The Pharmaceutical Journal
Vol 279 No 7476 p506
3 November 2007

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Pharmaceutical Services Negotiating Committee

Spotlight on service opportunities

Highlighting what she sees as some of the key drivers that will affect provision of pharmacy services in the future, Sue Sharpe, chief executive of the Pharmaceutical Services Negotiating Committee, said that pharmacy funding does not at present have the security and predictability contractors need.

“It is essential to ensure that moving forward all elements of the funding systems provide the right incentives, both for pharmacies and the NHS,” she said. “We need to ensure that the income levels, and the delivery mechanisms, support growth of pharmacy services in the way we want to see them grow,” she added.

This will mean looking at rewarding investment in provision of advanced and enhanced services, rewarding success in procuring savings on drugs budgets, and ensuring that the need for predictability and fair funding is met, she explained.

Mrs Sharpe pointed out that most elements of the community pharmacy service will be reviewed in the coming months — how the pharmacy operates, the control of entry framework, funding delivery mechanisms and, most importantly, what pharmacy can bring to the NHS. “Our aim is to make substantial progress in developing our core service priorities — providing more care and promoting healthy lifestyles,” she said.

Turning to the forthcoming pharmacy White Paper, she said: “We hope and expect that the White Paper will identify a framework in which there are real opportunities to change care pathways. It will need also to be a framework in which the threats to development of the pharmacy service will be identified and removed.”

Point of care testing opportunities

The opportunities for pharmacists in diagnostic testing are huge but there are also challenges, according to Gilbert Wieringa, who established a point of care testing pilot in pharmacies in Greater Manchester (PJ, 30 July 2005, p131).

He explained that diagnostic testing is a key enabler in empowering clinical decisions and encouraging people to manage their own health care.

Mr Wieringa, a consultant clinical scientist, believes that the new community pharmacy contract is where pharmacists have an advantage over health care scientists in offering diagnostic testing services. Although there is often spare capacity in laboratories each analysis generates an additional patient journey, he explained, whereas pharmacists can provide the whole service — analysis, interpretation and intervention.

Roger Kirkbride, an independent consultant, explained that the Manchester pilot is a Department of Health initiative, originally involving 22 community pharmacies.

GPs offer patients who are diagnosed with diabetes or coronary heart disease the choice of continuing to use existing services or accessing services offered by participating community pharmacies, including a full lipid profile, HbA_1c, body mass index and blood pressure measurements, as well as a structured review of lifestyle and other factors to aid self-management.

The original aims of the pilot were to integrate pharmacy, to challenge existing working practices and to explore the governance of point-of-care-testing in primary care, said Mr Kirkbride.

An IT system was developed, which generates a patient record of everything discussed during a consultation. It holds a copy of this in a central database at the strategic health authority and sends an extract to the patient’s GP to populate the Quality and Outcomes Framework, he explained.

Mr Kirkbride told participants that evaluation of the project has revealed that GPs are reluctant participants, mainly due to financial concerns but also because of concerns about pharmacists’ competence for diagnostic testing.

Continuity was a problem for participating pharmacies, with high staff turnover and takeovers and mergers largely accounting for the loss of 10 pharmacies from the pilot.

“There is still a long way to go before pharmacy is fully integrated, particularly in terms of their working relationships with GPs,” said Mr Kirkbride. However, the evaluation also revealed that patients like having a choice, value the pharmacy service and their conditions improve.

The full results from the pilot project will be reported in spring 2008.

Chlamydia screening

The National Chlamydia Screening Programme is struggling to achieve its targets, which creates real opportunities for pharmacy in delivering chlamydia screening services, Ajit Malhi, professional services manager at AAH, told participants.

Ravi Chana, diagnostic development manager at Roche Diagnostics, explained that chlamydia screening is now included in primary care trusts’ local delivery plans. Each PCT area must achieve a 15 per cent target for screening 16–24 year olds. “A lot of PCTs are currently only achieving 6–7 per cent. So there is a huge opportunity there that pharmacists can tap into,” he added.

However, Mr Chana warned that funding for the NCSP is not ring-fenced so pharmacists will need to make a strong business case. He advised those who are thinking of offering a screening service to start by finding out whether their PCT is meeting its target and to make contact with the PCT’s sexual health lead and the local chlamydia screening officer.

Service accreditation

A scheme that standardises primary care trust accreditation requirements for pharmacists and their support staff to deliver specific enhanced services, was described by Gail Thomas, chairman of the North West Harmonisation of Accreditation Group (HAG).

HAG has completed frameworks on emergency hormonal contraception, supervised administration, smoking cessation and needle exchange and is working on those for minor ailments, chlamydia screening and weight management.

The Royal Pharmaceutical Society’s English Pharmacy Board, of which Ms Thomas is a member, has asked her to see if she can get agreement on national accreditation for enhanced services.