The Pharmaceutical Journal
Vol 278 No 7449 p496, 501
28 April 2007

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AAH Pharmaceuticals convention

Embrace opportunities available in order to work with foundation trusts

Many of the principles of the legislation around foundation trusts mirror those used in community pharmacies, Patrick Geoghegan, chief executive of South Essex Partnership NHS Foundation Trust, told the conference. Pharmacists should, therefore, embrace the opportunities available to work with them, he argued.

“First, it’s about being patient-focused. That’s what you are,” he said. “It’s about choice. You offer people choices. It’s about involvement of carers and patients. You have to involve carers who support a lot of the people who come into contact with your services.” Foundation trusts were also required to provide an accessible service as community pharmacists are.

In addition, foundation trusts can commission services from whoever they think can best achieve their desired outcomes, Dr Geoghegan explained. “How I provide services is entirely up to me,” he said. “The commissioners do not dictate to me. I sit down and I agree an activity figure for them, the type of services I will provide based on outcomes. That means that I can commission or subcontract my services to any other person who can deliver that service on my behalf, provided that they achieve the targets that I have to achieve. And that could be you as community pharmacists.”

Community pharmacists could play a key role in educating service users and carers about their treatments and about side effects, he said, and that can have a huge effect on understanding and compliance.

“Why do I want to employ other people to educate us about some of the treatments that we provide in the community when I have you on my doorstep,” Dr Geoghegan asked. Community pharmacists have to start recognising that they are working in a changing world and that means they have to change as well,” he said. “You’ve got to start thinking of new ways of working and the world is your oyster. Don’t be frightened to challenge and don’t be frightened to ask. Because we don’t know where we’re going and I honestly do believe that we’d do it better if we worked together. That’s why I’m passionate about these joint ventures. They can work.”

There are also advantages for foundation trusts themselves in working with community partners, such as pharmacists, he added. For instance, in most cases, mental health is now treated in the community, but mental health pharmacy services are still often hospital-based, he said. “What I’m very keen to do is to address this by working with community pharmacists and saying, rather than me investing that money in the way it has always been traditionally invested, what I want to do is to invest it with organisations in local communities who [can] provide me with a local service.”

In addition, foundation trusts could also be a source of patient data for pharmacists, he said. For instance, South Essex Partnership NHS Foundation Trust has a database of 10,000 people.

“If you were in my neck of the woods, working alongside me, you would have access to over 10,000 people in the community who you could have business opportunities with, who we could be promoting you to.” Foundation trusts could, he argued, recommend particular community pharmacies on the basis on the services, information and support they provide. “From a PR point of view and a marketing point of view you have a ready set up organisation,” he said.

Changes in service provision will follow funding

Continual movement of income away from dispensing and towards service provision could mean that pharmacists no longer dispense on behalf of their patients, Steve Dunn, managing director of the AAH group, suggested.

The new community pharmacy framework in England and Wales means that the Government has control of the money that pharmacy can earn, he said, and could allocate funds in new ways in the quest for maximum value from their expenditure.

“Can we imagine a world in which pharmacy derives the bulk of its income from providing services to patients rather than dispensing them pills? Can we envisage a world in which there is little or no purchasing profit attached to the dispensing activity,” he asked.

Whatever happened, activity would follow funding, he said. “If there is no profit associated with dispensing, who will do it? Maybe wholesalers will have to change their business model to one where automated dispensing is performed by wholesalers on behalf of pharmacists and their patients. This would be a big business model change for wholesalers as well.”

In outlining a range of possible scenarios, Mr Dunn emphasised that he was not saying he would support such a move. “But it’s a possibility,” he said, “and if one starts from an analysis of what is possible one might well end up with a better vision of what is probable; and in understanding tomorrow, today, we will place ourselves in a much better situation to deal with the challenges and issues that may result.”

Pharmacists would also need, he argued, to understand how demographic changes, such as an ageing population and increases both in child-free and in large households would affect pharmacy. “Pharmacy is ideally placed to benefit from these changes,” he said. “The central role of pharmacy in the community could be seen as a place of support around, to take one example, parenting and providing links to other bodies and organisations that support parents.” Changes in working hours also presented opportunities, he argued. “Traditional opening hours are no longer going to be appropriate and those retailers who are successful will be the ones who match the times at which they provide services to the times that customers are prepared to buy them,” he said.

Reform could be a swing door, rather than a valve

Over the next few years “the big question” for health care in England will be whether the NHS has gone through changes that cannot be undone, King’s Fund chief executive Niall Dickson told the conference.

