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Practice-based commissioning (PBC) is a hot topic within the
English NHS, but what does it actually mean for pharmacists and what
resources
are there to help understand this new way of working?
For many pharmacists,
involvement in PBC will, to date, have been limited and many of the documents
related to PBC do not recognise the valuable input that pharmacists can
make in both the commissioning and the provision of services.
At a national level many representative bodies are lobbying for the involvement
of pharmacists in PBC so now is a good time for pharmacists to become
involved locally.
This guidance, produced by the Royal Pharmaceutical Society, in association
with the National Pharmacy Association, the Pharmaceutical Services Negotiating
Committee, the Company Chemists’ Association and NHS Primary Care
Contracting, is intended to help pharmacists understand what PBC is and
explain what needs to be done to extract maximum benefit from it. What is practice-based commissioning?
PBC is a tool to improve the quality of services and access for patients.
PBC supports the move of funding to front-line staff to enable the
delivery of innovative system reforms, patient choice, plurality
and investment. It supports the intention that commissioning should take
place as close to the patient
as possible to ensure cost-effective use of
resources.
Under PBC, all practices will be given a minimum indicative budget
which will be increased over time to enable the purchase of a range
of services
agreed with the PCT. A number of PCTs have already started the move
to fair share budgets for 2007/08. (The allocation of the practice
fair
share budget is based on capitation rather than historical spend.)
Many practices have chosen to pool their fair share budgets and operate
as
consortia, with shared responsibility and decision making.
PBC should involve a number of other health care professionals, voluntary
organisations, private sector organisations etc. The challenge of PBC
will only be met if there is effective collaboration between all professional
groups.
There are several benefits for community pharmacists who are involved
with PBC:
• Integration into primary care
• Retention of existing income streams and gaining new ones
• Increased patient loyalty and footfall
• Opportunity to develop new clinical roles including pharmacists with
special interests, prescribing etc
• Improved services and access for patients and the local community
Likewise there are risks for community pharmacists of not getting involved
in PBC:
• Potential loss of profitability to reinvest in skill-mix, premises
and opportunities as new services that pharmacies could provide are awarded
to other organisations or professions
• Potential loss of patient loyalty and footfall
• Failure to be involved in the design and delivery of new patient care
pathways
• Isolation from other primary care providers
• Lack of credible recognition from other health professionals and commissioners
What needs to happen at a local level?
At a local level, local pharmaceutical committees should:
• Find out how many PBC locality groups there are in their area and
who their clinical and commissioning leads are
• Talk to PCT commissioners and PBC consortia leads and offer pharmacy
advice and involvement to PCT-based commissioning groups
• Work with local PCT heads of medicines management teams to develop
a team approach to tackling medicines and pharmacy-related issues with
PBC consortia and PCT commissioners
• Make links with the Improvement Foundation regional leads (see Panel)
• Encourage pharmacy representation on professional executive committees
as these will be responsible for approving expenditure plans and will
have significant input into commissioning decisions
• Encourage LPC representation on the PBC delivery group or PBC steering
group at PCT level to ensure an opportunity to contribute to service
redesign and an overview of progress across all localities
• Actively promote the benefits of optimising the community pharmacy
contractual framework and accessible resources
• Get involved in the design of care pathways locally and ensure pharmacy
has a foothold
• Gain access to locality-based data relating to current referral and
admissions costs to identify opportunities
• Encourage collaborative working wherever possible
• Work with pharmacy development groups, where these are in place, to
take PBC forwards
• Learn how to write bids, tenders and business cases in the format that
is required locally (there may be a template available); PSNC guidance
to local pharmaceutical committees contains resources for preparing bids
and the NPA has published a suite of PBC business case templates which
are intended to be tailored for local use (see Panel)
• Increase the knowledge of PBC among LPC members and constituent
contractors and pharmacists
Community pharmacists should:
• Talk to their GP colleagues to find out what their plans are around
PBC
• Ensure clinical governance is an integral part of all the services
they offer in order to demonstrate and improve the quality and the safety
of all services that are currently offered
• Evaluate their existing services to secure continued funding and ensure
evaluation is included in any new services
• Gather information from their customers and patients to see what services
they would like to see provided within the PCT
• Talk to PCT and practice-based medicines management pharmacists to
understand how they can work together
• Talk to their LPCs and check their websites for information on PBC
Community pharmacists need to discover what the local needs are and
then approach the PBC consortia or PCT with solutions to their problems.
