Meetings

PSNC

The new community pharmacy contract was the hot topic at the PSNC conference last week. Clare Bellingham reports

The Pharmaceutical Services Negotiating Committee’s community pharmacy conference was held in Manchester on 3 November. It was attended by around 800 delegates including 350 representatives from primary care trusts

Community pharmacy will be valued

Through the new contract, community pharmacy will, at last, be properly used and valued, according to Sue Sharpe, chief executive of the Pharmaceutical Services Negotiating Committee. It will be challenging but it provides great opportunities, she said. “This is a brilliant contract for patients,” she commented. “It will also work for pharmacists, who will gain greater security, greater recognition, greater use of their skills. And it will work for the NHS — helping it to use community pharmacy fully, to meet the growing demand on the NHS.”

Turning to specific issues, Mrs Sharpe said that if there is one big missed opportunity in the new national contract it is minor ailments schemes. “Minor ailment schemes across the country work. They are cost effective. GPs like them. Patients like them. We are confident they will soon become an essential service,” she said. She explained that support for self care is a role that pharmacists have provided for a long time. “The extent to which this diverts people from unnecessary use of other more costly NHS resources has never been captured. But it is of immense importance,” she commented.
On new out-of-hours arrangements for GPs, Mrs Sharpe said: “In pharmacies the impact can be seen in the increased requests for emergency supplies, as patients cannot get their repeat prescriptions.” She added: “We remain worried that the new arrangements for out-of-hours supply of medicines are making extended pharmacy opening hours quite simply unviable. Pharmacies cannot sustain the cost of opening in evenings and, in some cases on Saturdays, when there is no dispensing activity. In many areas this is set to become a real problem.”

Changes to the control of entry provisions will be implemented next year. “It would be wrong to pretend that this is welcome, particularly for contractors who face already a programme of change with this new contract,” said Mrs Sharpe. “But the Government has acted to reduce the worst impact of its earlier proposals, and we are grateful for that.” She added that repeat dispensing services will make proximity to a GP surgery less important than convenience of access.

“This contract will provide great opportunities for everyone. But its full potential will not be realised unless primary care trusts work with local pharmaceutical committees and with contractors to make it work,” stated Mrs Sharpe. “Those PCTs that have ignored or been sceptical about pharmacy services must change their approach and seek to support and work with their local pharmaceutical committee and local pharmacies. The contract will be quite demanding for them,” she said.

Why the rush?

With the ballot on the new contract closing on 22 November, Barry Andrews, PSNC chairman, said that contractors had asked him what is the rush. “The answer is the election,” he explained. “There may be a change of Government or minister. We cannot afford to take that risk; that is why there is a sense of urgency.” Before the contract can be implemented, new regulations need to be prepared and the election is likely to be held by May, but could be as early as February.

Steven Williams, chairman of the contract planning committee at the PSNC, said that decisions contractors have to start making now are when and if they want to start providing advanced services, how and when to put a consultation area in, and how and when to get accreditation. Pharmacists also need to consider IT and clinical governance.

A critical moment in pharmacy’s history

“We have reached a critical — a historic — moment,” health minister Rosie Winterton told the conference. “This is probably the most significant turning point for the NHS and for community pharmacy in the history of NHS pharmacy services.”

Ms Winterton went on to highlight some points about the new contract. “First the categorisation of services which mirrors so closely that for GPs is as sure an indication you can have of pharmacy’s integration within the NHS,” she said. “Second, the breadth and depth of services which will be open to you to provide sends the clearest possible message that community pharmacy is first and foremost a clinical health care profession, not another retail identikit.” However, she added that she wants to capitalise on pharmacists’ entrepreneurial skills to find new ways of service provision.
Another important point is about funding which she described as more transparent and more secure than the current system. “I believe [the new system] will enable you to invest with confidence for the future,” she commented. Finally, she said that there are opportunities for pharmacists to be fully paid up members of the NHS. “Pharmacists, utilising their undoubted skills to best effect, can really impact on other pressure points within the NHS. This is a message I hope NHS delegates will be taking back today.”
Patient expectations are rising and NHS services in the future have to fit these expectations, said Ms Winterton. This could be achieved through maximising the skills of NHS staff and revolutionising the way services are offered. “Pharmacy is not stuck in a time warp. It has faced up to and indeed embraced considerable change in this new millennium. Some of that was catch up because community pharmacy lagged behind other areas of primary care. It is still not as prominent as it should be,” she said. “But views and perceptions have shifted: pharmacy is increasingly recognised as an indispensable element in primary care delivery.”

Ms Winterton said that she wanted to see pharmacy use its talent in helping patients with long-term conditions, by building on what has been achieved through medicines management schemes, in treating patients with minor ailments and in supporting better use of medicines. “These illustrate what is key: community pharmacists better integrated in the NHS, working closely with other primary care professionals, using their skills to deliver quality health care services to patients.”

The NHS should promote health rather than cater for ill health, she explained. Although pharmacy has shown already how much it offers in this area, it can do more and this will be reflected in the forthcoming White Paper on public health and subsequent pharmaceutical public health strategy.

Tackling premises requirements

One of the criticisms of pharmacy made by patients, the NHS and other health professionals is that pharmacy premises are not fit for providing new services, explained Colette McCreedy, director of pharmacy practice, National Pharmaceutical Association.

