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GP practices face legal threat for working closely with pharmacies

Practices are being warned not to enter into any ‘special arrangements’ with a local pharmacy without first approaching all local competitors, over fears they could fall foul of a ‘minefield’ of competition regulation.

Derbyshire LMC has urged practices to protect themselves from litigation by avoiding having any special arrangements with just one or two pharmacies, for example through a prescription direction arrangement or by allowing a pharmacy to promote itself in their surgery.

The GPC has said that it agrees with the LMC’s advice and raised concerns that ‘many pharmacies’ are approaching GPs about entering into partnerships.

This comes a month after the GPC issued a warning to the Department of Health over a recent increase in prescription direction schemes. In a letter jointly signed with the Pharmaceutical Services Negotiating Committee and Pharmacy Voice, the BMA warned that influencing a patient’s choice of pharmacy had the potential to undermine patient relationships and damage trust and cooperation between healthcare professionals.

The Derbyshire LMC newsletter states: ‘If one pharmacy offers, say, a prescription collection service or buys advertising space in the practice waiting room then the practice should offer the same facilities to other pharmacies that wish to do the same and that might, in the practice’s opinion reasonably be used by its patients.’

‘The position is complex when pharmacies offer medicines management type services to practices that are over and above the services offered under the NHS pharmacy contract but, again, we advise that practices should take steps to be able to show that other pharmacies have been offered the opportunity to provide similar services to the practice’s patients and that any decisions made by the practice have been taken solely in the best interests of its patients.’

The competition watchdogs, Monitor and the Competition and Markets Authority (CMA), who investigate complaints against NHS providers and pharmacists respectively, said they were unable to offer guidance on the issue until a complaint has been lodged. A CMA spokesperson told Pulse: ‘We can’t pronounce or set guidelines on issues we haven’t investigated.’

It added: ‘If we were to receive a complaint we’d look into it but that’s certainly not the same thing as launching an investigation.’

‘Ultimately it’s the responsibility of businesses such as GPs and pharmacies to ensure they comply with competition law.’

Chair of the GPC’s prescribing committee Dr Andrew Green told Pulse: ‘Our concerns really relate to the fact that many pharmacies are approaching GPs. I know that it’s often that way, it’s the pharmacists approaching GPs, asking them to step into special arrangements. And they have to be very careful indeed about these arrangements, because patients have a completely free choice about where they take their prescriptions.’

Dr Green added: ‘You have to apply a little bit of common sense because if you work in a market town, with only two pharmacies. Then I don’t see that you would have to approach a pharmacy 40 miles away.’

‘But, certainly you shouldn’t enter into an arrangement with one of those pharmacies and not another one. The golden rule is, it’s up to the patient where they take the FP10.’

Chair of the GPC’s Contract and Regulation subcommittee Dr Robert Morley explained: ‘It is a minefield, practices should be very cautious as they could fall foul of this guidance without realising something as common as a prescription collection scheme can also be interpreted as directing the patient.’

‘Practices may well have to consider investing time and effort in offering similar arrangements to every pharmacy in their practice area’.