Out-Law News 2 min. read

Health system could benefit from greater pharmacist input if legal challenges can be addressed, says expert

The health system in England could benefit if plans to involve pharmacists more in delivering treatments and care in GP surgeries are implemented, an expert has said.

Health regulations specialist Louise Fullwood of Pinsent Masons, the law firm behind Out-Law.com, said, though, there are legal and regulatory aspects which "need working out".

Fullwood was commenting after the Royal College of General Practitioners (RCGP) and the Royal Pharmaceutical Society (RPS) jointly outlined plans for pharmacists to play a greater role in treating patients on "day to day medicine issues" and in liaising with hospitals, community pharmacists and care homes "to ensure seamless care for patients". They would also visit patients at home "when needed", under the plans.

The RCGP and RPS said the proposals would help "ease current pressures in general practice and address the severe shortage of GPs" and lead to improvements to patient safety and care and cut GP appointment waiting times.

Fullwood said the plans are indicative of changes to the way primary care is delivered in the future, when services are likely to be more integrated.

"We see the future of healthcare as moving 'beyond the pill' (2-page / 547KB PDF) and the strictly delineated roles played by the individual stakeholders in the system, such as the big pharma companies, GPs, pharmacies and social care providers, into a much more integrated and patient-focused service," Fullwood said.

"There are great opportunities for the health care system in England to get the maximum benefit from our highly trained and well-regulated pharmacists – looking to a model more akin to, say, France, where a local pharmacy is often the first point of call for minor injuries and ailments rather than a GP," she said. "It is also an opportunity for pharmacies to expand their services and build on the advantages they have of being trusted local businesses on the high street or within the big supermarkets."

There are legal and regulatory barriers to overcome if pharmacies are to be integrated further into the primary care process, Fullwood said.

"Pharmacies can already apply for the right to deliver services above and beyond prescription services under the Pharmaceutical Services (Advanced and Enhanced Services) (England) Directions 2011," Fullwood said. "Approved pharmacists can undertake reviews of patients' use of medicines or appliances and, for example, record how medicines are affecting the treatment of long term illnesses, determine whether appliances issued to patients are being used effectively and deliver advice. This process would benefit from widening and simplification to encourage retail pharmacies to get involved."

"There is also a complex area around inducements/payments which stems from the fact that a growing number of GPs actually own or part-own pharmacy practices linked to their surgeries, or lease premises to pharmacies," Fullwood said. "The potential for closer working can run into difficulty or challenge when a GP may wish to have a closer relationship with such a pharmacy."

There is a risk that pharmacies could challenge GP decisions to select an alternative pharmacy to work closely with where they have an interest in that business, she said.

"We have also found that the statutory legislation on the extent to which GPs can receive a benefit from work derived from their ownership of a pharmacy is not straightforward," Fullwood said. "The key legislation – the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 – is not too clear on this point."

Under the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013, NHS pharmacists must not "give, promise or offer to any person any gift or reward … as an inducement to or in consideration of a person … receiving from [the pharmacist] any directed services".

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