The NHS plan for England published last week (see p182–3) promises to be of immense significance to the practice of community pharmacy. It makes clear beyond any doubt that the Government is prepared to pay for medicines management services - in other words, to pay pharmacists to help patients in a structured way to get the best out of the medicines they take. Admittedly, the national plan does not say what those medicines management services might be, but it is a safe bet that they will not be dissimilar to those that the Pharmaceutical Services Negotiating Committee, with the backing of the principal professional bodies, wants to see tried out in coronary heart disease (PJ, January 29, p187). In such services, regular meetings take place between pharmacist and patient to review treatment and identify problems, to develop a care plan and to review the progress of treatment. (As such and as we have pointed out before [PJ, April 22, p609], medicines management has the characteristics of pharmaceutical care, a practice model that is being developed in many parts of the world.)
For the time being, all that is definitely known about the Government's intentions is what is set out in a very short paragraph in the NHS plan. The Health Secreatary has promised more detail when Lord Hunt (Parliamentary Under-Secretary of State for Health) addresses the British Pharmaceutical Conference in Birmingham next month. However, we can add a little to the narrative in the short term. When Allen Tweedie (chairman of the profession's medicines management steering group) wrote to Lord Hunt recently to urge him support the medicines management trial (PJ, June 24, p940), Lord Hunt agreed that the proper management of medication was an important element in the prevention and treatment of coronary heart disease and that there was an important role for pharmacists. He made it clear that the Government was considering the proposal as part of its plans to modernise the NHS. So, it seems likely that it will be the PSNC's model that is taken forward.
The NHS plan will mark a further step in the process of switching the provision of pharmaceutical services from a commodity supply operation to a knowledge-based system where the pharmacist has the information he or she needs to manage a patient's therapy. The process started in 1986 with the Nuffield report, which urged a change in the way that pharmacists use their time in order to support them in their professional role, and continued with the Pharmacy in a New Age consultation process, which envisaged pharmacists taking the initiative in managing the medication of certain patients (Building the Future, September, 1997).
One of the key observations made by Nuffield was that remuneration systems were not neutral. They could be a powerful force for change. So, clearly, if the Government wants pharmacy to move down the medicines management/pharmaceutical care route it will have to set up appropriate reimbursement systems. There can be no doubt that the political will now exists to do this.