 |
Further developments
Other health care initiatives set out in the White Paper include:
· Legislation to merge the Healthcare Commission and
Commission for Social Care Inspection will be brought forward
· A National Reference Group for Health and Well-being
will be established to assess the accessibility and use of evidence
base for interventions
that support health and well-being.
· Specific funding will be allocated to the creation
of an expert carers programme, similar to the expert patients programme. |
In the introduction to “Our health, our care, our say” — the
Government’s White Paper on health and social care in England — Prime
Minister Tony Blair says: “We can make better use of the skills
and experience of those working in the NHS to improve care, cut delays
and make services more convenient. We want, for example, to expand the
role of practice nurses and local pharmacists.” And, speaking at
the White Paper’s launch, Health Secretary Patricia Hewitt said
that she believed there was a significant role for pharmacists in the
new direction the Government is taking.
Pharmacy in the White Paper
The White Paper includes a section describing how the Government plans
to make “expanded use of pharmacies and extended pharmacy services” in
response to the public’s desire — expressed in the “Your
health, your care, your say” consultation exercise — for
pharmacists to have an increased role in providing support, information
and care. “Pharmacies are now offering more services than ever
before thanks to the new community pharmacy contract that was introduced
in April 2005,” it says, before describing repeat dispensing,
consultation areas and signposting as well as diabetes, blood pressure
and cholesterol clinics being run in pharmacies.
The White Paper says that healthy living services will, in future,
be provided by community pharmacies and that the management of sexually
transmitted infections should be developed and expanded in community
settings, such as Boots has been doing with chlamydia testing in some
of its London stores. It also argues that most non-surgical treatment
could take place outside acute settings, for example in a pharmacy. In
spite of these important and prominent mentions of pharmacy, there is
nothing really new or unexpected for pharmacists in the White Paper.
This should not be a particular shock, David Pruce, director of practice
and quality improvement at the Royal Pharmaceutical Society, says. “It
is not really surprising that there is nothing on top of the new community
pharmacy contract — and no real surprises — since the contract
only came into effect in April 2005.” However, he adds, the White
Paper does emphasise the Government’s desire to build on the new
contract. In fact it says that the Government will “continue to
develop the contractual arrangements for community pharmacy services
in line with the ambitions set out in this White Paper”.
“Our health, our care, our say” has four
central ambitions for primary care services — which embrace all general
practices, opticians and pharmacies within the NHS. These aims — derived
from the consultation exercise — are
to improve prevention and early intervention services, tackle inequalities
and improve access to community services, increase support for people
with long-term needs, and increase the public’s choice in and influence
on local primary care services.
The Government intends to achieve these goals through six main mechanisms:
- Practice-based commissioning and payment by results
- Shifting resources
into prevention
- Increasing the amount of care undertaken
outside hospitals
- Increasing
the integration of services at the local level
- Encouraging
innovation
- Allowing different providers to compete for
services
Pharmacy can undoubtedly benefit from, and become involved in, all six
of these mechanisms to varying degrees.
Commissioning
As NHS budgets continue to grow and the take-up of practice-based commissioning
increases, the Government expects the percentage of each primary care
trust’s budget spent outside the current secondary care sector
to rise. In fact, a target may be set, from 2008, for this shift from
secondary to primary and community care if it is decided that such
a figure is necessary for individual PCTs to drive forward this change.
However, Ms Hewitt said at the launch of the White Paper that, overall,
she wants to see 5 per cent of NHS resources shifted from secondary to
primary care over the next 10 years, with the aim of making primary and
community services more responsive to people’s needs.
Mr Pruce is keen for hospital pharmacists to make the most of this shift. “In
terms of care moving out of hospitals and into the community, what I
would like to see is that when services begin to move out from hospitals
to the community, specialist hospital pharmacists will look at how they
can support integration between primary and secondary care,” he
says.
The combination of practice-based commissioning and payment by results
will, the White Paper argues, encourage commissioners to seek out providers
who offer better quality care, particularly for those that are the most
intensive users of health care. The Government will also explore whether
there are refinements to the current tariff that could encourage co-operation
between commissioners and providers.
These changes will offer a real opportunity for pharmacy, Mr Pruce says. “The
challenge for pharmacists will be making sure they are included in practice-based
commissioning, which will be one of the most important ways in which
pharmacy can become involved”.
