The Pharmaceutical Journal
Vol 272 No 7302 p716
5 June 2004

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Nucare

Pharmacy services must change and take account of Government agenda

The way pharmacists have traditionally delivered services needs to change to meet the needs of all stakeholders, Mahesh Shah, managing director of Nucare, said. He warned that the ways in which pharmacy might want to shape itself would be constrained by the Government’s agenda.

“Whatever we do in the future, however we might wish to change the canvass, the Government is going to have a huge influence.” He suggested that pharmacists must find ways to lobby the Government. “Without lobbying we are not going to be able to change the rules of engagement.”

Furthermore, to ensure that pharmacy effectively influences Government policy, all sectors of the industry — community pharmacies, wholesalers and manufacturers — must act together.

Mr Shah said that, at present, the focus of service delivery is on primary care. This focus was motivated by financial considerations because delivery of services via primary care is the most cost-effective solution. “This presents us with lots of opportunities.” He explained that Government policy is to broaden the provider base. “No longer does it want just doctors to provide the core services. It is seriously interested in other professionals providing that,” he added.

He pointed out that the Government was experimenting with different approaches to service delivery — for example the US Evercare model being piloted across 10 primary care trusts (PJ, 15 May, p601). This may have an impact outside the UK. “While the Government is looking across the pond to the US, the rest of Europe is looking towards the UK and trying to follow the experiments and examples set here. There is a knock-on effect with policies pursued across Europe.”

Pharmacy bodies and individual pharmacists must educate other professions about pharmacists’ training if pharmacy is to secure a place within the new service delivery models. “Doctors and nurses are largely ignorant about pharmacists’ training. That is a failing that we as a profession have. We haven’t sold our credentials properly to the decision makers.” He warned that there was a perception that pharmacy is largely commercially oriented. “[Other professions] have forgotten about our professional credentials.”

Mr Shah suggested that in the future the value of pharmacy businesses would be based on the size and quality of its client base not on turnover and prescription volume. “How many diabetics are registered with you? How many patients to you supply services related to coronary heart disease, asthma? ... I think there is going to be a huge land grab for these patients.”

He also suggested that money would follow patients with chronic diseases and that independent pharmacies would be in a good position to capitalise on this. “You are in close touch with these patients, you need to get them registered with you, get them close to you and build up your customer base. That will have a huge impact on the value of your business,” he said.

Ian Jones, professor of pharmacy practice, school of pharmacy, University of Portsmouth, said there had never been a better time for pharmacists. “The Government most certainly needs pharmacists.” However, Professor Jones warned that pharmacists underestimated their worth. “This is something in the psyche of pharmacists. We tend to think that doctors don’t value our worth but I think that they do.”

Contract imposition is a possiblity but is unlikely

Despite initial signs that the Government was not serious about negotiating a new contract, Steve Williams, chairman of the Pharmaceutical Services Negotiating Committee’s contract planning committee, said he did not believe the Government would impose a settlement on the pharmacy profession. “While they could, it would be more difficult for them to do it this time and I do not think they have any intention of imposing a deal on us at this stage.”

He explained that the profession is in a stronger negotiating position than it has been in the past. “The Government has signed up to negotiate a new contract. They agree that the PSNC needs to ballot its contractors and they accept that the PSNC needs support from those contractors.”

The Government has also entered into negotiations that are supported by an evidence base. “It has jointly funded with us the cost enquiry which has produced firm data which it has accepted. If the Government was to impose something that was totally unacceptable to contractors we could mount a serious campaign against what it has done and get significant support from all sorts of people.”

Participants at the convention raised concerns about the supplementary enhanced services being negotiated within the new contract. At the moment, how services that will fall under this category are delivered is often decided by pharmaceutical advisers within primary care trusts. “Under the new contract this must be done in a transparent and structured way, not like it is now, based on the whim of the local pharmaceutical officer,” warned Emma Hopkins from Middlesex.

Mr Williams acknowledged this concern. “That is why we have insisted that the financial security of community pharmacy is based around essential and advanced services, not around supplementary enhanced services.” He explained that both the PSNC and Government were keen on the use of pharmaceutical needs assessments — asking primary care trusts to undertake a survey of their local population to see which pharmaceutical services individual populations require.

“That way community pharmacy contractors know which services to provide — hopefully we will get away from the local preferences of pharmaceutical advisers and make it a much more systematic, knowledge- based process. That is something that the PSNC is pushing hard for.”