Equity in the distribution of community pharmacies in England: impact of regulatory reform.
OBJECTIVE
To examine whether relaxation of control of entry regulations for community pharmacy contracts in England, introduced in 2005, affected the distribution of community pharmacies relative to population need indicators.


METHODS
Community pharmacy locations and population need indicators were used to calculate three summary measures of distributional equity across Primary Care Trust (PCT) areas (n = 152): the Gini coefficient, Atkinson Index and community pharmacies per PCT population. The indicators were adjusted for need using data from NHS GP contract Quality and Outcomes Framework disease registers, deprivation, all-cause mortality and elderly population rates.


RESULTS
Numbers of community pharmacies increased by 397 (4%) between 2005 and 2007 with three supermarket chains accounting for 152 (38%) of new pharmacies. Over one-quarter of PCTs experienced increases of 5% or more in community pharmacies per capita between 2005 and 2007. Gini and Atkinson indicators showed small increases in distributional equity across all population needs indicators.


CONCLUSIONS
Deregulation was associated with more community pharmacies per capita and a small increase in geographic equity of community pharmacy distribution at PCT level. Future research should continue to monitor how pharmacy distribution changes over time and assess the extent to which the new regulatory framework has allowed clustering of pharmacies which could result in increased inequity below PCT level.
Wagner
Andrew
A
Centre for Innovation in Practice, School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester, UK. andrew.wagner@manchester.ac.uk
Hann
Mark
M
Noyce
Peter
P
Ashcroft
Darren
D
D003157:Community Pharmacy Services / Q000331:legislation & jurisprudence*; D004739:England; D018166:Health Care Reform; D006297:Health Services Accessibility; D006801:Humans; D011320:Primary Health Care