The Pharmaceutical Journal
Vol 273 No 7325 p710
13 November 2004

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Are contractors ready for the contract?

Clare Bellingham reports a Numark audit which shows that pharmacists have much to do before next April if the new contract is approved

Contract 2005 series

All community pharmacists in England and Wales know that, subject to approval in this month’s contractors’ ballot, they will be getting a new contract next year. But there is a difference between knowing that a new contract is on the cards and being ready for it. So just how prepared are pharmacists for the new contract?

An audit conducted by Numark gives cause for concern. Admittedly the survey was carried out before the Pharmaceutical Services Negotiating Committee published its new contract book and started its programme of roadshows, but it is still a strong indicator that pharmacists have much to do before the new contract is implemented in April next year.

The audit was sent to all independent Numark members in August. At the end of October, 287 pharmacies in England and Wales (out of 810 which were sent the audit) had returned their forms and these have now been analysed. Because of the low return-rate, Numark is extending the audit until the end of this month.
The aims of the audit are to help pharmacists review how prepared they are for the contract and to help Numark identify what support its members need. But the results
reveal much more: they give insight into grass-roots opinion.

So what do contractors think of the new contract? Asked to rate the statement “I am looking forward to the new community pharmacy contract” only 10 per cent strongly agreed and 37 per cent agreed, leaving a large proportion who either disagreed or said that they had no opinion on the matter. More negative news is the fact that 88 per cent were uncertain about the impact the contract would have on their pharmacy and 82 per cent felt that they lacked information to allow them to plan for the new contract. Only 25 per cent agreed with the statement “we are ready to deliver the new contract”.

Contractors recognised that their business mix is likely to change as a result of the new contract. Average figures for present business mix are 79 per cent NHS dispensing, 2 per cent extended NHS services and 19 per cent retail services. Respondents predicted these figures would change to 70 per cent NHS dispensing, 12 per cent extended NHS services and 18 per cent retail.

Specific issues
The audit did not just ask for contractors’ opinions: it also asked specific questions about the facilities and systems that pharmacists have to put in place to meet the requirements of the new contract.

Clinical governance forms a key part of the essential services in the new contract. Pharmacists have to have standard operating procedures for dispensing operations in place by the beginning of next year. The audit found that all respondents had started the process but only 51 per cent had written them all. A similar proportion had written a standard operating procedure for recording errors and near misses.
However, few had carried out a clinical audit in the past year, with 85 per cent stating that they had not undertaken one. Half of respondents had started to make formal records of continuing professional development and 38 per cent had started training in order to provide medicines use review.

Installing a consultation area is necessary to provide advanced services under the new contract. Two-thirds of respondents have installed some form of consultation area. Of these, 18 per cent are private rooms with equipment such as a sink or couch, 26 per cent are private rooms with seating, 19 per cent are semi-private areas (eg, partitioned off) with seating and 27 per cent are semi-private without screening. This 27 per cent would not meet the requirements of the contract. The remaining few per cent were classified as “other”. Of those who currently do not have a consultation area, 34 per cent plan to refit their premises in the next year, and 88 per cent to include a consultation area.

The audit asked about the diagnostic services contractors currently offer. Blood pressure monitoring was the most popular, offered by 32 per cent of respondents. Cholesterol testing is offered by 10 per cent, diabetes testing by 16 per cent, weight measurement by 29 per cent, height measurement by 10 per cent and osteoporosis testing by none. Contractors were keen to expand their services with 62 per cent saying that they would provide more services if funding were available.

Turning to pharmacists’ relationships with other members of the primary care team, the audit found that relationships with GPs tended to be positive.

However, opinions on relationships with primary care trusts (PCTs) were split. Slightly more respondents thought that their PCT understood their role than those who did not but there was less confidence that PCTs understood pharmacists’ needs.

Respondents tended to think that their PCT did not support them in delivering new services or to reward them fairly for locally commissioned services. Asked whether their PCT had a strategy for developing community pharmacy, 60 per cent did not know, 25 per cent said that it did and 15 per cent that it did not. Three-quarters of respondents said that their PCT has a community pharmacy facilitator. Less well known was whether or not the PCT had a pharmacist on its professional executive committee: 46 per cent knew it did, 12 per cent knew that it did not and 42 per cent of respondents did not know either way.

Action plans
“From the survey, it is clear that a lot of pharmacists have not seen the implications of the new contract. It is only now that people are starting to sit up and think that April is not that far away,” says Mimi Lau, professional services controller at Numark. “Although some pharmacists already have a lot of good things in place, others need more help.”

Numark will be launching its programme of help to members this week. “The approach we are taking is breaking the contract down into manageable chunks and giving contractors timescales to carry each out,” she explains. The first topic is clinical governance.

The National Pharmaceutical Association plans to bring out a contract “survival kit” and, at last week’s PSNC conference, contractors were given an action plan (see Panel). If the contract is approved in the ballot, contractors will have four months to get ready for implementation: many will need significant support.