|
Sue Carter: pharmacists need to work together to provide
local services |
With all the changes that have taken place in primary care over the
past few years, many pharmacists may feel that practice-based commissioning
(PBC) is one area that they have not yet got to grips with. Sue Carter,
a pharmaceutical adviser at Adur, Arun and Worthing Primary Care Trust,
is ahead of the game. She was appointed locality lead for PBC within
her PCT a year ago.
PBC is about service redesign. It is not about rationing or cost savings,
it is about developing care pathways to make sure that the right patient
has the right care in the right place at the right time, explains Mrs
Carter. Essentially the aim is to stop unnecessary referrals to hospital
and try to provide more services for patients in the community.
Collaboration
If community pharmacists are to grasp the opportunities inherent in
PBC, they may need to start collaborating on the types of services they
wish to provide, according to Mrs Carter.
Practice-based commissioners can reinvest the money they save through
reducing unnecessary hospital admissions in local services. The Department
of Health has specified that, of any resources freed against the practice
budget under practice-based commissioning, 30 per cent should be given
back to PCTs and the remaining 70 per cent can be used to commission
local services. This is where the opportunities for pharmacy will come
in.
“In the PBC-centred world, ideas will need to be about things that
affect care closer to home — things that prevent patients going to
hospital unnecessarily.” To be successful in the competitive provider
market pharmacists may have their comfort zones stretched, Mrs Carter says.
When looking at potential services, commissioners need to ensure that
there is equity of access for all patients in their locality. This means
that independent pharmacists would benefit from getting together in groups,
Mrs Carter explains. “It will be quite difficult for a single pharmacy
or a single chain to say that it will provide a service but it does not
want anyone else to do it. Pharmacies will need to work together in each
locality to provide services.”
Areas that have pharmacy development groups, or something similar, will
be in an ideal position to determine what services are needed and work
together to propose
solutions.
There are three localities within Adur, Arun and Worthing PCT and the
locality that Mrs Carter represents covers 12 practices. She spends about
one day per week on her role as PBC lead but predicts that this will
increase as PBC becomes established and the need for pharmacy input becomes
clearer.
“Much of the role so far has been working with colleagues covering
other localities, and with the director of commissioning and GP leads,
to work
out what the national guidance on PBC means for local services and processes.
It has also involved facilitating local understanding of the guidance
and local service development,” explains Mrs Carter. Referral data
A key driver for PBC is referral data. Mrs Carter says that her role
as locality lead is not dissimilar to that as pharmaceutical adviser.
A lot of the role is about influencing and changing behaviour but instead
of prescribing behaviour it is referral behaviour, she explains.It
involves collecting and analysing data from hospitals on referrals
and translating those data into information that is useful and illustrates
differences in behaviour.
“Not only is there a huge variation in referral behaviour between
different practices but there is often a variation between GPs within a
practice,” explains
Mrs Carter. The data highlight patterns that suggest a service in one
area is not as accessible as it is in another. In other words, you can
identify where a new service is needed, she explains. Comparing data
year-on-year also helps to identify areas where a service may be lacking.
For example, if data for dermatology outpatient appointments show that
they are increasing at a rate of 50 per cent per year, you may decide
that these patients could be treated as effectively by a dermatology
service provided in the community, she says.
The other way that commissioners can determine how to redesign services
is to gather intelligence from the frontline. “By talking to staff
who are close to the ground, such as pharmacists, GPs, nurses, community
nurses and social workers, you get a more useful and realistic picture
of what services are needed,” says Mrs Carter. She organises regular
meetings with these professionals, which, so far, she says, have mainly
been about coming up with ideas, getting used to new ways of working
and breaking down barriers.
The referral data and local intelligence help practices within the locality
to come up with a business plan. This plan is then used by the PCT to
commission the right level of services from hospitals.
Mrs Carter stresses that PBC is still in its infancy and community pharmacists
should not be worried if they are not yet involved in it. She advises
that, for now, they should be aware of developments, keep making relationships
with GPs and make it clear that, when the time is right, pharmacists
need to be included in service redesigns.
Resources on practice-based commissioning
· Practice-based
commissioning: achieving universal coverage.
Department of Health, January 2006
· Practice-based
commissioning: early wins and top tips. Department
of Health, February 2006
· Primary Care Contracting is publishing a series of practice-based
commissioning bulletins, which, so far, include: Preparing for
PBC; PBC and governance; and PBC and multi-professional involvement.
Bulletin 4 will focus on community pharmacy and PBC. The bulletins
are available to download from the PCC website
· The National Pharmacy Association has published guidance on PBC
for its members and local pharmacy leaders. It includes examples
of emerging models of community pharmacy engagement in East Sussex
Local Pharmaceutical Committee and Hampshire and Isle of Wight
LPC. It can be obtained by
e-mailing m.mcdonald@npa.org.uk |
|
The
Pharmaceutical Journal