12 June 2015
Article by Philippa Watkins, National Assembly for Wales Research Service
One of the elements of the Public Health (Wales) Bill, introduced on 8 June 2015, focuses on strengthening the role of pharmacies in promoting and protecting public health.
The Bill seeks to do this by changing the way Health Boards make decisions about pharmaceutical services, to ensure that the services provided are more closely aligned with the needs of the communities they serve.
Anyone wishing to provide NHS pharmaceutical or dispensing services must apply to the relevant Local Health Board for inclusion on that Health Board’s pharmaceutical list. Applications are decided by applying a control of entry test; the current test however focuses only on whether there is adequate access to pharmacies for the dispensing of prescriptions, and does not take into account the range of additional services that community pharmacy can provide. The public health White Paper stated:
This approach has not changed to keep pace with the developing public health role of community pharmacy, and does not support Local Health Boards in maximising their contribution to improving the health of local communities.
Under the Bill:
- Health Boards will be required to carry out ‘pharmaceutical needs assessments’ for their areas. This will enable Health Boards to identify how well existing pharmacies meet population need, and where additional pharmaceutical services might be required.
- The full range of services that can be provided by community pharmacies, and not just dispensing services, must be taken into account when making decisions about applications to provide NHS pharmaceutical services.
- Health Boards will also be able to implement improvement measures where there is a lack of quality or consistent delivery. This could include taking action against particular pharmacies for persistent breaches of terms and conditions of service, or inviting additional pharmacies to apply to provide particular services.
Responses to the White Paper consultation, from pharmacy representatives and NHS organisations, were broadly supportive of the proposals. Stakeholders agree that pharmacies could play a greater public health role, highlighting the strengths of community pharmacy-based health services such as their easy access due to high street presence and geographical spread, and ability to serve hard to reach groups.
Statistics show that there were 714 community pharmacies in Wales in March 2014, and that there has been very little change in the number of community pharmacies in Wales since 2006-07.
In rural areas, GP practices can also apply to provide pharmaceutical services to their patients. These are commonly known as ‘dispensing doctors’. At the end of 2014 there were 83 dispensing practices across Wales, with dispensing practice numbers also remaining stable. The Bill will require Health Boards to take a more integrated approach to identifying the pharmaceutical needs of their populations, and consider the contribution of dispensing doctors as well as community pharmacies.
The current contractual arrangements for community pharmacy were introduced in 2005. Under the contract, as well as the essential services which all pharmacies must provide (these relate largely to pharmacies’ dispensing role), Health Boards are able to commission additional services to reflect the needs of their populations. Some of these services are developed nationally (for example, provision of emergency hormonal contraception), but most at local level (such as supervised administration of prescribed medication, needle exchange, palliative care support and smoking cessation services). There is no requirement on pharmacies themselves to offer enhanced services.
The aim of the 2005 contract was to widen the range of services available from community pharmacies. However, it’s felt that the opportunities to commission and deliver additional services have not been sufficiently exploited. Stakeholders have described patchy and inconsistent provision of services, and a lack of funding streams to support the development of sustainable services. This is borne out by the latest statistics on community pharmacy services in Wales (2013-14), which highlight the variable distribution of some of these additional services across Wales (see illustrative maps on pages 8-10).
The Bill aims to encourage pharmacies to adapt and expand their services in response to local needs. The Explanatory Memorandum states that the changes provided for in the Bill will allow for gradual improvement in the quality and consistency of NHS pharmaceutical services.
The Public Health (Wales) Bill has been referred to the Health and Social Care Committee for Stage 1 consideration of the general principles of the Bill.