ࡱ> 02/5@ G!bjbj22 4*XXm$8 $X $       $|R      ) ) ) j   ) ) ) ; ;  gk p; ( 0X ; [ v; $$; ) )l $$ X$$This document has this to be said for it: it is clearly written and unambiguous in its intent. The great majority of the White Paper deals with a vision of the future of pharmacies as part of the wider provision of health care, advice, preventative measures and screening in line with government thinking as originally expressed in the Wanless Report. The underlying principles are that there is a demographic time bomb ticking with an ageing, more obese, alcohol-abusing fit population incubating chronic diseases which the NHS will not be able to tackle using its present traditional structures and systems. Therefore every effort must be made to encourage wider and more accessible opportunities for members of the public to engage with aspects of their own health before disease becomes apparent. Various examples of pilot schemes are given in the by now time honoured text boxes within the paper. Many seem to have resulted in large proportions of those taking part having been referred to their GP for further assessment. There are also assessments of current programmes, such as pharmacist medication use reviews which are thought not to have delivered uniform value for money, repeat dispensing and electronic transmission of prescriptions from practices to pharmacists. Uptake of both of these is judged to have been disappointing so far especially, the author points out, considering how much general practitioners complain about the time taken to generate and sign repeat prescriptions. The largest area of contention however is undoubtedly the small section (eight out of 77 paragraphs) in Chapter Eight Structural enablers and levers concerning dispensing doctors which, if implemented will have major implications for the provision of general medical services in rural areas of Somerset where a third of the 76 practices dispense to at least some of their patients. It will also have wider implications for rural communities who are losing amenities including post offices, schools, shops and public houses. A report from Oxford University this month found that 45 per cent of the neighbourhoods in England 14,493 out of 32,439 are more "geographically deprived" than in 2004. The relevant section (8.67) begins by saying that PCTs are currently not capable of full commissioning and so a control of entry regime will continue for pharmacies and dispensing doctors. The government believes that there are two concerns about dispensing consent for doctors. The first arises because of the condition that it is where the patient resides that determines whether a patient is able to receive convenient dispensing services from their GP. The White Paper sensibly acknowledges for the first time that this leads to inequity where patients living on opposite sides of the same street are treated differently and also that the one mile (inevitably these days 1.6km) takes no account of how far patients might actually have to travel to collect their medicines. The second concern is the proximity of dispensing practices to community pharmacies. Some people who receive dispensing services from their GP surgery walk past a community pharmacy...especially in market towns. A logical solution is offered to take the form of new control of entry rules for dispensing practices a single condition relating to the distance from the surgery to the nearest pharmacy instead of where the patient resides. If this rule were satisfied then the surgery could dispense to all the patients on its list and a dispensing practice would also be allowed to sell over-the-counter medicines in order to improve the availability of these products in areas without a convenient local pharmacy. At first reading it is possible to conclude that this new regulation might be for new applications but section 8.72 makes it clear that this is not the case. Transitional rules would be required and these would need to consider the financial impact on the GP practice of losing the right to dispense as well as the impact on pharmacy provision. Practices meeting the new criteria could find they dispense to more patients but...those who do not...will have to accept that they will need to wind down their dispensing role. We are reminded that provision for the removal of consent to dispense all ready exist, for example when a pharmacy opens in the vicinity of some a dispensing surgerys patients and these could provide a model for such a phased approach. This crucial section concludes by saying that the government recognises that although the present market entry arrangements are the inconsistent it recognises that they are the result of previous agreements between representatives of pharmacists and doctors. Therefore it states that any changes...should be part of a wider consultation on elements of the control of entry itself... It is also hoped that such a consultation will result in a streamlining so that in future consent to dispense is sought under a single regulatory route. This consultation exercise will be held in the summer of this year and there is a listening event in Bristol on May 8th where Somerset LMC and dispensing practices will be represented. It is vital that the impact of these plans on provision of medical services in rural areas of Somerset is widely advertised. The government will undoubtedly point out that dispensing doctors in larger practices are amongst the highest earners in the profession and seek to traduce their position as one of naked self-interest. However, with the governments expressed intention to removed the minimum practice income guarantee it seems that all practices and remember the high proportion of Somerset practices that dispense will be seeing considerable reduction of income to provide services over the next few years. The tragedy is that the current administration is unlikely to be moved by predictions of traditional general practices becoming financially unviable as this will simply serve to advance their plans to increase the proportion of services purchased from the alternative providers and delivered by employees rather than independent contractors. Therefore the wider implications for all ready beleaguered rural communities must be the main thrust of our arguments and forums wider than internal NHS consultations must be engaged at once.     Pharmacy in England: Building on strengths delivering the future A White Paper April 2008  @  T"PW60 hwmt }uquqh!jh!UhhOJQJhhOJQJhvjOJQJh=h=H*OJQJh=OJQJh=5OJQJh%ih%i5OJQJh%iOJQJhWhW6OJQJhWOJQJhhOJQJh OJQJhOJQJhOJQJ, vs )!B!C!D!E!F!G!$a$gd&$a$gd dgd&$a$gd F! 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