| Target your local population! Pharmacists hear this time and
time again. But how do pharmacists recognise the needs of their local
population?
And how do they then translate this knowledge into a useful service?
Under the new pharmacy contract, pharmacists will have to negotiate services
with their local primary care organisation. Combine this with the Government’s
agenda to shift the balance of power in the NHS from the centre to primary
care trusts, and it is clear that a successful future lies in local knowledge.
What pharmacists need to think about is how to target a service at their
local population. If a service meets a local need and, even better, achieves
a primary care organisation’s target, then it is much more likely
to be funded.
Communication
Resources
· The National Pharmaceutical Association has a number of generic
resources about how to put together a business proposal and references
about the NHS. It also produces numerous toolkits about specific
services.
· The Royal Pharmaceutical Society’s clinical audit unit
has produced a number of audit templates that could be used to
determine the baseline for a service.They can be downloaded from
the audit pages in the practice
section of the Society’s
website
· The Centre for Pharmacy Postgraduate Education runs a programme
of workshops about assessing needs for pharmacy development in
public health. Further information is at www.cppe.man.ac.uk
· A guide to community pharmacy services produced by the South
East Regional Forum of LPCs can be obtained by e-mailing the forum’s
secretary (vanessa.taylor@boots.co.uk). |
Case study: Chlamydia
The importance of networks is demonstrated
by the story of how pharmacists became involved in a chlamydia
awareness screening
programme in Hull. “The programme was not reaching its target
for the number of tests carried out,” explains Hilary Edmondson
of Hull Pharmacy Development Group. “The doctor who was leading
the programme knew about the pharmacy development group so contacted
us to ask if there was a way pharmacists could help reach the target.” Now
community pharmacists supply the home test to customers. |
Case study: Smoking
Pharmacists in Havering have helped the PCT
to meet its smoking cessation target. Mohamed Kanji, pharmacist
on the professional
executive committee of the PCT, explains how pharmacists became
involved. “The PCT was struggling badly to meet its smoking
cessation target,” he says. “The PEC was considering
a proposal to recruit more specialist smoking cessation advisers
to go into workplaces. But the proposal only said that it ‘hoped’ to
reach the target: we needed something better.” So he approached
the LPC and, with the help of the PCT’s stop smoking lead,
they came up with a proposal that stated that pharmacists would
ensure that the PCT reached its smoking cessation target in 2003–04.
A small number of pharmacists already acted as smoking cessation
advisers but this was increased so pharmacists at 38 of the 43
pharmacies in the area were trained. “We also got rid of
the maximum number of smokers per pharmacist: basically pharmacists
could see as many patients as they liked,” he says. Pharmacists
offer a comprehensive four-week support service and are paid £45
for seeing each patient for five sessions. The latest smoking cessation
figures show the success of the pharmacy scheme. “The PCT
has exceeded the 2003–04 target which was double the previous
year’s target. Altogether, 1,125 people have successfully
quit after four weeks and 75 per cent of these people were seen
by pharmacists,” he says.
The pharmacy scheme is now receiving permanent funding. A patient
group direction is to be introduced and it is hoped that the five
local pharmacists not in the scheme so far will join. |
Case study: Numark
Numark has launched a new category management
system that is all about targeting the local population. It uses
demographic information
about the pharmacy’s local population, along with data on
market share, to identify the particular customer types that live
within the catchment area of the pharmacy.
Emma Betts, Numark’s category development manager, explains
that the knowledge allows pharmacists to adapt their pharmacies
to their potential customers. Five customer types have been identified
and the pharmacy is provided with information about the percentage
split between these groups. The five groups are: families on a
budget, retired and comfortable, retired and on a budget, younger
families with a bright future, and property rich and secure. At
the moment, Numark pharmacists can use this knowledge to adjust
the range of products they stock and merchandise their pharmacy
more appropriately to their customers. In the future, Numark hopes
to extend the scheme to how enhanced services can be targeted to
a particular customer base. |
Case study: Minor ailments
Sometimes pharmacists are the best people to spot a gap in service
provision. In Devon, pharmacists identified a need and reported
it to the LPC. It is now being translated into a service.
