| Our coverage of the British Pharmaceutical Conference continues. Clare
Bellingham reports on the new pharmacy and GP contracts (p570) and
repeat dispensing (p571). Dawn Connelly covers session on local pharmaceutical
services (p572), the Community Pharmacy Medicines Management project
(p572), chronic disease management (p573) and negligence (p574)
The greatest thing about the new community pharmacy contract is that
pharmacists will be an integral part of the NHS and part of the delivery
of primary care,
according to Chris Town, chief executive of Greater Peterborough Primary
Care Partnership. He has been involved in the negotiations of both the
new pharmacy and new GP contract on the NHS Confederation’s
negotiating team.
He believes pharmacists have got a good deal on the new contract. But
they are only at the beginning of the journey, not the end, he warned.
Certain details are still outstanding on the new GP contract and it has
been in place since April this year.
Turning to NHS modernisation in general, Mr Town said that there are
10 drivers for change: the new GP and pharmacy contracts, the European
Working Time Directive, the new IT strategy, the choice agenda, the National
Institute for Clinical Excellence, new funding flows, clinical governance,
foundation hospitals, the plurality of providers and health and social
care integration.
The population’s needs and expectations are changing, he explained. “There
has been a decrease in communicable diseases but a significant increase
in cardiovascular disease, cancer, diabetes and respiratory disease,” Mr
Town said. Furthermore, the impact of consumerism has to be considered.
“The service is starting to buckle with
increasing workload and increasing demands. We need to modernise and
transfer services,” Mr Town commented. Pharmacy contract decisions
Contractors face a number of decisions with regards to implementing
the new contract, according to Steve Williams, chairman of the contract
and planning committee at the Pharmaceutical Services Negotiating Committee.
“First, they will have to decide how and when to move to providing advanced
services,” he said. “Contractors will also have to consider
how to use skill mix to allow them to take on new roles.” On top
of this is premises improvement, ie, the addition of a consultation area. “Contractors
need to think about how to future-proof their premises; for example,
to provide some of the enhanced services a sink will be needed,” he
added. Finally, they need to consider how to cope with the introduction
of new IT systems.
Working with other health care professionals and the primary care trust
is important for implementation of the new contract, he said. “PCTs
will be carrying out a pharmaceutical needs assessment to find out what
services are needed in its area. So contractors need to understand the
findings of these assessments.” Local pharmaceutical committees
need to develop links with PCTs and find out who is managing community
pharmacy.
Hemant Patel, Vice-President of the Royal Pharmaceutical Society, asked
if there will be an assurance that no contractor will be financially
disadvantaged under the new contract. “No, I can’t make that
assurance,” said Mr Williams.
Tony Schofield: fantastic news
|
In his presentation about the reality of the new contract, Tony Schofield,
a community pharmacist in South Shields, said that he thought it was
fantastic news. “I have been wanting a new contract since I qualified
and now I wish I were 10 years younger,” he said. However, he highlighted
some current issues facing pharmacists.
Regarding control of entry, Mr Schofield has serious concerns about competition
and choice. “How long will it be before we have a judicial review
on competition and choice,” he wondered. In particular, he knows
of at least one example of a new primary care centre that would “wipe
out three or four pharmacies”. He said: “We need something
to protect those pharmacists who have been supporting patients for years.”
The new GP contract offers potential for pharmacists, Mr Schofield said. “We
know that GPs need points because they get cash for them. There are lots
of areas where pharmacists could help, in particular, in chronic disease
management.” However, the new rules on out-of-hours care will have
a big impact on pharmacists, he said. He wondered if it is worth pharmacies
opening at weekends, particularly if out-of-hours prescribers are supplying
treatment at the point of consultation. And there is another possible
outcome of the new out-of-hours arrangements: “Some GPs providing
out-of-hours services are doing so well that they are only working three
days a week. This could lead to an even bigger shortage of GPs,” he
said.
Mr Williams commented that pharmacists should not rush into closing on
Saturdays. “Saturday is a good day for other functions, such as
carrying out medicines use reviews. Pharmacists could also provide a
minor ailments service. I would like to have seen this as an essential
service but we were unsuccessful in this, so I would encourage all PCTs
to commission it,” he said. GP contract implications
“Most GPs do not see pharmacists as a threat,” according
to David Jenner, NHS Alliance lead for the new general medical services
contract.
In fact, he said that many GPs could not wait to get rid of some of the
services that will fall into the enhanced category of the new pharmacy
contract.
New contracts in primary care are about rewarding and incentivising quality
of care, he said. The key features of the new GP contract are moving
from an individual GP to a practice-based contract, ending 24-hour care
responsibility and giving GPs a significant pay rise. “Most GPs
are expecting a 30 per cent increase over three years.” Six months
in, Dr Jenner commented, the new GP contract is already costing far more
than planned.
Dr Jenner said that the GP contract has great vision but has hit problems
with implementation. Pharmacy could learn simple lessons from GPs’ experience.
First, he said, do not underestimate the task of implementing a new contract.
Second, PCTs are stretched with a huge agenda at the moment so pharmacists
should be aware of their capacity. Check the fine details on funding,
in particular how much is being ring-fenced for pharmacy. New competitors
will emerge, he warned.
Concerns were raised over PCTs having to spend larger amounts of money
than expected on the GPs’ quality and outcomes framework and that
this would lead to them being unable to fund other services. “Uptake
has been significantly high, which is regrettable from a community pharmacist’s
point of view,” commented Mr Town. |
The
Pharmaceutical Journal