The Pharmaceutical Journal
Vol 278 No 7445 p378-379
31 March 2007

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Pharmaceutical Services Negotiating Committee

Concern over responsible pharmacist

Representatives attending the Pharmaceutical Services Negotiating Committee’s local pharmaceutical committee conference were urged to make their views about the role of the responsible pharmacist known. “If the Department of Health senses apathy, that will probably lead to [it] shaping the regulations in a way that you do not want,” warned Sue Sharpe, chief executive of the PSNC.

Steve Lutener, PSNC head of regulation, said that the committee had still not seen draft regulations on the role of the responsible pharmacist. The Health Act 2006 introduced the concept of the responsible pharmacist but the details of this, along with changes to supervision arrangements, will be set out in regulations. The PSNC expects formal consultation on these to begin within the next few months.

Several events on the role of the responsible pharmacist have been held by NHS Primary Care Contracting this year. Mr Lutener explained that it is clear from these that the DoH intends to consult first on the role of the responsible pharmacist and then, towards the end of this year, on supervision. “I can see the rationale for separating out these two concepts but there is considerable danger in developing the role and responsibilities of the responsible pharmacist if you do not know what supervision will look like,” he said. By the time supervision is debated it will be too late to influence the role of the responsible pharmacist, he added.

Several LPC representatives expressed concerns about the Health Act. John Hewitt (Bexley, Bromley and Greenwich LPC) suggested that there is a danger it may lead to someone deciding that pharmacists no longer need to be present in community pharmacies. “I believe that the Health Act, unless we react against it, could be very bad news for pharmacy and for pharmacists,” he warned.

Mike Holden (Hampshire and Isle of Wight LPC) underlined his concern about the direction of travel and the almost pre-emptive agenda that the DoH appears to be following to move the Act forward. “If there is one thing that should bring this profession together and unite it in a single campaign, it is this Act,” he said.

Call to renegotiate ZD scheme

It should be a matter of principle that contractors should not have to dispense a product at a loss, local pharmaceutical committee representatives argued. The conference was discussing the implications of changes to the zero discount arrangements made last year (PJ, 29 April 2006, p495).

Yogendra Parmar (Lambeth, Southwark and Lewisham LPC) said that, under the new arrangements, contractors are being faced with a dilemma: dispense items at a loss or risk breaching the terms of their contract for not dispensing them in a timely manner.

“The new zero discount arrangements were imposed, it feels to me, after a perfunctory consultation period by the Department of Health and were heralded as being cost neutral to the average contractor,” he said. “This, we believe in Lambeth, Southwark and Lewisham, is certainly not the case in practice. In fact, we are hard pushed to think of any scenario in which the contractor would benefit from these new arrangements,” he added. He urged the Pharmaceutical Services Negotiating Committee to renegotiate the zero discount scheme.

Mike Dent, head of finance at the PSNC, confirmed the PSNC’s position against dispensing products at a loss and said that it reinforces this position to the Department of Health regularly. “However, it may be impossible, in a broadly market-based system, to avoid losses at all times,” he said. He emphasised that the PSNC’s profit monitoring assessment process ensures that, on average, independent contractors will receive fair funding despite possible losses on individual lines. He indicated that the PSNC has also started to look at clawback and review its level and role.

Ash Soni, a PSNC member, said that changes to the zero discount arrangements have been used by pharmaceutical companies for their own benefit. “We as contractors are the ones that are paying the price for that. It should be down to the Government to negotiate with the pharmaceutical industry, not for us to have to pay the price,” he said.

PSNC chief executive Sue Sharpe pointed out that the issues around changes to the zero discount scheme — like what happened with GlaxoSmithKline and what is currently happening with Pfizer — are an indication of weaknesses in the Pharmaceutical Price Regulation Scheme. “The PPRS was built on manufacturers having an allowable 12.5 per cent distribution margin that they could feed into the system. What has happened is that they are not doing it any more,” she said. Manufacturers are saying here is an opportunity for us to cut costs and make a quick gain, she added. “If PPRS allows, but does not require, manufacturers to put money into the scheme, then the swings and roundabouts that in the past have worked reasonably well, cease to operate,” she said.

Consider all local commissioning routes

Local pharmaceutical committee representatives were advised to consider all routes of commissioning, not just practice-based commissioning, when looking to introduce a new service. However, it was acknowledged that practice-based commissioning is the “new kid on the block”.

Gareth McCague (Leicestershire LPC) said that pharmacists need to be aware of their unique selling points when trying to win a contract through PBC.

For example, he has combined two enhanced services — one for anticoagulation monitoring and one for anticoagulation initiation. “Anticoagulation monitoring is not rocket science. There is no requirement for a unique selling point,” he explained. By combining the two services pharmacists are using their therapeutic drug monitoring expertise. “That raises the bar so high that practice nurses cannot jump over it. And it is still not going to make doctors want to do it personally.”

He added that contractors need organisations like the PSNC to provide contractual and commercial acumen and support.

