Primary Care inequity

There have been many conversations about the differences between the independent contractor contracts.

General Practice is based on capitation and the QoF related quality payments with several national and local enhanced services.

Community Pharmacy is based on a cost per item from a global sum.

When you think about this generally, a GP practice is able to earn more money if it recruits more patients or delivers better quality service. This seems totally fair.

A community pharmacy finds that when they dispense more prescriptions the cost per item goes down. If the number of prescriptions increases by 3.3%, as during 2014/15, they will dispense the increased number of prescriptions and their income stays the same.

Going forward General Practice is expecting a 4% increase in their income. Community Pharmacy is expecting at least a 6% fall in the global sum. Should prescription numbers increase by the predicted 5% then this represents 5% more work for 6% less money.

GP practices have support for their premises, and we are led to believe, there will be an additional fund to support practices which need to expand. Whether this is notional rent reimbursements if the practice owns their premises or leasehold rent reimbursements, if they rent their premises or borrowing cost reimbursements if the practice have a mortgage or a loan to pay back. This gives General Practice a safety net in this time of increasing property values and in the future if interest rates increase.

Community Pharmacy has no such arrangement. A pharmacist not far from me has just had a rent review. His rent is to increase from £35k a year to £70k a year. This, in association with the planned reduction in global sum, makes his business unviable. So he is closing. That’s it finished – moving on – trying to salvage as much of his livelihood as possible. Patients will be confused having to find a different pharmacy to get their prescriptions and advice from and, no doubt, the local GP practices will pick up the flack and some extra work. I hope that the street within this deprived community survives losing a major presence – I suspect that it won’t.

If this same situation occurred in General Practice, the practice would complete a rent review memorandum and call in the District Valuer. Together they will agree the new rent and repayment to minimise or negate the impact on the Practice.

As a member of the public I don’t think that this is fair. But obviously the Government and NHS England does. What do you think?



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