Sue Taylor, chief officer of Devon LPCs, says: “The pharmacists
told us that a lot of people come in for something to treat conjunctivitis
or impetigo and how useful it would be if they were able to supply
something for these conditions.” So she approached a PCT
and explained how allowing this to happen would reduce the pressure
on the
out-of-hours treatment centres. The PCT is now in the process of
developing a patient group direction so pharmacists will be able
to supply medicines for these conditions. |
Where do pharmacists start? The message from local pharmaceutical committees,
primary care trusts, pharmacy development groups and pharmacy organisations
is clear: it all comes down to communication. For a service to be successful,
pharmacists have first to communicate with the primary care trust,
other local pharmacists, and other local health professionals and health
agencies.
“I can’t stress how important it is at the moment for pharmacists
to get the local communication channels open,” says Tim Harrison,
joint-chairman of Northamptonshire and Heartlands Pharmacy Development
Group. “With the new pharmacy contract, it is essential that pharmacists’ voices
are heard at the local PCT. Otherwise, they might end up in a situation
where the PCT comes up with a contract that pharmacists are not happy
with. Pharmacists have to get involved early; there is no point in grumbling
about it afterwards.”
But it is not as simple as a pharmacist deciding to approach a PCT with
a service proposal. Pharmacists have got to work together. Mr Harrison
explains the historical reasons why: “When PCTs were first set
up, some multiple pharmacies approached them and said ‘we can offer
this service through our pharmacies’. The PCTs were wary of being
divisive and were keen to involve as many pharmacies as possible, not
just one particular chain. Improving communication between us all, breaking
down the mistrust between contractors and improving communication with
the PCT is critical.”
This view is backed by Mohamed Kanji, a pharmacist on the professional
executive committee of Havering PCT. “PCTs want joint proposals
that come from all pharmacists. The best way to do this is through the
PEC pharmacist and LPC,” he says.
LPCs agree. Sue Taylor, chief officer of Devon LPCs, says: “The
general principle of the PCTs here is that they wouldn’t commission
a service from an individual pharmacist. If a PCT was approached by an
individual pharmacist, it would refer him or her to the LPC.” The
approach taken by Devon LPCs is to set up liaison groups that meet regularly
with the PCTs to identify gaps in service provision and work out how
pharmacists can plug the gap. The LPCs then negotiate a service level
agreement and funding with the PCT.
So how do pharmacists choose a new service? The answer lies not with
what interests them but with what the local population needs. And, to
get funding, it has to meet the needs of the local PCT, or perhaps the
local GP practice or some other local agency.
The most important document for pharmacists to consider is the PCT local
delivery plan (LDP). Many of these are available on the internet. The
LDP is a three-year plan that sets out the priorities and targets for
the PCT. It is also worth finding out about PCTs’ public health
priorities, often published in annual reports. National priorities should
also be considered. NHS plans and strategies, and documents such as national
service frameworks can indicate the future direction of travel that services
need to fit into. On top of these, the new GP contract provides many
opportunities.
Graham Hill, professional development pharmacist for East Riding and
Hull LPC, comments: “I wouldn’t consider developing a new
service without looking at the priorities of the PCT: any new service
has to meet them.” Mr Hill has been employed in his role for nearly
four years. “Initially I put in lots of bids but many were unsuccessful
because they didn’t meet the needs of the PCT. I quickly learnt
that communication is vital. You need to talk to the PCT first rather
than putting in bids cold,” he explains.
PCTs are not the only source of funding for pharmacy services. In Devon,
a couple of GP practices have already approached pharmacists and asked
them to run services such as blood pressure monitoring under the new
GP contract. “These agreements are on a one-to-one basis between
the GP and the pharmacist so there is no need to involve the LPC or PCT.
However, it is still worth talking to the LPC or PCT because they can
provide advice on protocols, service specifications and funding levels,” says
Mrs Taylor.
Of course there is an alternative to seeking funding: charging patients.
But Mr Hill warns: “Even with charged services, you have to consider
local referral procedures.” Talking to the PCT is always a good
idea. Needs assessment
Stuart McMillan, chairman of the South East Regional LPC Forum, says
that a pharmaceutical services needs assessment has to be carried out
in every PCT and that a community pharmacist representative should
be involved in that process. This is something that NatPaCT is looking
at. The organisation is producing a needs assessment toolkit for PCTs
to help them prepare for the new community pharmacy contract (see p175).
