies and GP staff.
Q38: Do the potential benefits of relaxed entry
restrictions outweigh the potential costs as identified in the Impact
Assessment?
Yes (X)
No ( )
Unsure ( )
Comments:
Do not relax. Have a national regulatory scheme.
A ‘performance’ regime for individuals who assist
dispensing appliance contractors in the provision of services
Questions for consultation
The Department proposes that dispensing appliance
contractors should - in 2009 – be assessed in terms of the need for
regulation against objective criteria to be formulated by the Extending
Professional Regulation Working Group. Those criteria will be available
later in 2008.
Q39: Do you agree the Department should assess in 2009
whether regulation is needed to govern those who assist in the provision
of appliances only?
Yes ( X)
No ( )
Unsure ( )
Comments:
Are appliances prescribed by GP’s and paid for by NHS? If
yes then the prescriber has to judge best source in conjunction with the
patient.
Q40: Are there alternative approaches which might be
considered?
Comments:
Are appliances prescribed by GP’s and paid for by NHS? If
yes then the prescriber has to judge best source in conjunction with the
patient.
Q41: If a risk were to be established, do you agree the
provisions of sections 149 and 150 of the NHS Act should be extended to
include those who assist appliance contractors in the provision of
services?
Yes ( )
No ( )
Unsure ( )
Comments:
Responsibility of the contractor to employ suitable staff
and if they do not then refer the contractor.
The question is hypothetical so cannot answer yes or no as
do not know the outcome of the hypothesis
Q42: Should self employed appliance contractors be
required to register with the Independent Safeguarding Authority and, if
so, how ?
Yes ( )
No (X)
Unsure ( )
Comments:
They are the contractor so should be covered by the
contractor regulations.
Q43: Should such requirements be subject to specific
limitations - for example, applying only to contractors who fit appliances
or who do so in patients’ homes?
Yes ( )
No (X)
Unsure ( )
Comments:
No, fitting is merely an extension of supplying.
CHAPTER 6: Other changes to the legislation
Amendments to the NHS (Pharmaceutical Services)
Regulations 2005
Questions for consultation
The Department proposes to make certain amendments to the
2005 Regulations and associated legislation.
Q44: Do you agree the amendments proposed?
Yes ( )
No (X)
Unsure ( )
If not, which do you not agree with?:
GP’s can No 5. Necessary and desirable are NOT
the same as necessary and expedient. If they are the same why change?
Leave as necessary and DESIRABLE.
No 7 No bribery of any sort. Level playing field.
Supermarkets can probably buy apples cheaper than GP’s or small pharmacies
so would have an unfair advantage
Q45: At this stage, no significant impact has been
identified from these proposals. However, if you think these amendments
would have a significant impact for PCTs or for business, please say what
this is and how best any such impact might be managed.
Significant impact/how might be managed:
GP’s can. No 5 Necessary and desirable are NOT
the same as necessary and expedient. If they are the same why change?
Leave as necessary and DESIRABLE.
No 7 No bribery of any sort. Level playing field.
Supermarkets can probably buy apples cheaper than GP’s or individual
pharmacies so would have an unfair advantage
Q46: Are there other amendments you wish to propose
that the Department should consider? If so, please say how they would
clarify or improve the working of the regulatory system.
Other amendments:
Keep PCT’s out of local regulation.
Amendments to the provisions relating to Local
Pharmaceutical Services (LPS) contracts
Questions for consultation
The Department is inviting views on whether amendments to
the legislation concerning local pharmaceutical services contracts should
be introduced.
Q47: Do you agree that the proposed changes to LPS
legislation are needed?
Yes ( )
No (X)
Unsure ( )
Comments:
This would be ‘incestuous’ and therefore bad. Separate
regulation and providers or contractors.
Q48: Are there other changes to the LPS legislation which
the Department should consider?
Yes ( )
No (X)
Unsure ( )
Other changes:
Regulated and regulators must be separated. Cf for
instance banks
Q49: No significant impact has been identified in respect
of these proposals. If you believe they would have such an impact, please
explain what this might be and how it might best be managed.
Significant impact/how might be managed:
As usual urban seem preferred to rural. Being rural is
not an optional choice by many, do not burden rural dwellers with the
consequences of circumstances not of their own making. You want to eat,
you need farmers. Supermarkets do not produce food they only sell it!!
Equality Impact Assessment
The Department’s Equality Impact Assessment is set out in
the accompanying Impact Assessment document. The Department welcomes
responses, particularly from those representing affected communities, to
advise whether key equality issues have been raised and addressed as part
of this consultation. If not, then the Department will take into account
comments made or accept other suggestions to address matters of equality,
and will conduct a further equality impact assessment based on those
comments and suggestions, as the proposals set out in this consultation
are developed.
Comments on Equality Impact Assessment:
All GP’s are small firms, especially the rural ones. Do
you propose to exempt them as well? I doubt it so treat all equally.
Impact on small firms
The Impact Assessments include the Department’s assessment
of the effects of various proposals on small firms. As any changes to
legislation would apply to all NHS contractors, the Department does not
consider it would be appropriate to exempt (either fully or partially)
smaller firms from these provisions.
The Department welcomes comments on the impact on small
businesses of the proposals set out here and in particular:
- How serious is the problem the proposals seek to address in relation
to smaller firms?
- What changes will smaller firms have to make to the way their
business operates?
- Is there likely to be a greater impact on the operations and
performance of smaller business than others?
- What are the likely approximate costs and benefits of the proposals
for small business?
Impact on small firms:
All GP’s are small firms, especially the rural ones. Do
you propose to exempt them as well? I doubt it so treat all equally.
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