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Community pharmacies in England could have new contracts with the National Health Service under proposals unveiled in the NHS plan on July 27. However, pharmacists will have to wait until September to find out more details.
Paragraph 9.8 of the plan deals specifically with pharmacy. It says: "Pharmacists will be able to take on a new role as they shift from being paid mainly for the dispensing of individual prescriptions towards rewarding overall service. Proposals will be invited for personal medical services-type schemes, that pilot alternative contracts for community pharmacy services. They will cover areas such as medicines management and repeat prescribing."
Speaking at a press conference the Secretary of State for Health (Mr Alan Milburn) told The Journal that further details of the new contracts would be announced by Lord Hunt, Parliamentary Under-Secretary of State for Health with responsibility for pharmacy, in his speech to the British Pharmaceutical Conference in Birmingham on September 12.
Mr Milburn added that there was much more that pharmacists could be doing in terms of giving advice and being an immediate port of call for patients. He stressed, however, that breaking down demarcations in health care was crucial.
Personal medical services (PMS) contracts for general medical practitioners pay them on the basis of meeting set quality standards and the particular needs of local populations. GPs can work on a salaried basis, part-time or full-time, under PMS contracts. The contracts can also cover other health care professionals in a team. The GP contracts have been used to encourage the establishment of medical practices in deprived areas. The NHS plan envisages one-third of all GPs working to PMS contracts by April, 2002 [Para 8.8].
Paragraph 12.5 deals with pharmacy in relation to primary care. It says: "By 2002, all NHS Direct sites will refer people, where appropriate, to help from their local pharmacy. There will be better out-of-hours pharmacy services and a wider range of over-the-counter medicines available. By 2004, every primary care group or trust will have schemes in place so that people get more help from pharmacists in using their medicines. There will be repeat dispensing schemes nation-wide to make obtaining repeat prescriptions easier for patients with chronic conditions. These changes will speed up services and help relieve pressures on GP surgeries."
However the plan also says: "If the problem is routine, NHS Direct will offer the option of ordering the prescription and arrange for delivery to the patient's door" [Para 1.11]. NHS Direct nurses "will be in regular contact to help patients manage their medicines" [Para 1.7].
The plan says that new "one-stop" primary care centres will be built where GPs "will be working in teams from modern multipurpose premises alongside nurses, pharmacists, dentists, therapists, opticians, midwives and social care staff" [Para 1.14]. By 2004, 500 such centres are to be opened.
Investment is to be made in electronic personal medical records for patients. By 2004, 75 per cent of hospitals and 50 per cent of primary and community trusts should have implemented these [Para 4.21]. Patient-held smart cards may follow if technology permits.
Electronic prescribing of medicines is now set to happen by 2004, "giving patients faster and safer prescribing as well as easier access to repeat prescriptions" [Para 4.21]. The implementation date for electronic prescribing by GPs has slipped by two years since it was first proposed (PJ, October 3, 1998, p524).
A comprehensive smoking cessation service is to be provided on the NHS by 2001. Nicotine replacement therapy will be available on GP prescription again, with the National Institute for Clinical Excellence providing advice.
The Committee on Safety of Medicines "will be asked to consider whether nicotine replacement therapy can be made available for general sale rather than only through pharmacies or on prescription" [Para 13.18].
Scotland and WalesThe national plan launched on July 27 applies only to England. Both the Scottish Parliament and the National Assembly for Wales will be bringing out their own health strategies in the autumn. These are expected to be broadly in line with, but not identical to, the English plan. |
Health Ministers Alan Milburn (left) and John Hutton at the press conference which followed the launch of the NHS plan |