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Review of dispensing GP practices

 
1. Background
 
For the vast majority of patients in NHS Grampian, medicines are prescribed by GPs and dispensed by Community Pharmacists (local pharmacies). Where patients have a serious difficulty of access to a pharmacy, an NHS Board can require the patient's GP to provide the dispensed medicines directly to the patient.
 
NHS Grampian currently requires nine GP practices to dispense for their patients. In some practices, NHS Grampian requires the GP to dispense to all patients, whilst in others it has defined a geographical boundary where patients living beyond a set distance from the practice can get their dispensed medicines from their practice.
 
These arrangements operate under the regulations governing General Medical Services (GMS). NHS Grampian is only legally allowed to require a patient's GP practice to supply medicines and appliances where it has been formally agreed that the patient will have a "serious difficulty" in obtaining such medicines or appliances (other than a Scheduled drug) from a community pharmacist.
 
The term "serious difficulty" is not defined but NHS Grampian can consider the distance to the nearest community pharmacy, issues of communication and other exceptional circumstances.
 
Following the Judicial Review of dispensing medicines by the Haddo Medical Group in 2015, NHS Grampian accepted the recommendation to conduct a review of General Practices providing a dispensing service to patients within Grampian. NHS Grampian agreed to the review of six dispensing practices and these are Auchenblae Medical Centre, Gardenstown Branch Surgery, Portlethen Medical Centre, Rhynie Medical Practice, Skene Medical Group and Udny Station Branch Surgery.
 
2. Why did NHS Grampian review dispensing arrangements at these practices?
 
The review was triggered by the need to make sure that NHS Grampian continued to act legally in requiring the above six GP practices to dispense for their patients. NHS Grampian can only legally require a practice to dispense for patients who have a serious difficulty in accessing prescribed medicines and appliances from a pharmacy.
 
3. Why did NHS Grampian exclude the practices at Glenlivet, Strathdon and Rinnes at Tomintoul from the review?
 
Glenlivet, Strathdon, Tomintoul probably represent the most remote and rural practices in Grampian. NHS Grampian renewed its requirement or authorisation for these three practices to supply to all of their registered patients within their respective catchment areas. It was agreed that all patients qualified as having a "serious difficulty" in obtaining from a community pharmacy, medicines or appliances on the grounds of distance from a pharmacy. NHS Grampian can legally require these practices to continue dispensing for their patients.
 
4. What was the response to the public consultation?
 
A public consultation was carried out from 4 July to 1 October 2016 in the six Practice areas and as part of NHS Grampian's review process. As part of the consultation six advertised public drop-in sessions took place and a total of 201 members of the public attended across the six areas. The key consultation question for individual patients was:
 
"If dispensing of medicines was not available at your GP practice, would you have a serious difficulty in getting your dispensed medicines from a community pharmacy?"
 
If individuals answered "yes", they were asked to describe what these difficulties would be. There was also the opportunity to state "no" to any difficulty. Individual responses to the consultation were collated and thematically analysed by one Public Involvement Officer working in the Public Involvement Team at NHS Grampian.
 
In total, 1,348 verified responses were received from patients in the six areas. 1,237 (91.8%) respondents stated that they would have a serious difficulty in getting their dispensed medicines from a community pharmacy.
 
The responses from Auchenblae, Gardenstown, Rhynie and Udny Station showed that the majority of respondents stated that they would have a serious difficulty. This ranged from 83.3% of respondents in the Gardenstown area to 98.7% from the Auchenblae area. The main themes for serious difficulty were distance and additional travel time and poor or non-existent public transport.
 
For Portlethen and Skene at Westhill, responses showed that most respondents would not have a serious difficulty in getting their dispensed medicines from a community pharmacy. This ranged from 57.1% of respondents from the Portlethen area who stated "no" to 65.7% from Skene at Westhill.
 
Representatives from groups, organisations, elected public representatives and independent contractors to the NHS such as community pharmacies or medical practices, were also invited to respond to the public consultation. A total of 21 responses were received from this category of respondent and were dealt with separately to the responses from individuals.
 
5. What happened to all the responses to the public consultation?
 
Reports of the findings from the public consultation were submitted to the Review Group which was provided with details of the consultation responses and key themes provided by individual groups and respondents. There was a report for each of the six areas and one summary report covering all six areas.
 
6. What is the Review Group?
 
The Review Group was set up to carry out the review, under the direction of the NHS Grampian Dispensing GP Practices Steering Group. The remit of the Review Group was to identify those individuals, receiving General Medical Services from Practices, who by reason of distance or inadequacy of means of communication or other exceptional circumstances, will have "serious difficulty" in obtaining from a pharmacist any drugs, not being Scheduled drugs, or appliances required for treatment in accordance with the National Health Service (General Medical Services Contracts) (Scotland) Regulations 2004 Paragraph 44 of Part 3.
 
