Appendix 1

Dispensing of NHS prescriptions by the Haddo Medical Group

for the population who live in and around Pitmedden

Findings of the

Review Panel convened on

Thursday 22 November 2012

Chaired by

Adam Coldwells

Executive Summary and recommendation to the Board of NHS Grampian

The Review Panel was convened to review the outcome and recommendations of the Dispensing Doctor Decision Making Group (January 2012) which reviewed the ongoing requirement for the Haddo Medical Group to continue dispensing for its patients in light of the opening of a new pharmacy in Tarves. The Review Panel has met and makes, in this report, a recommendation to Grampian NHS Board. The Board previously considered this matter in April 2012.

The Review Panel considered the written submissions from the Community Councils, RtHonAlex Salmond MSP and Mark McDonald MSP and received a verbal presentation on behalf of the Community Councils. The Review Panel has also had the opportunity to access information made available to the Dispensing Doctor Decision Making Group. The Review Panel has considered these submissions, and the challenges to the original decision posed in the context of the current regulations:

The National Health Service (General Medical Services Contracts) (Scotland) Regulations 2004, Part 3 Prescribing and Dispensing – paragraph 44 Provision of Dispensing Services relating to NHS Boards requiring GP practices to undertake dispensing for their patients

44.—(1)A contractor may secure the provision of dispensing services to its registered patients only if it is authorised or required to do so by the Health Board in accordance with this paragraph.

(2)Where the Health Board, is satisfied, after consultation with the area pharmaceutical committee, that a person, by reason of—

(a)distance;(b)inadequacy of means of communication; or(c)other exceptional circumstances,

will have serious difficulty in obtaining from a pharmacist any drugs, medicines or appliances, other than scheduled drugs, required for that person’s treatment, the Health Board shall require or authorise the contractor with whom the person is a registered patient to supply such drugs, medicines and appliances to that person until further notice.

The Review Panel considered all of the evidence presented to it and believes that the Community Councils presented new evidence which demonstrated serious difficulty by reason of inadequacy of means of communication. (Interpreted by the Review Panel around the provision of public transport for a proportion of the Pitmedden Community.)

The Review Panel recommends that the Board, in light of this new evidence, reconsiders its April 2012 decision and recommends that the Haddo Medical Group continues to dispense NHS prescriptions to its practice population with the exception of the Tarves neighbourhood, which was defined by the National Appeal Panel as the village of Tarvessurrounded on all sides by agricultural green land.
Background

This section provides a timeline of events prior to the Review Panel meeting.

  • For the vast majority of patients in NHS Grampian, medicines are prescribed by GPs (General Practitioners) and dispensed by community pharmacists (local chemists). This separation of pharmaceutical and general medical services supports safety in medicines supply and recognises that pharmaceutical services are broader than the supply of dispensed medicines. In areas where access to community pharmacy is poor the Health Board, under the General Medical Service Regulations, can require a GP practice to dispense for its patients. This is only allowed where the Health Board has agreed that patients registered with the practice have a serious difficulty in accessing prescribed medicines from a pharmacist.
  • NHS Grampian has historically required the Haddo Medical Group to provide dispensing services as it had agreed that patients using the main practice in Pitmedden and the satellite practices in Tarves and Methlick had serious difficulty in accessing prescribed medicines from a pharmacist.
  • NHS Grampian originally rejected the application for a new pharmacy in Tarves in December 2009, but that decision was overturned by the National Appeal Panel in June 2010 - available under hearings at:
  • NHS Grampian also rejected an application for a new pharmacy in Pitmedden in December 2010:
  • An appeal by the applicants for the pharmacy at Pitmedden to the National Appeal Panel was dismissed in April 2011 - available under hearings at:
  • In light of the opening of the new pharmacy at Tarves, NHS Grampian reviewed its requirement for dispensing by the Haddo Medical Group. In early 2012 Haddo Medical Group were given 12 months’ notice to cease dispensing services to registered patients living within the neighbourhood of the pharmacy, as defined by the National Appeal Panel as the village of Tarves. This cessation was in line with the NHS Grampian protocol in place at the time.
  • Soon after communication of this decision NHS Grampian received feedback from the pharmacy contractor in Tarves. This challenged the legality of using the neighbourhood of the pharmacy to define patients who no longer have serious difficulty in accessing prescribed medicines from a pharmacist. Following advice from the Central Legal Office it was agreed that NHS Grampian would revisit the decision as to which, if any, patients registered with Haddo Medical Group should continue to receive dispensing services from the GP practice. This advice confirmed that whilst in applying for an NHS community pharmacy contract there was a need to demonstrate inadequacy of services in a neighbourhood, this neighbourhood did not define the area to which the pharmacy could be deemed to provide services.
  • In revisiting the original decision NHS Grampian undertook significant stakeholder engagement. The main stakeholders – patients, public, public representatives, Independent General Practice & Independent Community Pharmacy were consulted with representations, letters and survey reports made available to the Decision Making Group. The review concluded that the new community pharmacy took away any difficulties in obtaining medicines in Tarves and that there was no serious difficulty of access to pharmaceutical services for patients living in and around Pitmedden.

