Adrian wrote:

>So, what steps should a PCG take to improve the profits to partners
>and the benefits to patients, in re-organising pharmacy supplies
>within the area of their Firm?
I'm not sure that PCG's can take any steps now. It's too late.
The PSNC has argued for and received assurances that community
pharmacy will retain the monopoly on scripts.
My initial thoughts would have been for bulk purchase of dressings
and feeds for direct supply to the patients by the PCG.

>Should Pharmacists be bought out and brought into the Firm as
>partners, or employed?
I'm not convinced of the idea of a PCG as the "Firm", but returning
to your question. There isn't a PCG "Firm" big enough to buy out
AAH, BOOTS or UNICHEM. In fact I think that given time the reverse is
much more likely.
I suspect that one of the few opportunities left for continued independence
(for both pharmacists and GPs) is for practice partnerships to occur
between GP practices and independent pharmacy contractors. Otherwise I
really don't see how pharmacy can integrate successfully.
Assuming that PCGs could buy pharmacy contracts on the open market,
employment
would be an attractive option for many pharmacists.

>If taken in as partners what supervision should be established
>nationally locally or regionally to deal with any perverse
>incentives - eg to prescribe and dispense in the most profitable
>combinations so as to increase income to the Firm, in which both GP
>and Pharmacy partners would share?
Why should GP/Pharmacy partnerships be any more prone to that than
dispensing doctors? AFAIK there is no evidence to suggest that patient
care from a dispensing doctor practice is any more expensive or any less
effective than from an non dispensing practice. I think that you too
are showing signs of being a victim of the war between pharmacists and
dispensing doctors.

>What alterations to the laws and regulations governing the supply
>and remuneration of Pharmacy are indicated?
Within a GP (or PCG) practice partnership the piecework system
of payment per item dispensed ought to go. Payment should IMO be
based on a  return of the costs of the drugs used, plus professional
allowance plus IOS for the practice.
The legal right for the pharmacist to prescribe on the NHS
(from the practice/PCG budget) those items not blacklisted that
they would be allowed to sell.
The ability to issue NHS scripts for those items and for those
patients which the GP had designated as repeat items for those patients.
Doesn't that seem like a fairly easy and safe way to reduce the workload
of GP's.

>The pharmaceutical police that I know are paid for the basic ideas of
>Cost.
I suspect that's one of the reasons PCG's are going to be pushed into buying
prescribing advice from a "group provider" rather than an independent
pharmacist.
The HA will still want to exercise control over the advice.

>>If the drug isn't acceptable to the patient,
>it means the GP has to provide another consultation,
Why not with the practice pharmacist;)

Regards

Jeff Green

Community Locum and Consultant Pharmacist

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