Although it is easier for PCTs than for an individual pharmacist to
carry out such assessments, this should not stop pharmacists being
on the look-out
for gaps in service provision and then to find out if the LPC and PCT
are aware of the issue.
Claire Jones, assistant head of NHS service development at the NPA, says
that pharmacists can carry out small needs assessments based on the priorities
that the PCT has identified. “Pharmacists can use them as a lobbying
tool. They can then say to the PCT ‘I know you have identified
a gap and then locally I have carried out a needs assessment to demonstrate
the particular need for the service here’,” she explains.
Once a need has been identified, the next step is to translate it into
a service that can be delivered. The advice is not to reinvent the wheel.
Peter Magirr, who heads Sheffield’s Community Pharmacy Development
Unit, says: “There is a well-established range of schemes that
pharmacists can get off the shelf that tie in well with targets. Pharmacists
should take advantage of this material.” He adds: “It is
also a good idea to network with people already providing services.”
A resource that might be useful is a guide
to community pharmacy services produced a few months ago by the South
East Regional Forum of LPCs (PJ,
19 June, p760). It sets out working examples of services that pharmacists
could provide.
Ms Jones adds that pharmacists should ensure that any service proposal
should set out exactly how the service will help meet the PCT targets.
Mr Kanji agrees: “It is important to have a properly costed plan
that sets out exactly how the service will achieve a PCT target. It should
state who will do what and when it is going to be done by.”
The choice of services that pharmacists have the potential to provide
is enormous. “At some point, pharmacists will have to specialise,” says
Mr Hill. The key to successful specialisation is co-operation with other
pharmacists. This will be vital to ensure an even distribution of services. Other support
It is clear that having a strong, effective LPC helps pharmacists to
set up services. But there are other groups that can provide support:
pharmacy development groups for one.
Mr Harrison says that one of the strengths of his pharmacy development
group was the fact that it brought pharmacists together and this helped
to break down the barriers between them. “We now have a fantastic
dialogue between the pharmacists in the area. As an independent contractor,
I can pick the brains of the local multiple branch manager to find out
how he is offering a particular service without there being any suspicion.”
Hilary Edmondson was one of the founder members of the Hull Pharmacy
Development Group. It has been essential in assessing local needs. “We
have recently been working on a blood pressure service. Through the pharmacy
development group, we surveyed all the pharmacists in the area to find
out which are already offering this service and identified gaps in service
provision,” she says. But she believes that the group cannot work
alone: a successful network has been set up between all the local pharmacy
organisations in Hull to share information.
Sheffield’s Community Pharmacy Development Unit is funded mainly
by the local PCTs with a further contribution from the LPC. Mr Magirr
explains its role: “Pharmacists need support in change. What our
unit has tried to do is act as a resource both for pharmacists and also
for PCTs.” The unit has mapped the pharmaceutical services already
being offered in Sheffield, set out the services it would like to see
and then performed a gap analysis between the two. “It is about
having a structured approach,” he explains. “I think that
pharmacists need some sort of dedicated support infrastructure.”
Another approach has been taken by UniChem. It has set up a network of
regional pharmacy consultative boards (PCBs) at which pharmacists discuss
ideas and gain support. “In the past, pharmacists have always been
in competition and now PCTs are expecting them to work together,” says
Mike Smith, overall chairman of the PCBs. There are five UniChem PCBs
and they meet quarterly. Before each meeting, board members telephone
pharmacists in their area to find out what issues are concerning them.
The board chairmen also meet to share ideas on a national level, which
has helped to pick up differences between localities. “In some
areas pharmacists are on the PEC but in others pharmacists are discriminated
against,” he says. “In these areas we encourage pharmacists
to engage with the PCT. If they don’t, opportunities will be missed.”
The message is clear: start communicating now! It may seem that pharmacists
have been waiting for the new contract for a long time but it is fast
approaching, and those pharmacists who have not yet established good
relationships with their PCTs need to act quickly. |
The
Pharmaceutical Journal