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When your pharmacy can give you a headache: a prescription for dispensing practices

As with any change, the drive to deliver primary care at scale carries with it the risk of unintended consequences. For a dispensing practice looking to merge or to move to shiny new premises, the loss of a valuable income stream from dispensing can be one.

PCC primary care adviser Charlotte Goodson cautions that the regulations in this area are particularly opaque and complex and dispensing practices need to take stock when planning changes.

As with any change, the drive to deliver primary care at scale carries with it the risk of unintended consequences.

For a dispensing practice looking to merge or to move to shiny new premises, the loss of a valuable income stream from dispensing can be one.

PCC primary care adviser Charlotte Goodson cautions that the regulations in this area are particularly opaque and complex and dispensing practices need to take stock when planning changes.

“Practice partners and managers need to be aware of the evolving regulations and the way they are being interpreted. This is complicated for them by the fact that while their clinical commissioning group might support – and even promote – a merger or moving into new premises, issues around dispensing are decided by NHS England.”

“Practices really need to understand what the regulations say and to talk to their local NHS England team well in advance of any merger or move. Decisions around local medical services are decided at CCG level but dispensing decisions lie with NHS England because they are pharmaceutical services.”

Goodson, who delivers PCC’s courses on dispensing requirements, says: “If practices are looking to merge or to move into new premises or to start dispensing from additional premises, they have to get fresh approval. Sometimes the discussions they need to have don’t start early enough. They really need to talk to their NHS England local team at an early stage. Decisions on applications for changes to the dispensing service will take up to four months and are subject to appeal. Even if the practice’s application to move is granted, their ability to dispense would be threatened if a business has submitted an application to open a pharmacy within 1.6km of the new premises. This could mean they lose their right to dispense from the new site or it could delay dispensing for up to 12 months.”

“I’ve heard of a case where a practice called NHS England on the Friday afternoon to confirm arrangements for opening up and dispensing in new premises on the following Monday.”

The complex rules – including the widely disliked “one mile rule” – apply to practices which dispense medicines rather than those with fully-fledged pharmacies.
However, if a co-located pharmacy is moving with the practice that also is an added complication the practice needs to consider.

Even NHS England cannot guarantee that dispensing status will be preserved if the practice location changes or it is involved with a merger. In some cases, CCGs supporting a practice move as part of their estates strategy are finding out late in the day that there is a significant barrier in the way.

The one mile rule generally prevents practices dispensing medication if there is a pharmacy within that radius. Goodson has heard of cases where the new site for an existing practice is safely at least a mile from the nearest pharmacy only for an application to come in for a new pharmacy. The practice can only continue dispensing if the pharmacy application is refused or if the pharmacy doesn’t open.

That can be a particular issue where a new residential development is underway. Hundreds of new homes might attract both an existing dispensing practice and a pharmacy.

Goodson says: “These issues are very political in rural areas in particular and the system does have its flaws but it’s unlikely to change in the foreseeable future.”

Until then, her sessions for practices and CCGs explaining the regulations and their practical implications are likely to remain popular. Goodson can also provide specific tailored advice to any dispensing practice that is considering merging or relocating.

PCC provides support for practices and commissioners to manage contracting issues around dispensing. Contact enquiries@pcc-cic.org.uk