B999 Health Trust has been set up as a social enterprise - this means that its main aim is to provide a service for the community. Any surplus income from running the phamacy will be used to support branch surgeries in the area and any additional health services. There are no shareholders and no-one will make a profit from the NHS services provided.

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The following information comes directly from NHS guidance on Government Regulations. The aim of the information is to help the public understand the application process - we leave it to you to decide whether this aim is fulfilled - we will do our best to make this information more 'people friendly' during the consultation process.

What services do Community Pharmacies provide?

It appears many people believe that the local community pharmacy (or 'chemist') is where they take their GP prescriptions to collect their medicines. However, modern community pharmacies offer a much more comprehensive range of services which are highly valued by many, but may not be recognised by those who have not had ready access to a community pharmacy e.g. those in very rural or remote areas where there has been no community pharmacy. As part of the integrated primary care team, GPs and pharmacists can be most effective in terms of providing high quality patient care when they work with each other.
Pharmacists have a wide knowledge in the science and use of medicines, and can help patients get the most from their medicines while minimising the risks associated with taking medicines particularly in relation to how certain medicines can interact with others. In addition, patients can get expert advice from a community pharmacy without the need to make a GP appointment.

The Right Medicine: A Strategy for Pharmaceutical Care in Scotland (published by the Scottish Executive in February 2002) outlined a commitment to work with the pharmacy profession to improve the public's health, provide better access to care, deliver better quality services for patients, users and carers, and develop the pharmacy profession. Four core pharmaceutical services have been introduced in response to that strategy and commitment:

Minor Ailment Service (MAS): through which certain groups of patients can register with the community pharmacy of their choice to enable them to consult with a community pharmacist for certain minor conditions direct from the pharmacy. The pharmacist advises, treats or refers the individual according to their needs.

Public Health Service (PHS): through which community pharmacy is used to support self-care and provide advice and information on health issues. This includes a smoking cessation service to help those who wish to stop smoking and a sexual health service which includes free access to Emergency Hormonal Contraception (EHC).

Acute Medication Service (AMS): this is the dispensing of acute or 'one-off' prescriptions but supported by the electronic version of the prescription, to increase patient safety, improve data collection and payment processes.

Chronic Medication Service (CMS): through which more use will be made of the professional skills of community pharmacists in the management of long-term conditions, in partnership with the patient and their GP. CMS is the final element of the new community pharmacy contract and is in the process of implementation.

The introduction of these services are part of a long term strategy to enable pharmacists to use their extensive training and skills and move focus away from just the provision of medicines towards the provision of patient centred care as part of the wider primary care team. Together these services will play an important part in shifting the balance of care by:

  • improving access for the public as they do not need an appointment to see their pharmacist for a consultation;
  • reducing unnecessary workload on GP and nursing colleagues therefore freeing up their time to see patients with more serious complaints;
  • helping to address health inequalities; and
  • making better use of the workforce by more fully utilising the skills of community pharmacists.

Applications

A 'pharmacy' can be opened by anybody, anywhere in the country. However, if someone wishes to provide NHS pharmaceutical services to the public, they can only do so with permission of the relevant NHS Board and must therefore apply to that Board to provide the services from premises they have identified. Applications to open a pharmacy to provide NHS services can be made by any individual, partnership or company, subject to the conditions specified in the Medicines Act.

When an application to open a pharmacy is made, NHS Boards are required by law to consider the application. This will require the establishment of a Pharmacy Practices Committee (PPC) to act on their behalf in considering applications. This committee is discussed further below. In considering the application, the PPC will consider the pharmaceutical services already provided in the area, the pharmaceutical services to be provided and any representations received by the Board and also any other information available which is relevant to the consideration of the application.

Under the law, the PPC consists of 7 members (a chair, three pharmacists and three non-pharmacist (lay) members) unless the application is for premises in a neighbourhood served by a dispensing doctor, in which case an additional member will be appointed by the Board from persons nominated by the Area Medical Committee ensuring wider representation on the committee. The three non-pharmacist (lay) members are entitled to vote reinforcing the independence of the decisions made. The pharmacists shall be chosen from persons nominated by each Board's Area Pharmaceutical Committee again reinforcing independence.

