The Pharmaceutical Journal
Vol 273 No 7320 p538
9 October 2004

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UniChem

A patient-focused, primary care-led health service is finally in reach

A patient-focused and genuinely primary care-led health service could finally be in reach. So said Howard Stoate, chairman of the All Party Parliamentary Group on Primary Care and Public Health. Dr Stoate outlined a number of issues to be resolved in order for pharmacists to be able to make the most of their new opportunities.

Protected time

Pharmacists and their staff should be given protected time during the normal working day to undertake extra training for better provision of primary care services, he suggested. “This is an idea which has worked effectively in general practice and other public sector spheres,” he said. “It would require extra funding so that pharmacies could bring in temporary staff to cover absences, but the long-term benefits in terms of having a more fulfilled and better qualified workforce working in our pharmacies more than outweigh the short-term costs.”

Dr Stoate called for a clear and coherent set of national guidelines that set out what training should be made available to pharmacy staff to deliver the new services and what standards should be met. This would ensure that community pharmacists are clear about what is expected of them and it would help primary care trusts in the implementation of these services.

Access to patient records

Dr Stoate hopes the new contract will pave the way for community pharmacists to become independent prescribers in their own right. In order to achieve this, access to patient records is a major obstacle that needs to be addressed, he explained. “Health ministers have expressed a willingness to take this next step on a number of occasions, but this has not yet translated into action.” Dr Stoate acknowledged the practical difficulties that this would involve, such as the expense of providing every pharmacy with the appropriate IT facilities, but said: “This is too important an issue for the Government to baulk at. Without action on this front it will be difficult to realise the full potential of the new contract and all that comes with it.”

More PCT pharmacists

Community pharmacists should be given a greater strategic role in the management of local primary care trusts, said Dr Stoate. “At the moment it is rare to find pharmacists involved in the decision making process at PCT level and as a result they lack any real say in defining local clinical priorities.” He added that increased PCT liaison with local pharmaceutical committees would also help ensure that PCTs make the best possible use of the skills of community pharmacists. This opinion was echoed by John D’Arcy, chief executive of the National Pharmaceutical Association, who said: “For too long community pharmacy has been appearing at primary care organisations with a begging bowl, asking for the scraps left over from budgets dedicated to keeping GPs happy or to funding gold-plated signage bearing the most recent PCO name change. A pharmacist on the management committee of the primary care organisation is an absolute must.”

A matter of urgency

Mr D’Arcy warned that pharmacists should prepare for the new pharmacy business model and become more proactive as a matter of urgency. “It has to be said that performing under the old contract, while relatively labour intensive, was not, relatively speaking, an overwhelming mental challenge. The new contract will change this. Pharmacists will need to engage more formally with patients, with other health care professionals and with PCOs,” he said. “They will need to ‘pitch’ for business with PCOs for enhanced services — quite a challenge for professionals who, since 1948, have waited for the business to quite literally walk in through the door.”

Every contractor should vote “yes”

Every contractor should vote in favour of the new contract in the ballot, which is likely to be held next month, said Barry Andrews, chairman of the Pharmaceutical Services Negotiating Committee. He said that each contractor should study the proposals carefully but he reminded pharmacists: “A ‘no’ vote is a vote to continue under the old contract, which provides no security for any moneys other than the present global sum income, and no protection of purchase profit income — a vote to continue with all the perils we have today.”

Fortune favours good pharmacists

Kenneth Clarke, MP, and senior non-executive director of Alliance UniChem PLC, reminded delegates that in the new contract the emphasis will move from payment on quantity of dispensing to payment for the quality and range of services provided. He said: “Those members who successfully shift their own business and practice into extending the range and quality of their service will do much better than those who do not. [Those who do not] might even see a decline in their income if they continue to rely solely on the quantity of their NHS prescribing.”

Mr Clarke reminded delegates that it is pharmacists themselves who have brought about this change: “The changes are not being forced on the profession, but they are changes for which I have heard the profession making requests and demands for as long as I can remember.”

He acknowledged that the time has come for pharmacists to be brave and approach their PCTs to offer these services, but said: “I also have a belief that fortune should not just favour the brave, hungry, ruthless entrepreneurs, but actually, the guy who knows his job properly: the guy who wants to do a conscientious job at work, the guy who actually wants to be combining the satisfaction of a professional life where you are serving the public, with actually getting a decent return and building up a business.” He added: “To be a good pharmacist over the next few years should be quite sufficient to earn you a steadily improving income.”