This item is relevant both to the dispensing practice pre-empting a pharmacy application and for the urban, or indeed virtually any, practice which now has the opportunity to own an in-house pharmacy.

Not so very many years ago the thought of any general practitioner owning a pharmacy, let alone having one on the premises, was almost unheard of except amongst dispensing doctors fearing the loss of their dispensing rights. To them, opening a pharmacy was just another way of protecting their income from the predations of community pharmacy. It worked in some circumstances but the practice had to get the application in very quickly. Of course, as the prescriber and dispenser to their patients they were in an ideal position to know whether a pharmacy would be viable. Ask around your friends and you may come across an ex-dispensing practice which happily supplements its income from its own pharmacy.

Politics, technology and patient expectations have moved increasingly rapidly over the recent two years.

InThe NHS Plan (July 2000) the government promised to "shatter the old demarcations which...slowed down care" (9.9.5) and create "500 new one-stop primary care centres" (Page 11 and 8.8.2) and to "modernise 3000 GP premises".

But, whilst encouraging pharmacists to "take on a new role" (9.9.8) or, indeed, new roles the government, with the help of the Office of Fair Trading (OFT), dealt High Street pharmacy a potentially severe blow.

The OFT Report dealt with the regulation of pharmacies into the an NHS Pharmacy Contract. To sum up their January 2003 Report they favoured a complete free-for-all to allow pharmacies to open anywhere without regulation.

It is safe to say that community pharmacy were slightly unhappy at that proposal and asked the government for its opinion. In July 2003 the Secretary of Trade and Industry, Patricia Hewitt, returned to pharmacy with new proposals. High Street pharmacy would continue to be regulated but not pharmacies opening in developments of greater than 15,000 square metres and those in one-stop health care premises.

So, there we have it. Looking at it bluntly, the 500 new one-stop health centres create in themselves 500 opportunities for 500 practices and the modernisation of premises creates another 3000.

It must be said that the new proposals have yet to be put in place as regulations but to the swiftest come the prizes so, be prepared.

In addition to those there are the many practices which, under the new contract, are seeking to improve services to their patients by including as many services to work under their roof as possible. How silly it would be not to include a pharmacy and how exceedingly witless not to own that pharmacy themselves.

Yet another player on the block is the NHS Local Improvement and Finance Trust (LIFT) scheme. This could be as helpful as the OFT report into control of entry. Some GPs may be able to relocate into a one-stop health centre with its own pharmacy and pharmacists are already being warned that if they do not act together quickly, the lease for that pharmacy could be sold to the highest bidder.

Steve Bremner, writing in October 2003 Pharmacy Magazine said:

"NHS LIFT is one of several models for funding improvements in the primary care estate that were announced in the NHS Plan. The Government plans to invest £1 billion by 2004 and build 750 one-stop health centres by 2008. There are currently 42 designated LIFT areas, each containing between two and seven sites and 10 of these are already at the preferred bidder stage. They are mainly in areas of deprivation and cover 40 per cent of PCTs.

"In LIFT areas, a project team sets up a LIFT company (Liftco), which is 60 per cent owned by a private sector partner that is appointed to work with the local health economy for 20 years. The Liftco then has exclusive rights to tender for any new health and social care schemes within the area.

"There are other regeneration initiatives that can be used to fund primary care estate, including the Neighbourhood Renewal Fund and New Deals for Communities. Development plans can be initiated by a variety of sources and utilise a range of funding, but the PCT will coordinate operations and is a vital source of information.

"All PCTs are being encouraged to develop a Strategic Service Development Plan (SSDP), which outlines a vision for primary care in their area for the next five to 10 years and includes details of planned premises. PCTs can either work with local contractors to ensure that their SSDP includes provision for a stable pharmacy network that meets patient needs, or they can see pharmacy purely as a source of income through premises rental. The PCTs plans will depend largely on relationships with local contractors, representations made to them and the importance it places on developing pharmacy services."

Finally, there are many practices, possibly dispensing already, which, as mentioned above may see the writing on the wall and wish to pre-empt a pharmacy bid.

Despite all this there will be some GPs who ask themselves - and me - why bother? The answers to that could fill a book in their own right. In fact, I covered them in an earlier discussion on "OTC Sales".

(10/11/03)