4 April 2012 Board papers Item 8 available at:

4 April 2012 Board minutes available at:

  • Following the 4 April 2012 Board meeting NHS Grampian communicated its decision to the Haddo Medical Group and further definition of the boundaries of continued dispensing for patients living in and around Methlick was undertaken by Community Health Partnership representatives and the Haddo Medical Group.
  • Following the notice to discontinue dispensing for patients living in and around Tarves and Pitmedden the Haddo Medical Group, which is an independent contractor, notified NHS Grampian of its intention to close the branch surgery in Tarves. This was reluctantly supported by NHS Grampian as there was felt to be no other viable option and that whilst the geographical points of access to General Medical Services offered by the Haddo Medical Group were changing the services themselves remained the same.
  • The decision by the Haddo Medical Group to close its Tarves branch surgery is a result of the cross subsidisation of their general medical services from dispensing income. Financial support for dispensing by general practice at the request of an NHS Board was put in place to cover the additional costs of providing dispensed medicines for registered patients. Dispensing by general practice was not envisaged to provide a net financial benefit to a practice. Aberdeenshire Community Health Partnership has worked with the practice to explore the financial impact of the loss of dispensing income and associated risks to the services they provide. Unfortunately, without the additional income generated by dispensing, the practice has had to review the services it can provide in order to achieve financial balance. This has led to their decision to close the Tarves branch surgery.
  • A series of meetings took place with key stakeholders and the community following the receipt of the practice’s notification that it intended to close the branch surgery at Tarves. A meeting in September 2012, which was hosted by the Rt Hon Alex Salmond MSP and First Minister for Scotland with representatives of NHS Grampian, the community councils and the local community focused on concerns of some of those present that the Board had failed to assess serious difficulty of access appropriately and that circumstances had changed since the decision to restrict dispensing was made. NHS Grampian agreed to work with the representatives of the community, Community Councils and other interested stakeholders to clarify issues raised at the meeting. NHS Grampian agreed that the concerns raised at the meeting justified a review of the decision to restrict dispensing for patients of the Haddo Medical Group and has put in place arrangements for a review using an independent Review Panel, the outcome of which will be presented to the Board before the end of 2012.
  • NHS Grampian held a further meeting with the Rt Hon Alex Salmond MSP and representatives of the community councils in October 2012 to support the community councils in clarifying their challenge to the NHS Grampian decision to restrict dispensing by the Haddo Medical Group.
  • The Review Panel met on 22 November 2012 and the community councils were offered the opportunity to present their case to the panel meeting. The recommendations from the Review Panel are now presented to the NHS Board for final decision making. Community council representatives have also been invited to present at the Board meeting.
  • The practice has always assured the local community that residents in Tarves will have access to the full range of services delivered by Haddo Medical Group and informal feedback indicates that there have been no service problems since the Tarves branch surgery closed on 7 Sept 2012.

Review panel membership and format

This report is prepared for the December 2012 meeting of Grampian NHS Board following a Review Panel hearing convened on Thursday 22 November 2012. The Review Panel was convened at the request of the Chief Operating Officer (DrPauline Strachan) following a series of meetings between the Chief Executive (Mr Richard Carey) and a number of politicians and the local Community Councils.

The Review Panel comprised the following membership:

Mr Adam Coldwells (Chair) / General Manager, Aberdeenshire CHP and Moray CH&SCP
Dr John Reid / Area Medical Committee
Mr Ken Manson / Area Pharmaceutical Committee
Mr David Stewart / External Representative from NHS Fife
Ms Norma Urquhart / Public Representative

The Review Panel considered its remit and agreed that it was concerned only with the relevant regulations as quoted on page 2 of this report. The Review Panel was very clear that it was NOT considering the closure of the Tarves branch surgery as this was beyond its remit.

The Review Panel received four written submissions from:

  1. Mark McDonald, Regional MSP for the North East
  2. Alex Salmond, Constituency MSP for Aberdeenshire East and First Minister
  3. Co-signed submission from Brian McDougall, Secretary, Udny Community Council and Bob Davidson, Chairman, Tarves Community Council.
  4. Tamsin Morris on behalf of the Udny and Tarves Community Councils

The Review Panel also received, at its hearing on 22 November 2012, a verbal submission from the Community Council group (presented by Chris York and DavidHekelaar) to support their written submission. In addition, this allowed the panel to ask questions of the Community Council representatives.

The Review Panel agreed that a copy of this paper, prepared for the Grampian NHS Board, would be sent to all those who made a submission to the review panel at the same point that the papers are circulated to the Board members.

The Review Panel considered the written and verbal submissions, the information provided about previous decision making and the information used by the Dispensing Doctor Decision Making Group that met in January 2012.

Although the Review Panel was presented with considerable information there was one over-riding new analysis of information presented on behalf of the Community Councils which, the panel believe, demonstrated serious difficulty by reason of inadequacy of means of communication. (Interpretation of this by the panel concerned the use of public transport by a proportion of the population of Pitmedden.) The full analysis was presented to the panel.

In summary, the analysis showed likely “whole episode” times for patients to be seen by a doctor and then get their drugs dispensed (including bus times) The analysis surveyed some 450 residents and demonstrated availability of access to a car during normal working hours. All of the analysis provided likely numbers of the population (using 95% confidence intervals from the survey) who might be involved. The majority of the Review Panel believed that serious difficulty was demonstrated.

The Review Panel considered the impact of these scenarios on the population and concluded that a proportion of the population would have serious difficulty. This suggested that Haddo Medical Group should continue to dispense to its practice population in all areas except that covered by the Tarves neighbourhood.

The Review Panel considered this serious difficulty very carefully against the provision of a”twice daily delivery service” by the Tarves Pharmacy but felt that, on balance, serious difficulty was still demonstrated.

Recommendation for the Grampian NHS Board

The Review Panel therefore recommendsto Grampian NHS Board that the Haddo Medical Group continues to dispense NHS prescriptions for its practice population in all areas except that covered by the Tarves neighbourhood which was defined by the National Appeal panel as the village of Tarvessurrounded on all sides by agricultural green land.

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