The Pharmaceutical Journal Vol 267 No 7157 p98 July 21, 2001

Articles

Providing primary care services — preparing the ground for a bid

Pharmacists interested in providing services and wishing to offer them to their local primary care organisation might find the following list of ideas and suggestions drawn up by Brian Curwain, chief pharmacist at the New Forest Primary Care Trust, a useful guide to preparing the ground and submitting a bid

1. Decide in broad terms what service you wish to offer Services you might want to offer could include, for example, a minor ailments service, an anticoagulation clinic, or a medication review service (see below). Although the local pharmaceutical committee should know of any pre-existing local initiatives, buy-in from the local primary care organisation is the most important thing at this early stage. Possible fruitful areas Possible fruitful areas for the developments of services by community pharmacists: Medicines management services Services to residential homes Domiciliary services to patients Services relating to specific conditions, eg, asthma, diabetes, hypertension Monitoring services, eg, cholesterol, warfarin, blood glucose, blood pressure, peak flow Repeat medication clinics, review clinics and concordance clinics Upper respiratory system conditions, eg, coughs, colds, sore throats Hay fever, bites and stings Minor skin conditions Gastrointestinal symptoms, eg, indigestion, constipation, diarrhoea Headache, pain relief Childhood infections, eg, headlice, worms, impetigo 2. Approach local stakeholders Local stakeholders would include practice managers, general practitioners and practice nurses, such as specialist triage, diabetic or asthma nurses. Do not overlook NHS Direct and any local NHS walk-in centres. (Details of these can be obtained from the National NHS Walk-in Centres Team; telephone Carolyn Heaney on 0113 254 6123 or Rebecca Chaloner on 0113 254 5223 for details). If you are in a locality with more than one pharmacy serving the local population and surgeries, consider acting collaboratively, if that seems appropriate. It would certainly be appropriate for a minor ailments service, because it would be more satisfactory for patients to have the same service whichever pharmacy they choose to use. Contact the local primary care group or trust pharmacist. He or she will be able to help if you need to know who to speak to locally and will also have an idea as to whether the proposed service would be supported by the PCG/T. Do not forget the patients themselves. Consult some of those whom your service is designed to benefit. Record their views. Show them how it will make things better and more convenient. 3. If the local response is positive, start to add details to the proposal Now is the time seriously to think about exactly what you propose to offer. Avoid overlapping with other services that are already being done well locally unless you have support from the relevant practitioners. 4. If possible, demonstrate that the service is needed in your locality, and that it can be done A two-week audit of your present practice in the area you propose might be a useful starting point. For example, you could record your actions and recommendations during patient consultations for the minor ailments that you propose including in your service. The number of such consultations will go some way towards demonstrating local need for the service. Avoid making records with easily-identifiable patient details. Your or the GP’s computer numbers (available from some repeat slips) would be better as systems are normally password-protected. You could record any recommendations and referrals made when discussing repeat medication with patients. Ask your local PCG/T pharmacist for advice about writing up your proposal. 5. Demonstrate your competence to deliver the service Being a pharmacist may not be enough. Do you have any training needs to bring you up to speed in the area? If so, seek the necessary training in whatever way is appropriate (consult the PCG/T pharmacist and think about industrial sponsorship of some training events). This will fit in with your personal professional development plan, which is likely to become mandatory in the near future (by 2003). 6. Demonstrate the impact you could have on surgery workloads and if possible on patient outcomes As you develop your proposed service, keep in touch with the local stakeholders. Their comments will be valuable throughout the process and it will ensure that what you propose has all-important local support. 7. Consult other pharmacists who have done similar things Learn from other pharmacists’ experiences. Read the pharmaceutical press and keep materials referring to successful projects run by community pharmacists. 8. Develop the protocols and referral criteria that you will use Show drafts of your protocols to your primary care and general practice colleagues. Modify things as required. 9. Decide how you will monitor the service and demonstrate its effectiveness At the very least you will need to record the extent of what you are doing for the PCG/T. Numbers of interventions and referrals will need to be recorded, and, in a process with various possible outcomes, they will need to be separately recorded. 10. Find out about the PCG/T planning cycle and process NHS organisations cannot give you an answer the next day. There will be a process to go through. The financial year begins in April and between Christmas and Easter there is a process called SAFF (service and financial framework) that determines the broad shape of services in an area. Small pilots may be able to be funded within a financial year but any recurrent funding will have to form part of the SAFF. Be prepared to accept a pilot to start with: it is likely to be the only option. 11. Finalise your proposal Agree tou finalised proposal with the PCG/T. Do not miss any deadlines needed for meetings. 12. Relax and wait for a good result

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