Introduction

Pharmacy in the acute independent sector

Introduction

Independent providers have been at the centre of pharmacy service provision for some considerable time. For example, Boot and Company Limited was founded in 1883 with their first pharmacist appointed in 1884 and, by 1933, there were 1000 Boots stores open. Independent hospitals also have a long history and some, such as King Edward VII’s Hospital: Sister Agnes (founded in 1899) in London, continue to operate as independent charitable hospitals today.

Since the National Health Service (NHS) was formed in 1948 there have always been independent contractors providing NHS service delivery, the most obvious examples being general practitioner services. This situation has been accepted as the norm for over 60 years, whereas the position of independent sector hospitals has not been as well integrated into the NHS over much of that period. However, there have been significant changes in the past 10 years, including greater cooperation between the NHS and independ-ent sector to maximise capacity. There have also been changes in the regu-lation of hospital services during 2010 that mean both NHS and independent sector hospitals are regulated under the same legislation, namely The Health and Social Care Act 2008¹ with the Care Quality Commission (CQC) as regulator, as discussed in Chapter 1.

In this chapter these significant changes will be reviewed under the following headings:

·        independent sector background and large hospital groups

·        independent sector and the NHS – from concordat to free choice

·        The NHS Plan and the independent sector treatment centres – NHS and independent sector

·        plurality of provision and patient choice

·        regulation of the acute independent sector – from homes to acute services

·        medicines management – delivering consistency of outcome to all service users

·        independent sector background and hospital groups.

The independent sector supports a wide range of healthcare needs, including diagnostic services, surgery, physiotherapy, assisted conception services, maternity services, oncology and palliation, as well as treatments not pro-vided by the NHS, such as cosmetic surgery.

Patients decide to use the independent sector for a variety of reasons, including ability to choose consultant or hospital, and the availability of treatments. Historically, length of waiting time was a significant issue and, whilst this has reduced, the greater flexibility to choose when to come to hospital remains attractive. Where fees are required for services these are often covered by private medical insurance, which may be through a personal policy or as a benefit of a patient’s employment. Other patients choose to pay fees directly: the proportion varies according to the market. Independent sector hospitals also provide NHS-funded treatment: this is where those commission-ing care for local populations have contracted with the independent sector to provide care. In these situations patients may choose the independent sector via the NHS patient choice scheme – no fees are paid by these NHS patients.

Independent healthcare providers are extremely diverse, ranging from single charitable hospitals to large groups of hospitals. However, all are regulated and monitored by the CQC. The larger hospital groups operating in the UK cover a wide geographical area and a wide range of procedures and treatments. The larger hospital groups include:

• BMI Healthcare, which is the largest independent provider of healthcare in the UK and has 60 hospitals. It is a division of General Healthcare Group, managed by a consortium led by the South African company Network Healthcare Holdings Limited (Netcare)

• Spire Healthcare, which has 36 hospitals in the UK and is owned by Cinven; it is a European company with large acquisitions in France, the Netherlands, Spain and the UK

• Nuffield Health, which is the UK’s leading health charity, and has 30 hospitals and, in addition, provides a network of other services, including a nationwide physiotherapy service

• Ramsey Health Care, which is an Australian healthcare group, is the fourth largest operator of private hospitals with 22 acute hospitals across the UK.

There is a focus of independent sector hospitals in and around London, and some groups, such as HCA International and Aspen Healthcare, have fewer but larger hospitals in a smaller geographical area. These hospitals may also specialise; for example, the Portland Hospital (HCA) for women and chil-dren, and the Parkside Oncology Clinic (Aspen). Further information on independent health, community care and childcare can be obtained from Laing and Buisson (http://www.laingbuisson.co.uk/).

Pharmacy service models vary in the independent sector depending on the size and specialities of the facility. Since hospitals are often much smaller than NHS trusts, the pharmacy team works more closely with the hospital senior management team, which may include a general manager and/or matron. The role of accountable officer for controlled drugs (see Chapter 5) is usually held by either the manager, who is often the registered person for the facility, or the matron.