The Government has provided some reassurance that pharmacy will be included,
however. At the launch of the White Paper Ms Hewitt said that PCTs will
be responsible for ensuring that good governance is observed, so that
GPs are not the only ones who can take advantage of the expansion of
health care in the community through practice-based commissioning, and
that other health care practitioner — including pharmacists — are
able to benefit from the opportunities offered. Prevention
The White Paper’s key measure to improve preventive care is the
NHS “Life Check” — a revised version of the “Health
MOT” suggested by “Your health, your care, your say”.
Pharmacy could play a key role in the “Life Check”, John
D’Arcy, chief executive of the National Pharmacy Association, believes.
The NHS “Life Check” is designed to help people assess their
own risk of ill-health, particularly at critical points in their lives.
It will be based on a range of risk factors and on awareness of family
history and will be made up of an initial self-assessment — either
on an online or a paper-based form — followed by a discussion with
a health trainer for those whose initial self-assessment indicates that
they are at significant risk of poor health. The service will be developed
and evaluated in 2007, with a view to wider roll-out thereafter.
Other measures to increase preventive spending are also proposed by the
White Paper. For instance, the Government will establish an expert group
to develop definitions and measures of preventive health spending, which
will report its findings later in 2006.
For the 2008 planning round, PCT local delivery plans will have to include
clear strategies for developing preventive services, including setting
an ambitious goal for a shift of resources to prevention. From 2008,
PCTs will be assessed annually against this strategy and the case for
setting a target for the percentage shift in the share of resources spent
on prevention will also be examined. Integration and innovation
In order to achieve its ambition for community-based care, the Government
argues that innovative providers — including pharmacies — need
to work together as part of a joined-up system.
For this to happen PCTs, and their local partners, will need to ensure
all investment is used to best effect, thereby reducing stays in hospital
and supporting independent living at home, and allowing hospitals to
devote themselves to meeting the clinical needs that only they are equipped
to meet.
“
Our health, our care, our say” explains that between 20 and 30
demonstration sites will be established over the next year to test this
new approach. At these sites, leading clinicians, their teams, their
PCTs and local councils will work together to ensure that care is being
transferred and that they are not just creating a demand for new types
of
services.
An overall programme to evaluate these demonstrations will be paid for
by the Department of Health, although funding for the delivery of care
itself will continue to be provided by practices and PCTs. These demonstrations
are also designed to develop models of care provision involving multidisciplinary
teams which will help determine future workforce requirements.
In addition, “Our health, our care, our say” proposes that,
from 2007, as part of the normal commissioning process, each PCT will
be expected to develop a systematic programme to review the services
it commissions on behalf of the local population, working with practice-based
commissioners and other local partners. “PCTs will be expected
to seek the views of patients and users as an integral part of this process,” the
White Paper says.
The Government also plans to strengthen links with communities by using
individual ward councillors as advocates for communities and it will
consider options for a “community call for action” when issues
of concern to a community have not been resolved through other channels.
And there will be increased powers for the public to petition those who
provide services commissioned by PCTs — including pharmacies — to
call for improvements in service. The White Paper suggests that, when
a specified number or proportion of users petition a provider for improvements,
the provider will have to respond, within a specified time, explaining
how they will improve the service or why they cannot do so.
PCTs will also be expected to ensure services are responsive to patients’ needs. “We
expect PCTs to be robust in their management of services that do not
deliver necessary quality,” the White Paper says.
“Where there are deficiencies in service quality, PCTs will be required
to set out a clear improvement plan as part of their wider development
programme. This may include tendering for a service where standards fall
below those expected. Depending on the precise service to be provided,
new providers could include GPs, nurse practioners or pharmacists wanting
to establish or expand
services.”
Such explicit mentions of the potential role of pharmacists in the Government’s
new health and social care plans may whet the appetite of those keen
to push forward the agenda established by the new community pharmacy
contract.
However, NPA chairman, Raj Patel, warns that pharmacists must become
involved to benefit from these changes. “Community pharmacy must
be allowed to operate from a level commissioning playing field — with
community pharmacists being actively involved in priority setting and
strategic decision making at local level,” he says. Only then will
the Government’s vision of expanded use of pharmacies and extended
pharmacy services come to life. |
The
Pharmaceutical Journal