“Is this a valve we’re just going through at the minute — in other words once you go through you can’t get back — or is it a swing door,” he asked. “Could we find that we go through this and we’re back out again and we’re back into targets, that the market system doesn’t really work and we revert back to where we were before?”

Mr Dickson said he suspected it could be a swing door. “ I think if the system proves to be very unstable it would be quite easy for a government or, indeed, possibly necessary for a government, to dampen down some of these reforms because they are powerful but they can also create some instability.”

As well as it being possible that NHS reforms could be undone, NHS politics was also likely to return to a world of thrift, he argued. “NHS politics is about to return to normal,” he said. “Funding and rationing will return. We’ve been through a phase where we’ve barely talked about these issues. Why? Because the money’s been pouring in, so that’s not really been the issue.

“Cuts and instability will return,” he said. “Some of those cuts are absolutely right — they’re about bringing about better care — but instability will come and will be blamed on the reforms, sometimes rather unfairly.”

One other key question is whether the public health system in England can develop to cope with future demands. That was the “wild card” in predicting the future of the NHS in England, Mr Dickson said.

“Will public health come of age,” he asked. The demands of the care system are far too great for a “prevention not cure” approach, he said. “That is juvenile public health of the past. The idea that we’ll just do prevention is nonsense.”

Instead, he insisted, the NHS needs a system that is focused on trying to keep people as healthy as possible.

“I think there may be signs that we’re heading towards a tipping point where the system will begin to engage differently,” he said. “Not because we’ve all suddenly seen the light or we’ve all suddenly accepted that we’re right after all, but that actually it’s unaffordable without the engagement.”

Renaming reflects radical changes in Scottish pharmacy

The Scottish Pharmaceutical General Council’s rebranding to Community Pharmacy Scotland reflects the organisation’s need to provide appropriate support for the new services community pharmacies in Scotland are beginning to offer, Harry McQuillan, chief executive of the SPGC told the conference. “It can’t be right that we ask 1,200 pharmacies in Scotland to change fundamentally how they operate and ourselves to carry on as we have in the past,” he said.

Mr McQuillan said that the minor ailment service now had 700,000 patients signed up, which represented around 25 per cent of the population that had been targeted for registration.

In addition, tier 2 of the public health service would be launched on 1 July. This will require contractors to release window frontage space for public health campaigns, which would be nationally consistent health campaigns and funded as a core service this calendar year. And, in April 2008, the chronic medication service would start, he said.

Explaining the differences between policy in England and Scotland, he said: “We have gone down a much more collaborative route, rather than a competitive one.” He added: “If you want consistency and progression, my argument would be that you should have a national contract, and that’s what we’ve adopted in Scotland.”

Government spotlight set to fall on NHS medicines procurement

The Government is likely to look more closely at the procurement of pharmaceuticals as it seeks the best value for taxpayers’ money, Sue Sharpe, chief executive of the Pharmaceutical Services Negotiating Committee, said.

Government procurement is coming under increasing scrutiny from the Treasury, as it looks at the delivery of high quality public services for the best value for money, she said. This renewed focus will involve setting the right procurement standards, capitalising on the Government’s collective buying power and playing a stronger role in the successful delivery of major projects.

Since pharmaceuticals in primary care make up £8bn of the total NHS spend on goods and services, it was not difficult, she said, to see that pharmaceuticals in primary presented “a tremendous proportion” of total NHS spend where procurement activity could be focused.

“Although we haven’t seen much of a change in primary pharmaceuticals procurement to date, we have begun to see a couple of manifestations of what is going on in areas that are of interest to pharmacy,” she said. For instance, at the end of last year the NHS’s Supply Chain Excellence Programme, which was set up to improve the effectiveness of supply management within the NHS, signed contracts with DHL to deliver supplies to NHS secondary care providers. “This is a very interesting move,” said Mrs Sharpe. “It is the first time we have seen a big outsourcing procurement for many years in the NHS, and it is interesting again to look at how that may, in future, move towards the sums of money that we’ve seen in NHS pharmaceuticals procurement.”

The Government’s recent consultations on chemical reagents, dressings and stoma and incontinence products also showed the potential impact of procurement activity on community pharmacy, she argued. “What there has been to date is fairly minor, but the old world of the Government taking very little interest in the procurement side has gone and it is no longer a viable business model to base your income on getting substantial and uncontrolled income from profits from purchasing.”

There are also a number of issues related to pharmacy where there is Government interest in procurement and getting good value for money. “At the moment there is no move to change or upset the current procurement systems which work so well in primary care,” she said. However, there is a need, she said, for the DoH to show and be shown that the present system is delivering good value for taxpayers — “better than they may think they can get from a centralised procurement mechanism”.