The Review Group visited each of the six areas under review and were open to presentations from any party, organisation or individual who wished to present their case verbally to the panel. A total of 81 contributions or submissions were made to the Review Group from across the six areas.
 
The Review Group has now concluded their deliberation and has produced a report outlining its findings. This report will go to the Grampian NHS Board on 6 July 2017.
 
7. What are the recommendations of the Review Group for each of the six areas under review?
 
Auchenblae Medical Centre:
 
The Review Group recommends that Auchenblae Medical Group should be required or authorised to continue to supply such drugs, medicines or appliances to those patients defined in the above qualifying classes who have a serious difficulty in obtaining their medication from a pharmacist. This requirement should be limited to the classes specified who are considered as having serious difficulty due to:
 
a) Distance from a pharmacist. This is defined by the Review Group as those patients on the practice list residing in post code areas of AB301 excluding the town of Laurencekirk (defined as the area between the railway line and A90), AB392 south of A92 and AB393 south of unclassified road running East to West through Tewel. The surgery should not be required to dispense to patients within the DD10 postcode.
b) An inadequacy of means of communication due to inadequate public transport provision.  Consideration has been given to the topography of area and the potential for weather disruption which, further exacerbates the serious difficulty relating to distance for the patients defined in (a).
c) Being a temporary worker, registered with the practice and employed and living on a local farm.
 
Gardenstown Branch Surgery:
 
The Review Group acknowledge the difficulties that the area has faced with regard to the delivery of primary care services. There are issues with regard to the distance to nearest community pharmacy. However this appears to be mitigated to some extent by the availability of the collection service and also by the fact that some patients are making the journey to Macduff to attend GP appointments and could access the pharmacy there if they choose to. It was noted that knowledge of the collection service was not universal and the Review Group would recommend that any such arrangements are made widely known to the residents.
 
A dispensing service is not available at this current time in Gardenstown but the review group would recommend that the Health and Social Care Partnership continue to work with the community in the planning of primary care provision within this community.  The Review group concluded that until the future provision of GP Medical Services is clarified it is not possible to assess whether there are any individual patients, or class of patients who qualify as having serious difficulty in obtaining drugs, medicines or appliances, other than scheduled drugs from a pharmacist.
 
Portlethen Medical Centre:
 
The Review Group concluded that as there is a community pharmacy co-located with the medical practice and the fact that there are community pharmacists within the surrounding areas, with good communication systems, that there are no individual patients, or class of patients who qualify has having serious difficulty in obtaining prescribed medicines and appliances from a community pharmacist.
 
The Group therefore recommends that Portlethen Medical Group is no longer required to dispense from the practice.
 
Rhynie Medical Practice:
 
The review group recommends that Rhynie Surgery should be required to continue to dispense to those patients, as individuals or those who fall within the defined qualifying class of patients who will have serious difficulty in obtaining their medication from a community pharmacist. This requirement is limited to those with serious difficulty due to:
 
a) Distance from a pharmacist. This difficulty applies to all patients registered with the practice residing within the agreed boundary of the practice but excludes those patients living in Huntly (AB548 and AB546).
b) An inadequacy of communication due to public transport provision.  Consideration included the topography of the area and the potential for weather disruption, which further exacerbates the serious difficulty relating to distance for the patients defined in (a).
 
Skene Medical Group:
 
The Review Group concluded that as there is a community pharmacy co-located with the medical practice and the fact that there are pharmacists within the surrounding areas that there are no individual patients or a qualifying class of patients who will have serious difficulty in obtaining from a pharmacist any drugs, medicines or appliances other than scheduled drugs required for treatment.
 
The Group therefore recommends that Skene Medical Practice is no longer required to dispense from the practice.
 
Udny Station Branch Surgery - Scotstown Medical Group
 
The review group recommends that Udny Station Surgery should be required to continue to dispense to individuals, and patients who fall within the definition of the qualifying class of patients, who will have serious difficulty in obtaining any drugs, medicines or appliances required for treatment from a community pharmacist. This requirement should be limited to those individual patients or those who fulfil the criteria of the qualifying class of patients who will have serious difficulty due to:
 
a) Distance from a pharmacist.  Dispensing should continue from the Udny Station surgery for those patients residing in postcode areas AB410 south of A920 and west of A90, AB419 south of A920 and west of A90 and AB210 east of A947.
b) An inadequacy of communication due to public transport provision, further exacerbates the serious difficulty relating to distance for those patients defined in (a).
 
8. When will this be discussed by Grampian NHS Board?
 
This will take place on Thursday 6 July 2017 at 10am in Committee Room 5 at Woodhill House, Westburn Road, Aberdeen AB16 5GB.
 
To access the Board papers, please click on the following links: