The Pharmaceutical Journal
Vol 274 No 7349 p593
14 May 2005

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Nucare convention

Pharmacists should now consider themselves as health care providers

Pharmacists should not think of themselves as being “in the business of pharmacy” or the supply of medicines, but as being health care providers, Mahesh Shah, managing director of Nucare, told conference delegates.

“We need to act as health care providers together with other professionals,” he said, “not in a way that we are subservient to another profession, but standing shoulder to shoulder with them.” He described pharmacists as the “real alternative” to other health care providers, including GPs and nurses. “We have the knowledge, we have the skills and we can do it,” he said.

Mr Shah noted that the new pharmacy contract supports the vision of pharmacists being health care providers and that the NHS policy drivers such as competition, choice, access and Agenda for Change will enable pharmacists to expand their role into the wider health care arena.

He outlined new opportunities for pharmacists, including a greater role in public health, screening and monitoring and independent prescribing. He urged delegates to participate in the consultation on independent prescribing. “I believe that the profession can only go further if we can show our credentials as credible independent prescribers.”

Mr Shah used the analogy of an iceberg to describe the new community pharmacy contract, since part of it has been revealed but there is still a large proportion of it that remains hidden. “What are the real new monies,” he asked. “The global sum of £1.766bn looks good but realistically speaking there is only £100m of new monies. Is this adequate?”

He pointed out that the impact of the creation of Drug Tariff category M was still uncertain. “£300m is going to be taken out of profit from purchasing,” he reminded delegates, “but how do we know it will be £300m and not more? We need more transparency.”

Mr Shah also pointed out that there is potential for the contract, as it now stands, to change. For example, he said that medicines use reviews, currently an advanced service, could become an essential service in the future. “It is going to be a moving goal post,” he said. “We need to make sure that we design the provision of services to be flexible so that if there are changes we can adapt to them quickly and efficiently.”

Mr Shah outlined the barriers that independent pharmacists must overcome, such as their remuneration, and how Nucare plans to help them.

Most independent contractors believe that the rewards offered to them under the new contract are inadequate, he said. “Nucare is going to be looking at the cost of provision of services through various providers to make sure that pharmacists are paid a fair amount for providing services compared to other providers.”

Time management and delegation essential

A recurring theme during the convention was how pharmacists will find the time to deliver the services newly required of them. Several speakers noted that pharmacists must delegate more of their time-consuming tasks such as dispensing and unpacking orders.

Narinder Gogna, director of Evolve People Solutions, said that currently pharmacists spend about 50 per cent of their time doing repetitive tasks (such counting prescriptions), 40 per cent delivering patient care (talking to patients and consulting GPs) and 10 per cent on service development (usually buying issues). In order to comply with the new contract, pharmacists will need to spend just 10 per cent of their time doing the everyday tasks, 70 per cent delivering patient care and 20 per cent on service development.

Mahesh Shah, managing director of Nucare, told delegates that a cultural shift is required. “We need to have a radical shift in our mindset to provide not just dispensing services but also additional services,” he said.

Rajni Shah, of Aucklands Pharmacy, New Barnet, asked whether too much time and energy was being focused on enhanced and advanced services when most of pharmacists’ remuneration will come from essential services.

Mr Shah pointed out that services such as medicines use reviews will eventually form a substantial part of pharmacists’ revenue. “If we really want to expand what we do and be considered as health care providers we have to step out from just concentrating on essential services and look at enhanced and advanced services,” he replied. He added that at a later date advanced services will almost certainly become part of essential services.

Ted Butler, managing director of TBA/Pharmacy Management, added that enhanced services open up an additional revenue stream coming from the PCT that pharmacists should take advantage of.

Trevor Gore, pharmacy training and development manager at Reckitt Benckiser Healthcare, pointed out that PCTs are legally obliged to provide these services but are not legally obliged to get them from pharmacy. Pharmacists should therefore seize this opportunity.

Identify PCT targets

Pharmacists should engage their primary care trusts and find out what their main issues are, Ted Butler, managing director of TBA/ Pharmacy Management, told delegates.

He advised pharmacists to look at the new general medical services contract and see what criteria GPs are getting paid for.

For example, gastrointestinal medicine is not one of GPs’ 10 critical domains for payment, he said, yet many PCTs are concerned about over prescribing of products for the condition.

This represents an opportunity for pharmacy, he said, especially since many PCTs regard upper gastrointestinal problems as a minor ailment.

“Never make the assumption that PCTs know what pharmacists are capable of doing,” he warned. “Practice-based commissioning is one of the biggest opportunities that will come your way.”