| The new community pharmacy contract negotiations in England
and Wales are progressing well. With the structure and overall funding
agreed and
an announcement on distribution expected next week, implementation in
January is looking likely.
The first and second tiers of the new contract will be covered by a national
agreement. But for the third tier — which covers enhanced services — pharmacists
will have to depend entirely on primary care trusts. All enhanced services
will be commissioned by PCTs so if a PCT does not see a need for a particular
service, pharmacists will not get paid for providing it. This commissioning
role means that PCT awareness of the new contract, and of what community
pharmacy can offer, is vital. The problem is that this awareness is far
from uniform.
Sue Sharpe, the Pharmaceutical Services Negotiating Committee’s
chief executive,
acknowledged the problem earlier this month. “PCT awareness is
variable at the
moment. Although some PCTs are active in commissioning services from
community pharmacists now, others say that they do not have the funds — they
don’t see the service in terms of its value and potential to save
money elsewhere,” she said. “It will take time for PCTs to
get up and running.”
Because of these uncertainties, contractors should be reassured that
the funding for the essential and advanced services is agreed
nationally and will provide them with their essential income. But PCTs
will be more than a source of money: they will also have a role in accrediting
pharmacies (the exact
details of this are yet to be finalised).
Therefore, it is essential that PCT awareness about the new contract
is increased. Pharmacists who work within PCTs — such as on the
professional executive committee or as a pharmaceutical adviser — have
an important part to play in this. But so, too, do all pharmacists and
pharmacy organisations.
NHS Confederation guidance
This week, the NHS Confederation (which is representing PCTs in the
new pharmacy contract negotiations) tackled the problem head-on. At its
conference (see p369), it launched a guide about what PCTs should
be
doing now to prepare for the new contract. The guide was produced
in collaboration with the National Primary and Care Trust Development
Programme (NatPaCT), the Department of Health and the PSNC. It outlines
the benefits of the new contract and summarises what action needs
to
be taken now (set out in the two panels).
Benefits of the new contract
· Supports community pharmacy in becoming an integral part of
the NHS family
· Supports PCTs in meeting local needs
· Creates a source of innovation in services
· Supports the delivery of national service frameworks
· Improves the management of patients with long-term conditions
· Supports the delivery of high-quality, safe clinical services
· Helps achieve the 24–48 hour access targets
· Supports patients in self-care
· Provides access to a greater choice of services
· Ensures better value for money through encouraging quality
prescribing and reducing waste of medicines |
PCT action needed now
· Appoint an implementation lead with direct input into the primary
care contracting team
· Designate a senior executive at board level to ensure integration
across primary care services
· Appoint a community pharmacist to the professional executive
committee
· Engage with local pharmaceutical committees, pharmacy development
groups and community pharmacists
· Assess the capability and the capacity of the PCT to implement
the changes
· Conduct a pharmaceutical needs assessment using the NatPaCT
tool (PJ, 7 August, p175)
· Plan how the development of pharmaceutical services will support
the delivery of national targets and address local needs
· Incorporate new pharmacy commissioning opportunities and pharmacy
premises requirements into the strategic plans
· Highlight the implications of the new pharmacy arrangements to
other primary care practitioners and health care providers |
Chris Town, chairman of the
pharmacy contract negotiating group at the NHS Confederation, suspects
that the majority of PCTs have done little
preparation for the new contract. “But given that they implemented
the General Medical Services contract in time, they ought to have the
capacity and to have learnt significant lessons from GMS to implement
the pharmacy contract.” He recommends that key priorities for PCTs
now should be to organise a meeting about the contract with local pharmacists,
to identify a group of people within the PCT to lead the implementation
of the new contract and to think about what services could be commissioned
from community pharmacy.
Information for PCTs will not stop here. The four organisations are also
producing a series of detailed briefings which aim to help both PCTs
and community pharmacists prepare for the new contract. They will be
available in the autumn and will cover the three tiers of services, commissioning,
funding, information technology and control of entry.
Some PCTs already have structures in place to deal with the new pharmacy
contract. Heather Gray, chief pharmacist at South East Herts PCT, says: “We
have set up a
primary care contracting strategy group. It started with the GP contract
and now its role is getting wider, with the pharmacy, dental and optometry
contracts. This group takes an over-arching view in primary care.” The
role of this group is already important but, as more and more commissioning
power falls to PCTs, its importance will grow. Reporting into the over-arching
group is a pharmacy contract steering group that will carry out day-to-day
work such as needs assessments.
Needs assessments are relatively new for pharmacy. Ms Gray comments that
although a number of PCTs have undertaken surveys of existing services,
few have researched the genuine needs of the local population. “It
is about moving from the mindset of having a service here and there to
using data to find out what is needed,” she says.
But a pharmaceutical needs assessment will not guarantee new roles for
pharmacists. “We have to be up-front about the fact that it might
not be a community pharmacist who ends up providing a service,” she
says. The PCT might commission another health professional instead. But
this cuts both ways and pharmacists might take on services traditionally
provided by GPs or nurses. As one of the options that the over-arching
primary care contracting group will consider when it grants service contracts,
pharmacy will be more at the forefront of PCTs’ minds than has
been the case in the past.
Ms Gray says that implementing the new pharmacy contract will be easier
for PCTs than implementing the new GP contract. But she warns that within
some PCTs there is an attitude that pharmaceutical advisers will be able
to deal with the new contract.
This concern is echoed by Alastair Buxton, head of NHS services at the
PSNC. “The contract should be overseen by a primary care manager
not just dumped on the pharmaceutical adviser,” he says. “Pharmaceutical
advisers will be key professional advisers for the PCT but the manager
with day-to-day responsibility needs to take a wider, strategic vision
to ensure the PCT gets the most benefit out of the contract and ensures
that community pharmacists are utilised.” |
The
Pharmaceutical Journal