Selling the benefits
Community pharmacy is already involved in service redesign in a number
of areas such as sexual health, smoking cessation, weight management
and prescribing. Under PBC, community pharmacists could offer:
• Improved access to services and improved capacity, eg, minor ailment
schemes
• Support for the management of long-term conditions, including repeat
dispensing schemes, medicines use reviews, etc
• Reduction of avoidable hospital admissions and bed days, through repeat
dispensing schemes, medicine use reviews, etc
• Reduction of waste, through repeat dispensing schemes, medicines use
reviews, etc
• Cost-effective prescribing, through supporting PCT initiatives to help
make prescribing savings
• Reduction in accident and emergency costs
• Involvement of public and patients in service planning
• Reduction of health inequalities and improvement of public health
Community pharmacists do not need to compete with other health care
professionals for these services but they can look for opportunities
where they can work in collaboration with others for the overall benefit
of patients.
Sources of useful information on practice-based commissioning
Department of Health The Department of Health has set up a separate
section on its website which contains all the resources it has produced
for practice-based
commissioning (PBC), including frequently asked
questions and the latest news.
Improvement Foundation The Improvement
Foundation is running the national PBC development programme, which
currently
involves 70 per
cent of primary care trusts. The main programme consists of a collaborative,
which is running in three waves. Local pharmaceutical committees
and pharmacists need to be aware of any teams within their area and
either get involved or learn from these sites.
Details
of the centres and the programme
The local
centres are in the process of setting up PBC days for all PCTs
and, again, pharmacists are encouraged to get involved in these.
Other
resources include a “Practice
based commissioning assessment framework” (2005).
This framework is designed to help practices and PCTs to undertake
a diagnosis of their capacity and capability to meet the challenges
of implementing PBC and to identify development needs.
The Improvement Foundation website also contains a great deal of
information
on PBC and also “at a glance” guides as well
as examples of service redesign.
The Improvement Foundation development programmes, including the
leadership programme, are also available to community pharmacists
and quality improvement skills training can be delivered locally
to community pharmacy teams. Further details are available from
regional Improvement Foundation centres.
National Pharmacy Association The National Pharmacy
Association has produced a “Practice based commissioning resource” (March
2006), which explains PBC and demonstrates what it means for community
pharmacy. It includes a number of key messages for pharmacists about
how they can get involved at a local level and how they can put the
case forward for pharmacy involvement.
The NPA has also published a suite of PBC business case templates,
which can be tailored for local use. See www.npa.co.uk (members
only).
NHS Alliance The NHS Alliance has published a number
of really useful documents, which are available at www.nhsalliance.org.
However, these
are only available to download for members of the organisation. National
Association of Primary Care The National Association of
Primary Care has a number
of useful documents for member commissioners
and providers, many of which are related to PBC.
Pharmaceutical Services Negotiating Committee The
Pharmaceutical Services Negotiating Committee has produced “PBC:
a practical guide for LPCs” (2007) and regularly updates
LPCs in PBC developments. Its website has a page dedicated to PBC
that includes action points
for LPCs (only available to LPC members).
Primary Care Contracting Primary Care Contracting has provided a
wealth of information around PBC and has developed a bulletin
on pharmacy and PBC. They also have regional advisers who may
be a useful resource locally.
Health Policy Forum Health Policy Forum is made
up of representatives from the Company Chemists’ Association, the NPA, the PSNC and
the Royal Pharmaceutical Society. In December 2006, the forum published “Making
commissioning effective in the reformed NHS in England” which
sought to determine what makes for good or effective commissioning.
Pharmacy Management Pharmacy
Management published
an article entitled “Commissioners’ corner:
practice based commissioning” in July 2006. This paper
defines PBC, sets it in the context of the overarching system reforms
programme
within the NHS and identifies opportunities for pharmacists.
Commissioning toolkit for long term conditions The commissioning
toolkit is a website that brings together information and resources
to help commission effective patient centred services. |
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The
Pharmaceutical Journal