Society has role in standards for new contract service
The Royal Pharmaceutical Society needs to develop standards for new services offered under the new NHS contract for community pharmacy in England and Wales, said Sue Sharpe, chief executive of the Pharmaceutical Services Negotiating Committee, in an address to the Society’s October
Council meeting. Standard-setting could begin as soon as the model
service specifications for new services had been signed off by the
Department of Health.
After outlining the events that had led to the new contract, Mrs Sharpe
explained the contract’s three tiers — essential services,
advanced services and enhanced services (PJ, 18 September, p385).
She said that the advanced services tier will be the first national clinical
pharmacy service in Britain, But, as her colleague Alastair Buxton had
said, “If we get it wrong, it will be the last clinical pharmacy
service provided under the national community pharmacy contract.”
Mrs Sharpe added that there is some misunderstanding about advanced services.
They would be part of the national contract, with funding, structure
and requirements prescribed nationally. They were not for local commissioning.
If a pharmacy meets the premises accreditation requirement and the pharmacist
has his own personal accreditation, he can provide and be paid for those
services. The role of the primary care trust would be to identify its
preferred target patient groups. So, for example, a PCT could ask accredited
advanced service providers to undertake reviews of particular groups
of patients, but the pharmacy would be paid for it under the national
contract.
What the PSNC has done, said Mrs Sharpe, is to establish a dynamic contract
where, as more pharmacists become accredited to provide advanced services,
that becomes part of the standard pharmacy service. Then, as new care
roles such as pharmacy prescribing, diagnostic testing and population
screening develop, that will then become part of the advanced service
specification, which is the voluntary tier.
The key financial element of the contract is to reward quality as well
as volume —stepping on from the original concept of rewarding quality
instead of volume, and recognising that volume has its related costs.
Advanced services provides a forum in which innovators can move quickly.
Many pharmacies will be able to begin to offer advanced services early
in the life of the contract. But there will also be opportunities through
the enhanced services, the top tier, and through the way in which some
core services are offered. Pharmacists will be able to compete on quality
of service, and not simply on convenience of access.
Mrs Sharpe added that, is that the implementation programme is manageable.
The new contract is due to start early in 2005, with a period until the
autumn for adapting from old to new contract before formal measures to
secure compliance begin. Then there will be in each case a minimum period
of notice given where a contractor is felt not to be performing a core
element of the essential services.
Mrs Sharpe said that anyone who meets the advanced services accreditation
requirements and can demonstrate that he meets all the essential services
requirements will be able to proceed immediately to providing advanced
services. Within a year a substantial number of pharmacies would be providing
not just the essential service framework but the advanced services as
well.
During discussion following the presentation, Michael Schofield said
he had been involved in establishing the board that would implement the
electronic patient care record, “If you put that development alongside
the new contract then the potential is enormous,” he said.
Asked about the setting of standards for the new services, Mrs Sharpe
said that, in her view, the PSNC’s role was to agree the contractual
framework, the PCT’s role was to monitor compliance with clinical
governance requirements and the Society’s role was to set professional
standards around the services and ensure compliance. The Society’s
Code of Ethics actually set a good framework for the quality aspects
of the contract.
Gill Hawksworth said that she did not want community pharmacists to miss
out on medicines use review. She was concerned that community pharmacists
would have face-to-face access to the patient but would not initially
have access to patient records.
Mrs Sharpe said that one feature of the pace of change in the NHS was
a lack of “joined-upness”, and there were needs for adjustments.
Access to electronic health records was certainly an on-going programme.
A basis of the medicines use review at present is the pharmacist’s
knowledge and questioning of the patient as to what medicines they are
taking and how they are taking them. There is a value in that, even if
not accompanied by access to the records. The community pharmacist can
also look at the use of over-the-counter medicines, herbal products and
other health aids, which will not be in the electronic health record.
Hassan Argomandkhah asked for an assurance that the fees for enhanced
services would be standardised. Postcode differentiation in neighbouring
PCTs would not be to the benefit of public health.
Mrs Sharpe said that the aim was to set standard service specifications
and standard valuations. But because they are locally commissioned services,
no one can prevent the PCT and the local pharmaceutical committee, and
indeed the individual contractor, negotiating a departure from that and
providing their own local bespoke service.
Graham Phillips said that there had been attempts to do away with postcode
prescribing but the enhanced services in the new contract seemed to be
postcode pharmacy, because they depended on the attitude of individual
primary care organisations.
Mrs Sharpe said that there was a collision between the Government’s
policies of removing postcode prescribing and localising decision-making
level. There inevitably will be variations around the uptake of the enhanced
services by PCTs. But the dynamic nature of the contract means that a
service recognised as valuable will move from the locally commissioned
enhanced services through into the national essential or advanced services.
Answering a question from Clive Jackson, Mrs Sharpe said that in implementing
the new contract the PSNC would work closely with the Department and
those NHS institutions that survive the latest organisational throes.
Mr Jackson asked for the PSNC’s view on how the enhanced services
will fit with the developments of alternative provider medical services
and PCT-led medical services.
Mrs Sharpe said that when community pharmacists want to offer enhanced
services, they may have to compete not only with each other but with
other service providers. They will have to show that they can provide
high quality, cost-effective services.
Answering a question about accreditation, Mrs Sharpe said that the Department’s
view was that recognised academic institutions would accredit courses
and course providers. In terms of other accreditations, the PSNC wanted
to start to standardise the accreditation pathways, so that someone accredited
by one PCT does not need to undertake a different course if they move
to a new PCT area.
Gerald Alexander suggested that the Society should organise and oversee
a national programme of accreditation in conjunction with the PSNC and
other pharmacy bodies.
Mrs Sharpe said that she was not sure if she agreed with that, but she
was happy to talk to the Society about it.
Answering a question from the Vice-President, Mrs Sharpe said that major
enhanced services such as smoking cessation and supervised consumption
were already the subject of locally agreed systems. She suspected that
such services would continue until the enhanced services were negotiated
at local level. Working with the Department and the NHS Confederation,
the PSNC is well advanced with establishing model service specifications
for the major enhanced services. They will roll out with the new contract,
but uptake will be a matter for local negotiation.
The Secretary and Registrar said that it was important for the Society
to see the service specifications so that it could be involved in setting
standards.
Agreeing, Mrs Sharpe said that the PSNC expected final sign-off of the
service specifications from the Department of Health ed them to signed
off within a few days. They would then be sent to the Society. |
The
Pharmaceutical Journal