The "legal test"

The PPC of Boards must consider whether an application to open a community pharmacy is "necessary or desirable" in order to secure the adequate provision of NHS pharmaceutical services by persons on the pharmaceutical list in the neighbourhood in which the related premises are located.

The arrangements made by Boards with community pharmacists must comply with Regulations made under the NHS (Scotland) Act 1978. Those Regulations (the NHS (Pharmaceutical Services) (Scotland) Regulations 2009 as amended) set out the ways by which persons can apply to provide NHS pharmaceutical services and set out the terms and conditions under which those services will be provided.

It is the role of the NHS Grampian Board, to administer the arrangements set up by the 1978 Act and related Regulations. This includes a requirement that the Board must prepare lists of the persons with whom they have made arrangements for the provision of NHS pharmaceutical services and the premises from which they will provide those services. The list that Boards prepare is known as their "pharmaceutical list".

An application for inclusion in the Pharmaceutical List, is essentially an application to provide NHS pharmaceutical services from identified premises in the relevant Board's area. The procedure for consideration of applications is set out in the 2009 Regulations and is explained in more detail below. These Regulations apply only to pharmacies that wish to provide NHS pharmaceutical services; a non-NHS 'pharmacy' can be opened anywhere by anybody.

Application Process

As above, an application may only be granted if the Board's Pharmacy Practices Committee (PPC) is satisfied that it is "necessary or desirable" (See section 27(3)(c) of the 1978 Act and regulation 5(10) of the 2009 Regulations) to approve the application in order to secure the adequate provision of NHS pharmaceutical services in the neighbourhood in which the premises are located. Cases of 'minor relocation', or where a new provider applies to take over existing arrangements for the provision of services, are considered in a different way under the control of entry.

It is important to note that whilst NHS pharmaceutical services can be provided from premises selling other items and services, such other commercial aspects are not a consideration of the arrangements when NHS Boards are determining whether an application should be granted. Similarly, the effect on neighbouring pharmacies' income unless the granting of the application is likely to lead to adequacy not being secured by reason of their viability, or the presence of dispensing GP surgeries, is not a consideration. The arrangements focus on securing the adequacy of NHS pharmaceutical services from persons on the pharmaceutical list that are provided to patients in the neighbourhood and whether an application must be approved to secure adequate provision is available.
On receipt of an application to which the control of entry rules apply, the Board must first notify a number of parties about the application. The Area Medical Committee, the Area Pharmaceutical Committee and any persons already included in the pharmaceutical list whose interests might be affected if the application were granted are entitled to make representations to the Board and thereafter must be given notice of the Board's decision. If representation has been made, such persons and the applicant are entitled to appeal against the decision and those appeals are determined by an independent body - the 'National Appeal Panel' (NAP).

The NHS (Pharmaceutical Services)(Scotland) Amendment Regulations 2011 now require NHS Boards to notify a dispensing GP if there has been an application to open a pharmacy in the area within which they dispense. A Board's Area Medical Committee is the avenue for all GPs to offer any representations regarding an application and the AMC also has a subsequent right of appeal if they offer representations.

The key aspect of the application process is the legal test. The Board's PPC must consider applications in line with this 'test'. In short, this requires the PPC to:

  • Identify the boundaries of the 'neighbourhood' in which the premises named in the application are located (this will vary greatly e.g. in a city this may only be a street or two whilst in a more rural setting, it could be a whole village(s)), and particularly identify the reasons why this area constitutes a neighbourhood;
  • Consider and agree whether the current provision of NHS Pharmaceutical services from persons on the list in that neighbourhood is adequate and;
  • If the current provision is not adequate, consider and agree whether it is necessary or desirable to approve the application to secure the adequate provision of NHS pharmaceutical services in the neighbourhood.