It was clear from the National Health Service plan for England that the Government was committed to changing patient's experience of the NHS and making that experience more patient-centred, Mrs CHRISTINE GLOVER (President of the Royal Pharmaceutical Society) told the conference. This meant that PDGs had to talk to primary care organisations (PCOs) — primary care groups and trusts — and other policy makers in terms of patients, not pharmacy. Moreover, they needed to understand the agenda of PCOs and make sure that any proposed services matched those agendas and could solve PCOs' problems.
Given Government commitment to NHS Direct, NHS walk-in centres, e-commerce, electronic prescribing, etc, pharmacy could not afford to stand still. Pharmacists had to broaden their thinking and learn to sell themselves. As experts in medicines, they were a vital part of the health care team. The fact that poor medicines management was a significant cause of hospital admissions had to be got across to the policy makers. And who better to improve management of medicines than pharmacists? PDGs had to be assertive, and they had make a strong case of patient benefit because that was what the Government was interested in. The policy makers could not do without pharmacists. And they needed to hear that, loud and clear.
Mr PETER STEPHENS (manager, corporate relations, IMS Health) explained how PCOs and the NHS plan would influence the way health care services were accessed and delivered. Because they combined purchasing and providing on a far wider scale than ever before, PCOs were now extremely powerful. This had several implications. For example, two thirds of PCOs had said that they would change service level agreements with health authorities in the next 12 months, and the advent of unified budgets would mean increasing flexibility in shifting money around.
Another change was that medical practices within PCOs were sharing prescribing data. More significantly, they were sharing general medical services data (ie, information on the money paid to general medical practitioners to provide services). This meant that GPs could see what other GPs were being paid for similar services in different areas. PCOs were also taking on hospital roles for the first time. As part of the NHS plan, the Government had agreed £900m for intermediate care by 2004. To put this in perspective, a King's Fund study had shown that a health authority needed a caseload of 120 patients in intermediate care to save 20 per cent of its inpatient budget. This represented real change, not just a few beds here and there.
PCOs had several pressures to conform. For example, standards laid down in the national service frameworks would be written into GP contracts, and GPs who did not fulfil them would be in breach of their terms of service. Since most GPs might be in breach in some disease areas, it was not yet clear how this would be managed.
Structures such as NHS walk-in centres, NHS Direct and nurse prescribing would affect health care delivery. NHS Direct was changing the way people accessed health care. A survey in the north-east had shown that 61 per cent of callers intended to access urgent medical care, and calling NHS Direct reduced this to 17 per cent. The intention to access general practice increased from 25 to 45 per cent and self-care increased from 14 to 38 per cent. By 2002, all call centres would have pharmacy as a disposition (point of referral) and NHS Direct would change what people wanted from pharmacy.
Moreover, a number of changes could affect delivery of medicines. For example, PCOs might buy medicines direct from manufacturers. A local health group in Wales had already been identified to pilot this, and the pharmaceutical industry was starting to offer a number of financial incentives. For example, one company had recently offered its statin to a PCG on the basis that if a certain lipid level was not achieved in the target population, the PCG could have money back. If the lipid level was achieved the PCG would pay for the drug in the normal way.
All changes had implications for pharmacists in that their role would become more clearly defined. For example, IMS data showed that only 62 per cent of the under-75s with ischaemic heart disease were prescribed aspirin, and over-the-counter sales were unlikely to be making up the rest. There was a great opportunity for pharmacists to ensure that PCOs achieved standards laid down in the NSF for coronary heart disease to the benefit of patients.
Continuing on the topic of opportunity for pharmacists, Mr DAVID PRUCE (audit development fellow, Royal Pharmaceutical Society) looked specifically at clinical governance issues. Pharmacists were good at clinical governance because it was scientific, and they therefore had a great deal to offer PCOs as well as monitoring their own services. Clinical governance featured in "Pharmacy in the future: Implementing the NHS plan "and health authorities would have to demonstrate that local frameworks for clinical governance included community pharmacy services as well as the contribution pharmacists could make to the clinical governance of other services.
A huge number of central initiatives — from national service frameworks to National Institute for Clinical Effectiveness guidelines — had to be implemented. Several of these talked about medicines, and pharmacists could help PCOs to make sure that these were implemented at the local level. Specific areas for pharmacist input included secondary prophylaxis in patients with coronary heart disease, smoking cessation and compliance in antidepressant therapy.
The Society had developed about 40 different audit templates on different areas of pharmacy practice. These were available on the Society's web page or on CD-ROM.
Review of Society’s branches |
| In parallel with the work of the pharmacy development
groups, the Royal Pharmaceutical Society was preparing to
review its branch and regional network, Dr NICOLA GRAY (a
member of the Society’s Council) told the PDG
meeting. Although the network was the envy of other
professions, there was variability across Britain. In
particular, too much work was being done by too few. One
aim of the review therefore was to reduce individual
fatigue and overload by bringing in other pharmacists. A key part of the exercise would be a series of regional meetings, facilitated by Council members and Society staff, in spring, 2001. The aim would be to review the role of the branches and regions in the light of structures that would be needed locally to undertake key functions. Every branch should send representatives because the review had to have ownership. To encourage ownership, those attending the meetings would be asked to network with colleagues locally beforehand. The idea was to obtain views on issues such as what resources were needed to enable pharmacists to make the most of local opportunities and who would provide these resources, as well as how the regions should be planned and what were useful boundaries. It was not intended to be an authoritarian exercise imposed by the Society. Although there would be areas for discussion, regions would be encouraged to forge their own identities and use resources as they thought best. |