Proposals for three new advanced services outlined

In his last speech as chairman of the Pharmaceutical Services Negotiating Committee, Barry Andrews highlighted some of the achievements in community pharmacy and also put forward proposals for three new advanced services that should be funded under the community pharmacy contract in England and Wales.

“Pharmacists are now providing a wider range of patient services, with a stronger clinical focus, than ever before. And they’re delivering real value to the NHS locally and nationally,” he said.

“New services are focused on helping people who have long-term conditions, and on promoting better health and healthy lifestyles among the public,” he added.

“One pharmacist told me last week that around 70 per cent of the asthma patients with whom he had carried out a medicines use review had not been taking their medicines properly. When you consider that 90 per cent of deaths from asthma are preventable by good management of the condition, and that 75 per cent of hospital admissions are avoidable, you can see just how big a difference MURs by pharmacists can make.”

Mr Andrews went on to say that he thought that pharmacists had only just started to prove what pharmacy can do for the NHS. In his view, public health is the prime focus for the future development of pharmacy services. “And that is where we want to see the next phase of service development take place,” he stated.

The three specific proposals he has for advanced services are for all community pharmacies to be commissioned to provide:

• First, a service to identify people with weight problems, indicating a risk of developing obesity-linked diseases

• Second, a national emergency hormonal contraception and chlamydia screening service, helping to tackle teenage pregnancy rates and support family planning services

• Third, a minor ailments service, improving patients’ access to treatment and building extra GP capacity to focus on higher priority issues

These services should be nationally agreed and funded, and implemented in partnership with primary care trusts locally, he emphasised. “Given the important role that community pharmacy plays in community health services, I ask all primary care trusts to ensure that their local practice-based commissioning arrangements enable community pharmacists to be service providers. Commissioners need to recognise and factor in the positive impact pharmacy can have in delivering on local health priorities.”

Mr Andrews also raised concern about the Galbraith review into control-of-entry arrangements. “Continuing uncertainty created by the series of reviews of control of entry inevitably risks casting a shadow and creating a blight on investment. We all want the regulation of pharmacy locations to be efficient and well-organised but let us not allow the review process to slow down the pace of service development.”

LPCs call for national MDS payment system

Pharmacies should be able to supply and be paid for monitored dosage systems for patients who need them, even if they do not have to be supplied to meet the requirements of disability discrimination legislation.

Proposing a motion to this effect, Gary Elton (Buckinghamshire LPC) said that this was a service that doctors, nurses and patients want. Pat Hoare (Buckinghamshire LPC) added that pharmacists should not have to explain to patients that they would not be paid for providing an MDS unless the patient satisfied a Disability Discrimination Act assessment.

“The demand is there and I want to continue to be perceived as a professional person,” Mrs Hoare said.

Two motions calling for additional services to be available from community pharmacies were accepted, as was one that would make the provision of enhanced services easier.

Stockport LPC successfully called for a national patient group direction to be introduced to allow pharmacists to provide urgently needed repeat medication and appliances without prescription and to be paid for them by the NHS; rather than have to make an emergency supply under the Medicines Act at the patient’s expense. Stockport LPC also successfully called for a national agreement that pharmacists who were accredited by one primary care trust to provide an enhanced service should have that accreditation recognised by other PCTs without further training.

A resolution put forward by Hertfordshire LPC, and which called for a minor ailments service to be developed as an advanced service, was accepted without being formally proposed.

Simon Moul (Essex LPC) successfully called for the development of a communications strategy in support of medicines use reviews. His LPC had achieved editorial coverage in local newspapers and now had opportunities to promote MURs through BBC local radio and television. Such campaigns were best conducted locally to suit local demographics, he explained.

A related motion, proposed by Terry Silverstone (Kingston, Richmond and Twickenham LPC) and calling for a heavy-hitting national television campaign, failed. Mr Silverstone argued that the cost of such a campaign would be justified because the potential total income from MURs was £100m.

Two resolutions, one from Central Lancashire LPC and the other from Kingston, Richmond and Twickenham LPC, called on the Pharmaceutical Services Negotiating Committee to continue to oppose direct-to-pharmacy distribution schemes and to press the Department of Health to seek assurances from manufacturers not to expand them until the impact of Pfizer’s scheme had been fully evaluated.

PSNC chief executive Sue Sharpe told the conference that the DoH was concerned about the potential impact of such schemes on supplies to patients, NHS costs and the Pharmaceutical Price Regulation Scheme, but that it could not intervene on competition grounds.

Other successful motions called for out-of-pocket expenses to be fully reimbursed so that no prescription had to be dispensed at a loss (Hertfordshire LPC), and for contract applications to be kept confidential by PCTs and for PCT staff who have, or who intend to have, either a personal or family interest in pharmaceutical services, to have no access to such information nor to play any part in contract decision-making (Derbyshire LPC).

David Kent (Camden and Islington LPC) failed to convince the conference that the PSNC discriminated against small contractors in the way it negotiated the distribution of remuneration.