Bedfordshire LPC 6 February 2011

1. Bedfordshire LPC6 February 2011 David Reissner

2. Control of Entry Today • An application will be granted if it is necessary or expedient to secure in the neighbourhood the adequate provision of pharmaceutical services • The test is adequacy, not improvement

3. Health Act 2009 and Health & Social Care Bill 2011 • Each PCT must have a Pharmaceutical Needs Assessment for its area. • The contents of PNAs are dictated by Regulations

4. Contents of PNAs • Age; • Disability; • Gender; • Reassignment of gender; • Race; • Religion or belief; • Sexual orientation;

5. Cont/d Contents of PNAs • The demography of the area; • The benefits from having a reasonable choice • Any different needs of different localities within its area; • The pharmaceutical services provided under arrangements with any neighbouring Primary Care Trust; • Any dispensing services or other NHS services provided in or outside its area (the need for pharmaceutical services in its area).

6. The New Control of Entry – Test 1 • An application may be granted if the PCT is satisfied, having regard to the PNA, that granting it would meet a need in the area for services or some of the services specified in the application • The applicant need not satisfy the PCT it is necessary to grant the application in order to meet a need

7. New Control of Entry - Test 2 An application may be granted if the PCT is satisfied, having regard to the PNA and to any matters prescribed, granting the application would secure improvements, or better access, to pharmaceutical services in the area

8. How would you know if a PNA is Fit for Purpose? • Some PCTs believe there is no need for any additional pharmacy anywhere in their areas • Some PCTs do not want to grant any application because new pharmacies cost them money • Some PCTs are incapable of identifying needs • Some PCTs used to grant every application because they believed it would improve access and increase choice

9. White Paper: Liberating the NHS – Next Steps (December 2010) • Commissioning community pharmacy services will become the responsibility of the NHS Commissioning Board. • GP consortia will have influence and involvement. • The NHS Commissioning Board will go live in April 2012. • PCTs will be abolished in 2013. • Local Authorities will have Health & Wellbeing Boards. Health & Wellbeing Boards will have responsibility for PNAs. • DH will work with professions to ensure NHS Commissioning Board will have local knowledge and clinical expertise. • The Department will move to a "willing provider" approach for community services, reducing barriers to entry by new suppliers. What are the implications for control of entry?

10. Next Steps – What Liberating the NHS is likely to mean for Control of Entry • Local Involvement Networks will become part of local HealthWatch. • Local HealthWatch will provide local intelligence to enable HealthWatch England to ensure the views of patients, carers and the public are represented to commissioners • HealthWatch England will be an "independent consumer champion" • The Health and Wellbeing Board of each local authority will have responsibility for the local Pharmaceutical Needs Assessment

11. 3 Reasons for not Abolishing Control of Entry • The effect on the balance sheets of pharmacy businesses • All 100-hour pharmacies would be lost • Government would lose control over spending on pharmacy expenditure, including infrastructure payments and fees for MURs

12. How will Control of Entry Work? • Applicants having pre-application discussions with PCT to explore needs • Existing providers maintaining dialogue with PCT to meet identified needs • The appeals process

13. Exemptions • 100-hour pharmacies – expected to be abolished • Will there be a glut of exempt applications new before Regulations prevent future 100-hour pharmacies? • Existing 100-hour pharmacies will probably have to continue providing services for 100 hours • Distant selling (mail order/internet) exemption may be abolished. • If distant selling exemption remains, it may be extended to include appliance contractors

14. Minor Relocation • Minor relocation may be freed from the constraints of neighbourhood boundaries

15. Market exit PCTs (or successors) are to have new powers to take action where there are concerns about: • Quality of service or • Performance of existing providers

16. Timeline • Consultation on new Regulations – unknown • New control of entry test – 3 weeks from close of consultation • NHS Commissioning Board April 2012 • PCTs abolished 2013

17. Charles Russelldavid.reissner@charlesrussell.co.ukFacebook – Charles Russell Pharmacy TeamFollow me on Twitter @davidreissner This information has been prepared as a general guide only and does not constitute advice on any specific matter. We recommend that you seek professional advice before taking action. No liability can be accepted by us for any action taken or not taken as a result of this information. Charles Russell LLP is a limited liability partnership registered in England and Wales, registered number OC311850, and is regulated by the Solicitors Regulation Authority. Any reference to a partner in relation to Charles Russell LLP is to a member of Charles Russell LLP or an employee with equivalent standing and qualifications. A list of members and of non-members who are described as partners, is available for inspection at the registered office, 5 Fleet Place, London EC4M 7RD.