Hospital Pharmacist
Vol 9 No 6 p180
June 2002

Review of circulars and official publications
by Alex Bower, MRPharmS

The long-awaited document on "Local Pharmaceutical Services: guidance notes", together with an "Outline proposal proforma" was issued by the Department of Health in April. Local Pharmaceutical Services (LPS) provide for pharmaceutical services to be obtained in contract with a Primary Care Trust (PCT). Any individual or body corporate (other than a PCT) can be an LPS provider as long as they employ a pharmacist to meet the requirements of section 52 of the Medicines Act 1968. LPS contracts must include dispensing but can also include a broader range of services than traditionally associated with the current, national contract, eg, diagnostic testing and therapeutic monitoring. Services such as optometry and chiropody can also be provided at the same premises as part of an LPS contract. Regulations governing the admission of pharmacies to pharmaceutical lists (the control of entry regulations and the rural dispensing regulations) do not apply to LPS schemes. PCTs will, however, have to assess the likely effect of an LPS scheme on existing pharmaceutical services, general medical services or personal medical services. Funding for services will come from a transfer from the global sum in relation to the level of dispensing remuneration which would have applied under the national contract. There is no reference to additional funds to pay for new services. Submissions are invited by 28 June or 1 November, with implementation being expected about three months after approval is granted. The introduction of LPS is likely to represent a major development for the profession. It is anticipated, however, that there will be a number of points on which colleagues require clarification over the coming months before the full implications can be assessed.

Hospital pharmacy managers may wish to consider whether or not LPS schemes could improve opportunities for joint hospital and community pharmacy working. The documents are available here.

"Modernising supply in the NHS" was issued in April by the NHS Purchasing and Supply Agency (NHS PASA). The report proposes the creation of a "middle tier" of purchasing to bridge the gap between the NHS PASA and individual trusts. This will be achieved through inter-trust collaborative groups to be known as supply management confederations. These bodies will be formed on a geographical basis but will not necessarily be conterminous with the new strategic health authority boundaries. Confederations will be trust-led but will encompass all NHS organisations in a local health economy, eg PCTs. The approach is expected to deliver benefits in: purchasing savings and reduced costs through economies of scale and increased leverage, development of centres of procurement excellence, improved career prospects for supply professionals, and collective support and raised standards for poorer performing trusts.

The report notes that it is not only supplies departments that are under scrutiny; a considerable amount of procurement is handled directly by other trust departments or clinicians, such as pharmacy, pathology and estates. It is indicated that the NHS PASA has a responsibility in ensuring that all purchasing in the NHS, regardless of where or by whom it is conducted, is properly controlled and represents best value. A stated aim of the NHS PASA is to increase the proportion of expenditure covered by national supply arrangements from 20 per cent to at least 34 per cent. The alternatives to a national supply arrangement are seen to be local (trust) level supply management or "inter-trust" supply management where a group of trusts pool expertise. Pharmacy has a good track record on collaboration through long-standing drug contracting processes. The report does not make specific reference to drugs but pharmacists with a responsibility for this activity within their role will wish to assess the potential implications of the proposed changes on the way drugs are procured. The report is available via www.pasa.doh.gov.uk

A "Guide to collaboration in R&D between the NHS and other research funders" was issued in May. The guide seeks to encourage collaboration between the NHS and research funders, both commercial and non-commercial bodies. The costs of research and development (R&D) are split into research costs (eg, data collection, analysis, etc), NHS support costs (eg, extra blood tests, extra inpatient days, etc) and treatment costs (patient care costs which would continue to be incurred after the R&D activity had stopped). Where patient care is being provided which differs from the normal, standard treatment, the difference between the total treatment costs and the costs of the standard alternative are termed the "excess element of treatment costs" or, alternatively, just "excess treatment costs". All R&D in the NHS must have written confirmation, on behalf of the chief executive(s) of the relevant NHS care organisations, that they agree to host the research. Sponsors must agree to fund the R&D cost components indicated or, in other cases, there must be a written agreement between the host NHS care organisations, the sponsors and any other funding sources which sets out how the full cost of the work to the NHS will be met. The guide explains the basis on which "NHS Support for Science" is available to NHS bodies and other providers of NHS services. A statement on NHS collaboration with the pharmaceutical industry is attached as an annexe to the guide.

The guide, which will be of particular interest to pharmacists who arrange and/or undertake research and to those who are members of ethics committees, is available as a PDF (* 15K).

The Scottish Executive issued "Consultation and public involvement in service change — draft interim guidance" HDL (2002) 42 on 21 May. Public involvement is seen to reduce the risk of providing inappropriate services or services that do not deliver in a way that people want or need. The report notes that consultation should apply for substantial developments or variations in primary care such as strategic service plans and out-of-hours services. The extent to which the public should be involved in a pharmacy service change will need to be assessed at the time and will be dependent on the nature of the change. The circular will be helpful, however, to any pharmacist, not just those in Scotland, in identifying the issues to be considered when a public involvement exercise is appropriate.

  * PDF files on PJ Online require Acrobat Reader 4 or later.

Mr Bower is a consultant pharmacist