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	The Pharmaceutical Journal Vol 271 No 7261 p174 9 August 2003	This page Reprint Photocopy
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Letters to the Editor

The new contract

Partial vision or wilful blindness?

From Mr N. Baumber, FRPharmS

I must assume that collection and delivery services and secondary dispensing, which is the integrated provision of dosage trays and support services for elderly and disabled people living at home, are rolled up and concealed in the phrase "intermediate care services". Otherwise, there is not one mention of their existence in the "Framework for a new community pharmacy contract". This simple omission demonstrates that the Department of Health does not know, or does not want to know, the extent and value of our existing services, what they cost, how they underpin all their other primary care services or how they are funded.

The new vision for community pharmacy sees "intermediate care services" as an additional service to be funded at the discretion of the primary care trusts, not an essential or an enhanced service. Unfortunately, in my part of the world, there is only wilful blindness when it comes to primary care trusts recognising the contribution of pharmacy's services and paying for them.

Having evolved from the contract to supply medicines to National Health Service patients, these two central service developments consume nearly a third of the costs in my pharmacy and are essential to the community. They are a lifeline to housebound patients and of fundamental importance to (i) the general practitioners and nurses who need rapid solutions to their problems, to (ii) social services, workers, carers, wardens and emergency response teams trying to maintain fragile people at home and to (iii) the motivation of pharmacy staff, and the operational structure and focus of a caring pharmacy. Not once has funding been offered by the NHS, so the total cost of this enormous workload is supported by community pharmacy contractors and must run close to £200m per annum.

We have no idea whether there is to be additional money made available or whether the global sum is to be recycled so that the supply contract is pressured to fund the service contract. If it is the latter, then I have to say that tampering with the existing payment mechanisms, such as reducing the dispensing fee by as little as 5 to 10 per cent, or redeploying the professional allowance, or collapsing the Drug Tariff reimbursement price of medicines, will destroy the means to a beneficial end.

We need the stability created by a central contract available to all, not the instability and inevitable bureaucracy imposed by cherry-picking PCTs that have no remit for understanding or maintaining our viability.

Noel Baumber
Grantham, Lincolnshire

ALASTAIR BUXTON, head of NHS services, Pharmaceutical Services Negotiating Committee, replies:

Mr Baumber asks whether the new contract negotiations are considering the provision of compliance aids by community pharmacies and also prescription delivery services to vulnerable patients. Both topics have been and continue to be discussed in the negotiations. The issue of compliance aids has been raised by many pharmacists at the PSNC new contract roadshows. The PSNC is discussing with the Department of Health the details of a service which will provide compliance aids to disabled patients who require help taking their medicines. This service, which is required to ensure that pharmacies are able to comply with the requirements of the Disability Discrimination Act, is likely to require some kind of patient assessment to determine the level of support required by the individual. The PSNC will continue to work to ensure that these important facets of the community pharmacy service are recognised in the new contractual framework.

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