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Opening Hours - Urgent action needed
At the March PSNC meeting and at the LPC Conference, the implications of recent changes to the GP contract relating to increasing their surgery hours were discussed. The Department of Health is seeking increases in the availability of GP appointments outside the GP's core hours. The proposal agreed by a recent ballot of GPs is to recycle some of the QOF points and to replace the existing Directed Enhanced Service for access. GPs will provide extended opening of half an hour per 1000 patients. Changes to hours will be subject to local discussion between PCTs and GPs, having regard to the results of patient surveys.
In some areas, GPs have extended or amended their hours either into the evening or into the weekend or both. The periods of public demand for pharmacies to dispense prescriptions may have changed (for example, where pharmacies had previously aligned their hours to the local surgery hours).
When the new pharmacy contractual framework was agreed in 2005, pharmacies could decide their own hours, and all pharmacies were entitled to set which would be their 40 ‘Core' hours, and what supplementary hours would be available. Changes to core hours require an application to the PCT, which has 60 days in which to reach a decision of whether or not to grant it. Changes to core hours are allowed 30 days after the PCT has granted an application. Changes to supplementary hours can be made without the approval of the PCT, but 90 days notice is required.
If GPs do change their surgery hours, so that there are unmet needs for pharmaceutical services, pharmacy contractors need to make a decision whether to change their own opening hours voluntarily. This is a commercial decision. Sometimes, changing hours will result in the pharmacy being open for a very small number of prescriptions where the dispensing income does not meet the costs of providing the service. Where the time cannot be used constructively for other non urgent pharmacy activities (such as completing paperwork, cleaning schedules, dispensing of repeat medication ready for collection etc), the pharmacy contractor may decide that voluntary additional opening cannot be justified.
Local Pharmaceutical Committees may be able to assist pharmacy contractors by identifying with the PCT, the hours when GPs are opening for additional hours, followed by mapping voluntary pharmacy opening (and taking into account the availability of 100 hour pharmacies). Then, if there remain unmet needs, the LPC may work with the PCT to see if an out of hours Enhanced service can be commissioned. If it looks unlikely that pharmacies will agree to enter into voluntary or an out of hours Enhanced service, the PCT may issue directions which compel a pharmacy to open - this should be a fall back position - and it is in the contractor's and the PCT's interests to try to avoid this. LPCs are well placed to try to broker an agreement which stops short of the formality of a PCT direction to open.
Changes to hours must have at least 90 days notice. It is a breach of terms of service to amend hours without giving this notice. But, it is highly unlikely that a PCT would be acting in the public interest, if it adopted a policy to rigorously enforce that provision in cases where the pharmacy wants to open for additional hours immediately, in order to meet the additional requirements brought about by the GP surgeries extending their hours. LPCs can discuss this principle with the PCTs, to determine whether the PCT would be content with a pharmacy opening for additional hours without giving the 90 days notice.
Pharmacy contractors should without delay, establish whether their local surgeries are intending to amend their opening hours, and if so, to consider whether an amendment to the pharmacy opening hours is appropriate.
Posted 4 April 2008