The Pharmaceutical Journal Vol 267 No 7177 p826
8 December 2001

Pharmaceutical Services Negotiating Committee:
How LPCs and community pharmacists can adapt to the changing NHS

The reorganisation of the National Health Service will change the relationship between contractors and health service managers, Chris Town, chief executive, North Peterborough Primary Care Trust, told the conference. "In the past, this relationship has been at arms length."

He said PCTs would have large budgets and would have the autonomy to make decisions. However, PCTs would have to demonstrate to the Government and the public that they were making the most of their budgets. "This money will be up for grabs and PCTs will use it to incentivise contractor professions to work differently. You might be threatened by this but there are real opportunities," he said.

Mr Town advised pharmacists to think about who might take on local leadership roles. "As a profession, pharmacy needs to think how it will gear up at a local level."

He said he hoped pharmacists would explore the opportunities surrounding local pharmaceutical services (LPS) schemes and not dismiss them out of hand. "Only half the rules have been written, so pharmacists can set the agenda," he said.

Mr Town thought that pharmacists should be given the right to make appropriate referrals within the National Health Service. "Patients need quick access through services, so why shouldn’t pharmacists be linked into the 0 process?"

He added that there would be a move away from individual general practitioners to primary care teams that could include a pharmacist. However, there were local challenges, as the quality of primary care varied across all the professions. Good practice was not universally accepted so systems would be needed to share it.

Local pharmaceutical committees (LPCs) and PCTs needed to work more closely. "It is up to LPCs to make themselves known to PCTs." Mr Town also advised pharmacists to make it clear to PCTs what they did and what the opportunities for pharmaceutical services were. "The agenda is so huge that you must start to lobby now. Sell your skills," he said.

Strategic health authorities

Graham Butland, chief executive, South Essex Health Authority explained that under the new NHS arrangements, the existing 95 health authorities would be replaced by 28 strategic health authorities (SHAs). "The strategic health authorities will be quite different from existing health authorities, with a different role." Attached to these SHAs will be 400 PCTs directly accountable to the SHAs. However, funds will be allocated direct to PCTs, which would be responsible for determining how to use resources for the benefit of the local population. "The only resource that SHAs will have is capital money for strategic change."

Mr Butland explained that the chief executive of each SHA would prepare an annual delivery agreement and produce a detailed franchise plan setting out how they will run the SHA. "This will give the chief executive power as it will be a public document setting out how health care services will be delivered." Mr Butland said that SHAs would be responsible for:

• Workforce confederations
• Securing public money for training
• Ensuring PCTs/trusts develop services

He added that SHAs would "contribute upwards" to resource allocation and management.

LPC representation

There would be opportunities for LPCs to feed into the strategic framework of SHAs, but it was unlikely that LPCs would have day-to-day contact with SHAs. "The key relationship for LPCs will be with PCTs," he said.

Pharmacists, therefore, needed to put pressure on SHAs to ensure that all PCTs had suitable LPC representation.

PCTs would have to work within this framework and Mr Butland predicted that they would work together to deal with certain matters collectively. "I doubt that individual PCTs will always work alone."

Mr Butland commented that the test of the health service reforms would be how much resource was allocated to involving citizens in the NHS. "There is a real tension in the system, as the public still think of the NHS as hospitals."

He predicted that SHAs would have fewer people on the permanent payroll and that they might buy in expertise as it was needed. He concluded that the reforms being made to the health service would, in the long run, change the focus of the NHS. "There is a real chance that we will modernise the service and that the public will recognise it as being beneficial to them," he said.

Medicines management and LPS

Prescribing by pharmacists is the logical end point of medicines management, said Dr Jim Smith, chief pharmaceutical officer at the Department of Health. "The obvious place for pharmacist prescribers is in specialist clinics but the profession can help write the rules." He added that he hoped to see the first pharmacist prescribers by mid-2003.

Explaining the development process for LPS contracts, Dr Smith said that pilot schemes would test new ways of contracting and a consultation paper on this was likely to be issued this year. Based on this paper, regulations would be issued in the spring with the first pilots starting late in 2002. He acknowledged that timetable was tight but said that the Department was concerned to deliver.

He explained that involvement in LPS would be voluntary but discretionary, ie, not all pharmacies would be entitled to participate. He added that an LPS contract would have to include at least some dispensing but would not be limited to this service. Contractors would have to chose between an LPS contract and the national contract but could return to the national contract if they wanted to opt out of the LPS contract. Dispensing doctors and PCTs would not be able to provide LPS, said Dr Smith. He expected schemes to involve existing contractors, although NHS trusts might also be involved.

Responding to a question on the funding of LPS contracts, Dr Smith said that there would be a reallocation of money from the global sum. Any new services built into the contract would be funded with new development funding direct from PCTs.

Dr Smith concluded by saying that the NHS wanted contractors to work collaboratively not competitively. He conceded that the business base of community pharmacy might make this difficult.