FEATURE
Backlash over PHARMACY
FUNDING CUTS
In an open letter to the Pharmaceutical Negotiating Committee, revealed at a meeting hosted by Minister of State for Community and Social Care at the Department of Health Alistair Burt at the end of last year, the Government has announced that funding for community pharmacy in 2016/17 will be cut by £170m. The cut, from £2.8bn to £2.63bn, is a reduction of more than 6% in cash terms.
T
he letter is signed by the Director General, Innovation, Growth and Technology,
Department of Health and the Chief Pharmaceutical Officer.
The decision to publish the letter is unprecedented, and in stark contrast to the secrecy that the NHS has always insisted on for negotiations in the past.
While officials say it is not yet clear how many pharmacies will close, Minister Burt estimates it could be between 1,000 and 3,000, out of 11,674 overall.
Speaking at a meeting of MPs and peers at the All-Party Pharmacy Group earlier this month, he said the extent of the closures would depend on the ability of individual pharmacies to cope with NHS funding cuts.
But he warned smaller, independent pharmacies were most likely to be affected and this would be looked at. Sandra Gidley from the Royal Pharmaceutical Society said, "We have a number of concerns.
"We have spent a lot of time and energy encouraging people to come to pharmacies for health advice to cut pressure on A&E departments and GP services. Under the plans pharmacies could be forced to cut staff and have less capacity to give important health advice.
"The Government must consider the capacity that the community pharmacy
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pharmacyinfocus.co.uk
network provides to relieve pressures on GPs and A&E."
Meanwhile the Department of Health estimates there was a rise of around 20% in the number of pharmacies it funded between 2003 and 2015.
And it says approximately 40% of community pharmacies are found in clusters - with three or more within 10 minutes' walk of each other. Officials say other changes need to be considered too - such as click-and- collect services to allow patients to file prescriptions online.
A Department of Health spokesperson said, “We are investing record amounts in the NHS, but the whole health and care sector must make efficiencies to fulfil the NHS's own five-year plan.
"We want to improve the way patients access their medicines, through click-and-collect as well as being able to see pharmacists in care homes, GP surgeries and A&E.
"There is no estimate of the number of pharmacies operating in coming years and with NHS England we are consulting on a scheme to give better support to isolated or rural pharmacies."
The news bears an eerie resemblance to that which came to the fore locally in 2011 as the Department of Health in Northern Ireland threatened proposed cuts, and closures.
Adjustments to pharmacy funding through the remuneration system for the purposes of reducing pharmacy numbers could be challenged on a legal basis, pharmacy specialist lawyer David Reissner, of Charles Russell Speechlys says.
“In my view, it would be unlawful to use the remuneration system to reduce the number of pharmacies. A lawful scheme for reducing pharmacy numbers would have to include a means to identify locations where there is a perceived surplus. A reduction would have to be achieved in a lawful and rational way, eg by specific regulation that might require compensation for giving up contracts (as happened when market entry regulations were introduced in 1987).
“However, a judicial review, as has been attempted several times in Northern Ireland by pharmacy, would be the only route to challenging the lawfulness of the pay cut, he advised.
“The Secretary of State has a very wide discretion to determine pharmacy remuneration, but the discretion is not unfettered. The only way to challenge the lawfulness of the pay cut would be to apply promptly to the High Court for judicial review.
“Community Pharmacy Northern Ireland has successfully brought judicial review proceedings in Northern Ireland three in recent years. On the first occasion the lord Chief Justice ruled that the Drug Tariff was unlawful and that
pharmacy contractors are entitled to be paid fair and reasonable remuneration.”
On the second challenge, Mr Justice Treacy ruled that a determination of remuneration was unlawful. He said, based on a ruling that the Minister did not have sufficient information to know whether the remuneration set was fair and reasonable. Speechly’s represented CPNI in these cases.
The most recent, and third attempt however was unsuccessful. Dismissing the case brought, Mr Justice Treacy ruled: "There is no basis whatsoever upon which the applicant can establish a legitimate expectation that interim payments would continue beyond 2012/13." He also rejected the claim for a declaration that the department is failing to offer fair and reasonable payments.
Pharmacists across the country faced the same dilemma now in the vision of their counterparts on the mainland as they took in the potential impact of a Government cut in their budget, introduced on 1st April 2011.
“At the very least, I can see staff being laid off and, even at that you would be struggling to make ends meet and, possibly, your level of pharmacy service would drop,” said a Fermanagh pharmacist at the time.
CPNI applied for a judicial review of the cut and estimated that it could mean £38m taken from their funding by the year end, March 31st next. >
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