In order to provide advanced services in the new contract, consultation areas will have to meet certain standards. Although the minimum specifications are having an area where two people can sit down, a high level of speech privacy and clear signposting, Ms McCreedy said that she thinks there is another to add: “It would be hard not to have a table or shelf,” she explained. In a medicines use review, somewhere to put paperwork and patients’ medicines is needed.

In terms of privacy, she commented: “It is about sound reduction not sound proofing. It is not inappropriate for people to be able to hear that a conversation is taking place so long as they cannot hear what is being said.” Neil Williamson, head of pharmacy planning at the NPA, added that acoustics engineers are currently testing a number of materials that will be used for sound reduction.

There is no requirement for a consultation area to have a door. Ms McCreedy said that an advantage of a more open structure, rather than a closed room, is that it is possible for the pharmacist to be aware of what is happening in the pharmacy during the consultation. Not having a closed room also helped to protect the pharmacist from increased risk of violence or accusations arising from a one-to-one consultation. Using glass doors or screens was suggested as another solution. “I haven’t met that many patients who want the consultation area to be closed off,” she said. Some customers prefer to talk on the shop floor but it is still important to put the facilities in place so that patients have the option. She stressed that staff need to know how to use a consultation area.

Issues around enhanced services

In order to plan enhanced services, the first thing that has to be done is a pharmaceutical needs assessment, explained Barbara Parsons, head of pharmacy practice, PSNC. Services have to be selected according to the those needs and funding identified. It is up to the local pharmaceutical committee and primary care trust to negotiate the funding. No specific funds have been made available for PCTs to commission enhanced services from pharmacies. Services should be set up according to service level agreements. In order to ensure sustainability, they need to be incorporated into PCT planning and regularly audited, she explained.

Steven Williams, chairman of the contract planning committee at the PSNC, said that it is up to PCTs and contractors to negotiate fees for enhanced services. “The idea of giving benchmarks is to try to ensure commonality. We appeal to contractors to be consistent and to adhere to the costing we have given.” But, he added, it is a competitive market and there is nothing the PSNC can do to force contractors to stick to the benchmark prices. PCTs can approach contractors directly to commission services. He hoped that commissioning would be done through LPCs.

Mr Williams explained that the contract will be reviewed every three years. This will include examining whether enhanced services should move to become advanced or enhanced services. “Should that happen, they would need to be costed and funding for them put into the global sum or money given to PCTs to give out as practice payments,” he explained.

Questions about future funding answered

Commenting on the take-up of the funding for advanced services and the introduction of IT, Steven Williams, chairman of the contract planning committee at the PSNC, said that there will be a review after six months to see how things are progressing in these areas. “Then we will see if adjustments are needed.” The limit of 200 medicines use review per pharmacy in the first year, will be raised in future years, he said.

In terms of future changes to funding, Sue Sharpe, chief executive of the PSNC, said: “Whether the annual uplift will go into increasing the dispensing fee or into a practice fee will be for review year on year.”

A threshold of dispensing 2,000 items for establishment payments is needed, explained Jeanette Howe, Department of Health. “In negotiating the new contract, we needed to ensure value for money for taxpayers, patients and the NHS, and a fair contract for pharmacy,” she said. In considering the cost of pharmacy, there is an element of fixed costs that have to be taken into account, she said.

Action plan for LPCs

Mike King, head of professional development at the PSNC, gave an action plan for LPCs:

Develop local relationships with PCTs
Ensure robust corporate governance arrangements are in place
Ensure that the local pharmacy contract implementation group involves the LPC
Have a clear strategy for the LPC’s work
Ensure resources are in place to deal with the workload
Liaise with the other local committees
Provide contractors with support when needed
Communicate efficiently with contractors
Use the local media to communicate with the public about the new contract
Work with the PCT on local needs assessments
Prepare for negotiations on enhanced services
Network with other LPCs across strategic health authorities

Lessons for LPCs from doctors’ experiences

Russell Walshaw, secretary of the joint East Yorkshire and Northern Lincolnshire Local Medical Committees, discussed the lessons local pharmaceutical committees could learn from the experiences LMCs had had with the new GP contract.

“Primary care organisations set their own priorities and are keen to get value for money,” he explained. So LMCs have needed staff to liaise with the PCOs and to persuade them to commission services. “It was a big disappointment for GPs that many enhanced services were not commissioned,” he commented. Furthermore, some existing services were stopped immediately when the new GP contract was introduced because PCTs did not want to continue commissioning them.

What lessons could LPCs learn? “First, to establish links with PCOs. Go as high up the chain as possible; insist on seeing senior officers,” he said. It is important to meet the PCO chief executive, to have regular formal meetings with the organisation and to insist that senior officers attend. “Make sure the LPC sees copies of all letters sent to contractors,” he added. Next, he suggested that LPCs should establish links with the other local committees. LPCs should recognise that PCOs need their support in introducing the new pharmacy contract.

Dr Walshaw said there are some sensitive issues between doctors and pharmacists. Under the new GP contract, it is possible for alternative providers to be funded for medical services and this could include pharmacies. Other issues are that could happen as a result of the new contracts are doctors losing dispensing patients and the new enhanced services in pharmacy encroaching on medical practice and funding. LPCs and LMCs should work together, he suggested. “We should support each other, not score points off each other,” he said. Together, LPCs and LMCs could support each other’s contracts, work closely over sensitive issues and aim for a seamless service.