The Pharmaceutical Journal
Vol 273 No 7321 p573
16 October 2004

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Can pharmacists rise to the challenge of chronic disease management?

The 2004 British Pharmaceutical Conference and Exhibition “Medicines: from cell to society” took place at Manchester International Convention Centre from 27–29 September

BPC 2004 summary

For the first time, chronic disease management is one of the top priorities for the NHS, said Chris Ham, from the Health Services Management Centre, University of Birmingham. Professor Ham has spent the past four years on secondment to the Department of Health, leading the work of the strategy unit and working on the NHS Improvement Plan.

There are 17.5 million people with chronic diseases in Britain, he said. “A high proportion of GP consultations, hospital admissions and accident and emergency attendances are attributed to people with these long-term conditions,” he added. In fact, 5 per cent of inpatients account for 42 per cent of acute bed day usage within the NHS. “If we can identify who these people are and we can manage and support them in the community there will be benefits for acute hospitals, and benefits in how NHS scarce resources are used, and might be used in better and different ways.”

However, it is unlikely to reduce costs, said Professor Ham. “I do not think that the driver behind this policy is cost cutting or cost reduction. It is more likely that resources will be spent in different ways,” he said.

Good chronic disease management relies on good primary care. The NHS is well placed to deliver this because it is starting from a high base, said Professor Ham. “But we know that NHS standards and NHS performance is still pretty variable.” It needs to be consistent if we are going to make further progress.

The NHS Improvement Plan puts more emphasis on service integration, with specialists working alongside generalists, including pharmacists, said Professor Ham. He added that the new contract for community pharmacists will allow more flexibility and the opportunity to provide additional and extended services to support primary care and contribute to this more integrated approach.

He then highlighted some of the challenges for implementation of the NHS Improvement Plan. They include:

· A new payment by results system in which hospitals receive a sum of money for every admission (This is an incentive to increase hospital activity rather than reduce it.)

· A risk of fragmentation (NHS foundation trusts are being set up which are based on acute trusts only; they are not integrated with chronic care providers.)

· Commissioning (A lot of chronic disease management hinges on the ability of primary care trusts to be smart commissioners and commissioning is developing slowly.)

“There is potentially a bigger role for the independent sector in taking this policy forward,” said Professor Ham. He explained that one of the Government’s objectives has been to increase the diversity and the polarity of health care providers to support the policies on access and waiting. “The Evercare pilot, an initiative of United Health Group, a US health care organisation, is one example,” he said. He added that companies like Pfizer are now becoming more involved in the area of managed care.

He concluded by saying that although chronic disease management is now on the agenda it needs to have a much higher priority across the NHS. “That priority depends on a much more integrated approach between primary and secondary care.” The question to pharmacists is: “Can you rise to the challenge that has been thrown down by the improvement plan?”