The Pharmaceutical Journal
Vol 268 No 7184 p189
9 February 2002

Border Region meeting
The Border region of the Royal Pharmaceutical Society held an evening meeting on 24 January in Chester-le-Street, County Durham, attended by more than 120 pharmacists from all branches of the profession. Malcolm Goldie (secretary to Gateshead & South Tyneside and Sunderland local pharmaceutical committees) report

Global sum concept "rotten to the core" [more]
Changes have drained staff morale and enthusiasm [more]
Avoiding the seven deadly sins of service provision [more]

Global sum concept "rotten to the core"

The global sum concept for funding National Health Service pharmaceutical services is rotten to the core and utterly fails to provide for the present or future funding, according to Sue Sharpe, chief executive of the Pharmaceutical Services Negotiating Committee. The new contract, which had been promised by the year's end, had to refund actual NHS service costs and provide a reasonable return on investment. Hard evidence of the current situation was needed and research would be needed.

The new contract was just one of a range of pressures faced by community pharmacists. Others were the introduction of local pharmaceutical services, the delivery of new services, the threatened Office of Fair Trading survey, and difficulties in funding the service. To these had to be added the key planks of Governmental policy: clinical governance and lifelong learning; structuring a service around patients; breaking down professional barriers; and providing equity of care and confounding social inequalities.

Into this complex picture had to be added the shortage of pharmacists (and other health care professionals), under-investment in the service and the recent series of high profile health care failures (eg, Bristol). The result was a can of worms. Resolution was not an easy task, but the situation was not impossible if one kept a positive outlook and saw the difficulties as opportunities. The profession had to become a body that influenced rather than responded, engaged locally with primary care trusts, and developed alliances and partnerships.

Looking at services that might be developed. Mrs Sharpe said that structured medicine usage had to remain a priority because 50 per cent of preparations were not used properly. The PSNC-devised pilots of medicines management were to start soon.

Repeat dispensing could be developed using the concept of a "master" prescription for, say, six month's supply, dispensed monthly. But under current payment methods, the inevitable increase in prescription numbers would further lower contractors' income per script. Hence the new contract needed to address the increased responsibility of the pharmacist and not just pay for a supply role.

Out-of-hours pharmaceutical services could be provided by a deputising service, but the question of community pharmacist involvement was as yet unresolved.

The notion of pharmacists prescribing non-prescription medicines for patients on low incomes had been so successfully piloted in the area, but was feared by Government as a huge lever to increase costs.

Domiciliary visiting was desirable, but the pharmacist's absence from the pharmacy negated a major strength of the profession — accessibility. A way forward was needed.

New roles for the PSNC itself included the development of a quality framework for the new contract, the roll-out of new core roles — which had to be deliverable and not pie in the sky — and finding ways of halving the prevalence of medication errors.

On the funding of pharmaceutical services, Mrs Sharpe said that, apart from replacing the global sum concept, the immediate issues were payment for generics and control of entry.

Asked how a community pharmacist who joined a PCT professional executive committee could take a full part in its meetings, which were invariably held during working hours, Mrs Sharpe said that there was no simple answer but one possibility was to negotiate protected time, say by pharmacies not opening till 10.30am on one Wednesday a month.

Changes have drained staff morale and enthusiasm

The uncertainty of repeated change in the NHS had drained morale and enthusiasm from administrative staff, said David Flory, chief executive designate of the Northumberland, Tyneside and Wearside Strategic Health Authority. Staff needed re-energising and remotivating if the new organisation was to deliver from April next. Much needed to be accomplished before the StHA could begin its work. As yet, no other staff has been appointed but because the authority would have no more than 75 employees, half the present HA employees in the area would lose their jobs.

Early tasks included appointing key staff, defining targets and setting priorities — the foremost of which had to be the delivery of the NHS plan. The Government had set out not only what had to be achieved, but also how it was to be accomplished. The StHAs were seen as the new front-line organisations, empowered to find local solutions to problems.

The current inequalities of service delivery — which extended to standards of quality and clinical differences — were unacceptable to the StHA. People across the region had every right to expect uniform service quality. One problem was that residents were reluctant to accept treatment outside their immediate area, but if a first class service were to be put in place flexibility would be needed by all concerned to make the most efficient use of resources.

The primary care trusts would control all funding under the direction of their professional executive committees, which would be responsible for making the system work. The StHA would be responsible for performance management of what the PCTs delivered, but how they did it was their concern.

Avoiding the seven deadly sins of service provision

A warning against "seven deadly sins" that would create the conditions for service failure was given to the Border region meeting by Joe Asghar (regional pharmaceutical adviser). The seven were arrogance, denial, blame, messenger shooting, averting one's gaze, passive learning and a failure to "think systems".

During his address, Mr Asghar examined the impact on pharmaceutical services of a wide range of topics in the National Health Service. One of these topics was patient empowerment. Mr Asghar said that patients, or at least their representatives, were demanding better and better quality and were set to put increasing pressure on health professionals.

Another topics was the provision of out-of-hours services. It was not clear how this may be delivered with community pharmacist involvement. Different models would need to be examined.

Pharmacist prescribing was a topic that would run and run, but community pharmacists would eventually be integrated into the prescribing process.

The implementation of national service frameworks would see an increase in medicine expenditure, with a need for targeting. Monitoring of clinical outcomes and workforce training and skill mix would also need to be addressed.

Clinical governance was a vehicle for continuously improving the quality of patient care. An organisation-wide approach was needed that would produce local professional self-regulation and promulgate good practice and the ability to learn for failures of care. Opting out was not an option and there was a need to gain the confidence of participants.