Dispensing GPs in England are losing dispensing market share to pharmacies; the greatest risk facing rural practices is the provision for pharmacies to offer ‘unforeseen benefits’, new NHS data for England shows.
The new report, General Pharmaceutical Services in England: 2006/07 to 2015/16, shows that dispensing GPs dispensed 84.6 million prescriptions, a marginal fall of 400,000 items or 0.5 per cent since 2014-15. Dispensing GPs’ share of the total dispensing volume of 1.087 billion items has also fallen marginally – 0.2 percentage points, to 7.8 per cent – share that has been handed directly to pharmacies.
Examination of the data shows that rural areas are most vulnerable to applications to open pharmacies that deliver ‘unforeseen benefits’ as defined by the pharmaceutical needs assessment (PNA).
During 2015-16 there were 29 applications to open pharmacies in controlled areas, of which 13 related to applications offering unforeseen benefits as defined by the PNA. Of the 29 applications received, eight (28 per cent) were granted during 2015-16; of these eight, five related to unforeseen benefits.
The unforeseen benefits provision of the NHS (Pharmaceutical Services) Regulations 2013 enables a locality to secure improvements or better access to pharmaceutical services in general, or to specific pharmaceutical services, that were not identified within the PNA. The opportunity for a pharmacy on the grounds of unforeseen benefits may arise due to changes since the PNA was published, for example new and innovative types of service delivery, or service redesign that would be of benefit to patient groups.
In granting an unforeseen benefits application, NHS England is required to consider:
- Whether there is a reasonable choice with regard to obtaining pharmaceutical services in the area
- Whether people who share a characteristic which is projected under the Equality Act 2010 (e.g., age or disability) have difficulty in accessing pharmaceutical services
- Whether the application provides an innovative approach to the delivery of pharmaceutical services
- Whether granting the application would confer significant benefits on people in the area which were not foreseen when the relevant PNA was published
- Whether it would be desirable to consider, at the same time as the applicant’s application, applications from other persons offering to secure the same improvements or better access.
The statistics, General Pharmaceutical Services in England: 2006/07 to 2015/16, also reveal an increase in the number of distance selling pharmacies – a rise of 39 to 266 and no reduction in the number of 100-hour pharmacies. There were no successful distance selling pharmacy applications in controlled areas during the year.
The document also shows that community pharmacies dispensed 995.3 million items, a rise of 1.7 per cent compared to 2014-15; they increased their share of the dispensing market directly at the expense of dispensing GPs (+0.2 percentage points) to account for 91.5 per cent of total dispensing volume in 2015-16.
During the year, the total number of pharmacies grew by eight (net) to 11,688. Of these, 4,448 are classed as independent, a fall of 0.1 per cent on 2014-15 to account for 38.1 per cent of market.
The report also documents pharmacy activity areas and shows the following:
- Average number of items per pharmacy: 7,096 – a rise of 1.6 per cent
- More pharmacies dispensing over 8,001 items per month – 33 per cent market share (+2 percentage points)
- Pharmacies more than doubled the number of EPS prescriptions dispensed: 30,175 – a rise of 122 per cent
- Increased MUR and NMS service delivery (per pharmacy average is 300 MURs (up from 292) and 87 NMS (up from 83)
- Av NIC per item: £8.13 up 2.4 per cent.
However, since 2006, average NIC per item has fallen 22 per cent (from an average NIC per item of £10.36). Factors blamed for the fall include:
- The Medicines Margin Survey resulting in adjustments to Category M generic drug reimbursement prices as agreed under the Community Pharmacy Contractual Framework
- An increase in generic dispensing rates (due to patent expiry and loss of exclusivity for a number of leading branded drugs) and the continued efforts to promote generic prescribing where clinically appropriate
- The Pharmaceutical Price Regulation Scheme (PPRS), which has resulted in a reduction in branded drug prices (with price cuts of 7.0 per cent in 2005, 3.9 per cent in 2009 and 1.9 per cent in 2010). There were automatic permitted price increases of 0.1 per cent from 1 January 2011, 0.2 per cent from 1 January 2012 and 0.2 per cent from 1 January 2013. The 2014 PPRS agreed that the drugs bill will stay flat over the first 2 years of the scheme and will grow slowly after that.