Shrinking the pharmacy network in Northern Ireland?
A pharmacy contract must mean much more than getting a prescription dispensed. Giving patients access to more services is where the focus must be, says Terry Maguire...
The government has always had the jaundiced view that there are too many community pharmacies in Northern Ireland. They want the most efficient network for the public purse and, in their view, this means fewer contracts.
I strongly disagree with this. Market forces largely created the current network of 525 pharmacies and it does serve our dispersed population pretty well. Financial support to maintain rural pharmacies in more remote areas works and, of course, there have always been concerns about the excess of pharmacies around large prescribing GP practices in urban areas.
In the 1960s, we had over 700 contracts for a lower population, but back then, few households had access to a car and public transport was less developed. From time to time, the supposed over abundance of pharmacies becomes an issue, and the last few months has been one of those times.
Under the banner of a Pharmaceutical Needs Assessment, the SPPG (historically the Health Board) produced a ‘sustainability report’, which it shared with CPNI. The paper has been deemed ‘confidential’ and the CPNI board decided that, respecting its status, it would not share this report with contractors.
A report marked ‘confidential’ from the DoH is a valid reason not to share more widely. However, it is understandable that there are concerns among independent contractors. The multiple groups will have been informed in detail by their representative on the CPNI board and it might be suggested that independents on the board are seeing a report that could have commercial implications that give them an advantage over their non-board colleagues.
I must emphasise that I just don’t know because it has not been shared. What little has leaked is that SPPG wants to get the network down to 475 contracts, meaning a loss of 50 contracts or 10 per cent of the network. CPNI could, of course, go to war on this and open up yet another front. However, and assuming this leak is accurate, this level of reduction could be achieved painlessly and without impacting patient access to pharmaceutical services or damaging the commercial interests of contractors.
A number of closures are currently happening. There are many examples where a contractor owns two contracts in one location. Closure of one would not impact patient access while consolidating the commercial value of the business in one contract, retaining full goodwill value.
Boots did this in Hollywood, but in that case other contractors probably benefitted as the two contracts were not juxtaposed. In Ballycastle, the two contractors in the town own the four contacts. They have, I believe, agreed to each close one contract, reducing four to two. In that location, this works.
In Botanic Avenue in Belfast, two contracts owned by the same contractor have been reduced to one, which potentially consolidates all that business. The same again at Ballyhackamore in South Belfast. There are other locations where this could easily happen: Fingahy in Belfast, where one contractor has three contracts out of four, and Ardoyne, Dunville and Albertbridge Road, where the contractors have two pharmacies almost next door to each other and little competition nearby.
I’m sure these contractors will quickly tell me to go and mind my own business, and they may have a point. But their main consideration is, as mine would be, loss of the practice allowance and a fall in goodwill. The same number of prescriptions need to be dispensed at a flat dispensing fee, but they may benefit from better utilisation of pharmacists.
A reduction of 10 per cent in pharmacy contracts means a £1 million saving for SPPG per year on the practice allowance. This is really very small beer and I would argue that this petty amount of savings is not incentive to potentially deprive communities of their pharmacies. Why not invest more in the excellent existing network?
But if it is as SPPG insists, it seems sensible that an incentive to secure closures should be considered. Back in 1986, the last time an incentive for closures was offered, it was very different as at that time the network was largely made up of independents so closures required a pay-off for a lifetime of service, which was in most cases regarded as very mean.
But I’m perhaps getting ahead of myself. As I said, the 10 per cent reduction figure is only speculation and only the CPNI board and SPPG have this information.
A pharmacy contract must mean much more than simply getting a prescription dispensed and we, and our patients, are benefiting from new service delivery. Giving patients access to more pharmacy services is where the focus must be.
Terry Maguire is a leading community pharmacist in Northern Ireland.