Scotland
Community pharmacists in Scotland will also be getting a new contract
in 2005 but it will differ from that in England and Wales. A
future series of articles will examine the new contract in Scotland. |
Early in 2005, community pharmacists in England and Wales will
have a new NHS contract. Although the implementation date is still to
be finalised,
January looks probable. In the run up to implementation, this series
of articles will examine each of the new services that pharmacists will
be expected to
provide under the new contract. (“Pharmacy contract” is used
to describe the new contractual framework which, as with the current
arrangements, will be national arrangements laid down in secondary legislation.)
Pharmacists’ current contract was agreed in 1987 and is now out
of step with developments in pharmacy and the NHS. The old contract focused
on throughput of a high volume of prescriptions. The new contract has
different aims: it will reward high quality services, harness the skills
of pharmacists and pharmacy staff, and provide minimum standards for
pharmacy.
Basic structure
Key points
1. Community pharmacists will be working
under the new contractual framework in early 2005
2. The new contract is focused on high quality services rather
than dispensing large volumes of prescriptions
3. The new contract is made of three tiers: essential, advanced
and enhanced services
4. All contractors will be expected to provide essential services
and eventually it is hoped that all will provide advanced services
5. Enhanced services are commissioned locally by PCTs although
a national specification for each service will be drawn up |
The new contract is formed of three tiers:
essential services, advanced services and
enhanced services.
All contractors will be expected to offer essential services. Advanced
services will
require accreditation of the pharmacist, the pharmacy premises or both.
These two tiers form the national pharmacy contract.
On top is the third tier of enhanced services. Although a service specification
and value will be agreed nationally for each
enhanced service, they will be commissioned
locally by primary care trusts.
The contract structure is expected to
develop over time, so those services currently classified as enhanced
services could be moved to either the essential or the advanced sections
of the contract.
Funding for the nationally contracted
essential and advanced services has now been agreed. In August, the Pharmaceutical
Services Negotiating Committee accepted a £1.766bn deal from the
Department of Health to fund the contract in England (PJ, 28
August, p277).
An announcement on how this sum will be distributed to individual contractors
is expected to be made next week. Funding for the contract
in Wales should also be announced imminently. Essential services
There are seven essential services. They must be provided by all community
pharmacy contractors and are not open to local negotiation.
First is dispensing. Dispensing covers the supply of medicines and
appliances, and the provision of advice about the medicines dispensed
and about possible
interactions with other medicines. It also includes making a record
of what has been dispensed and possibly the advice given (this will
be decided
within the next few weeks). The dispensing service will also include
the provision of compliance aids needed by patients with
disabilities. The next essential service is repeat dispensing. This
will operate along the lines of the repeat dispensing pilots.
Clinical governance is an essential requirement for the contract. Contractors
will be expected to ensure that standard operating procedures are used,
that adverse incidents are reported to the National Patient Safety
Agency, that continuing professional development is undertaken by pharmacists,
that
services are audited, that patient satisfaction questionnaires are
carried
out and that interventions are monitored.
Another essential service is in public health. This will include opportunistic
one-to-one counselling on smoking cessation and coronary heart disease
risk factors, promoting
vaccination against influenza and providing education about appropriate
use of antibiotics.
Signposting patients to other health care providers is also an essential
service. Linked to this is support for self-care; this essential service
will include receiving referrals from NHS Direct and provision of advice
to patients on treatment of minor ailments, thus reducing burdens on
GPs.
The final essential service is medicines waste disposal. Advanced services
The second tier of the contract is advanced services. In order to provide
them, pharmacists will have to be accredited or the pharmacy premises
will have to fulfil certain requirements. Although part of the national
contractual framework, not all contractors are likely to provide advanced
services from day one because of the additional requirements. However,
it is hoped that, in time, all contractors will provide advanced services.
There are two advanced services: medicines use review and a prescription
intervention service.
The medicines use review involves a
pharmacist undertaking a face-to-face
review with a patient. The review will be
concordance-centred and identify any problems the patient has with his
or her current medication and then address these problems. It will also
examine the patient’s knowledge of his or her medication and help
the patient to develop this knowledge. Information will then be fed back
to the patient’s GP.
The prescription intervention service is similar to the medicines use
review but is initiated differently. Instead of a planned review, the
prescription intervention service will be a review triggered by a pharmacist
identifying a significant issue with a patient’s prescription. Enhanced services
Enhanced services will be commissioned
locally by primary care trusts. A service specification and value — either
in pounds or, like the new GP contract, in points — will be agreed
nationally but PCTs will be able to vary these according to local needs.
Because enhanced services are commissioned, how many of them a particular
pharmacy provides will be determined by local needs so a definitive list
of all the enhanced services pharmacists could offer is impossible to
determine. However, some examples of enhanced services that are expected
to be commonplace are:
· Minor ailments management
· Diabetes screening
· Substance misuse services
· Coronary heart disease screening
· Disease-specific medicines management
· Palliative care services
· Emergency hormonal contraception
· Full clinical medication review (ie, “Room for Review” level
three)
· Concordance services
· Out-of-hours services
· Care home and intermediate care services
· Prescriber support services
· Domiciliary assessments
· Head lice management
· Smoking cessation service
· Gluten-free food supply service |
The
Pharmaceutical Journal