PJ Online | P&MM: Do not miss the boat - pharmacists can get in on the new GP contract

Prescribing & Medicines Management
Issue no 3, p8-9
May/June 2003

Features

Do not miss the boat — pharmacists can get in on the new GP contract

Pharmacists should not miss the boat. PCTs are already thinking about how best to support the medicines management targets in the new GP contract. Sam Crowe reports

Sam Crowe is a freelance journalist

Medicines management in primary care has been firmly enshrined within the new GP contract currently being considered by the medical profession. Ten quality targets relating to organisational aspects of medicines management look set to provide a platform for greater pharmacist involvement, and PCTs are already thinking about how best to support the changes, once the contract is accepted.

There are also likely to be opportunities for community pharmacists to play a greater role in primary care teams in the chronic disease management aspects of the new GP contract, PCTs say. And, if a new contract for pharmacists is negotiated that complements the GP contract, pharmacists could be providing many more clinical services in future.

That is certainly one vision of the proposed changes, says Karen Acott, pharmaceutical adviser at North Devon PCT. She says: "It really depends where you are coming from as a PCT, because within the GP contract there is a heading entitled medicines management, which is largely organisational. But within the enhanced quality services domain there are many other items that relate to medicines management, and particularly chronic disease management, where pharmacists could play a role."

Medicines management and the new GP contract

General practices that can show they are achieving up to 10 medicines management standards will be rewarded with extra payments, under the new system for achieving the quality targets. This should provide significant

opportunities for pharmacists to work more closely with primary care teams, not just on organisational standards, but around structured medication reviews and aspects of chronic disease management too, pharmacists believe.

The new GP contract is split into four domains, two of which attempt to assess the quality of service that GPs are providing in the clinical and organisational aspects of general practice. The third domain is for additional services practices might want to provide, while the fourth domain, patient experience, measures the quality of care from the patient's point of view.

In all, there are 42 quality points out of a total possible of 184 (nearly half of the points are for records management) available from the organisational management part of the new GP contract.

In particular, practices will earn points for:

• having up-to-date emergency drugs for anaphylaxis, as well as a system for checking the expiry dates of emergency drugs at least annually

• ensuring prescriptions are available for collection within 72 hours (excluding holidays and weekends) or 48 hours (double points)

• recording evidence of medication reviews in patient notes, and that review is carried out for all patients on repeat prescriptions at least once every 15 months

• meeting PCT prescribing advisers at least annually, agreeing three actions related to prescribing and providing supporting evidence

• ensuring all details of prescribed medicines are available to the prescriber at each consultation.

Source: The new GP contract, appendix A. See www.bma.org.uk for further details

Contract is a commissioning tool

Ms Acott sees the new GP contract as essentially a commissioning tool, and hopes that any new contract for pharmacy will complement it — to deliver a much more integrated primary care service. "I think PCTs have to step back from seeing primary care as purely driven by GPs and say what are the best skills that nurses can bring, and what are the best skills that pharmacists can bring, and who are the best people to do the job."

However, she adds that the current structure of the new GP contract is underfunded for medicines management. She also believes that many of the GPs she has spoken to locally say that the extra points on offer for medicines management may not be worth going for. "It is hardly worth them doing it because it is a small aspect of one domain." Her message to pharmacists is that they must become more proactive in taking up the new opportunities offered by the GP contract. "Pharmacy should realise that it could be a lot more proactive in bidding to run enhanced services, as I can't do the bidding for them," she says.

Workforce issues

And although Ms Acott believes that pharmacists will become much more integrated with the primary care team in time, this is only likely to happen when GPs and nurses realise that they are unable do all of the work themselves.

"We have a chronic shortage of nurses and a chronic shortage of GPs — there are also pharmacist shortages too, so there needs to be some backfill put into the profession to release pharmacists to do these new jobs."

Her advice to the pharmacists is not to price themselves out of the market. "From a commissioning viewpoint PCTs will go for the cheapest provider, which may be nurses. LPCs and the PSNC need to scope out exactly what pharmacy can deliver pragmatically, as often pharmacists will say they cannot provide these services because of a lack of locum cover and so on."

PCTs which are already members of the national medicines management services (MMS) collaborative see the developments as a continuation of work they are doing already.

Hazel Smith, director of clinical service delivery for Peterborough North PCT, a first wave MMS site, says: "Irrespective of the new GP contract, we are already providing medicines management services and we will be expanding those under the terms of the new contract.

"Under our local development plan we've invested extra money to take on more pharmacists so we can provide a link to every practice across the PCT area," she adds.

IT shortcomings

But for some PCT pharmacists, the IT requirements of the new GP contract may pose problems. PCTs take on responsibility for practice-level IT systems next February.

The new contract's data-heavy requirements will mean PCTs must procure primary care IT systems that can collect and analyse practice information at a much more detailed level than before.

Dr Brian Curwain, chief pharmacist for New Forest PCT, says that while the drive towards more information sharing between practices within PCTs is one of the most powerful levers for change, it will require much more time and money to get right. "PCTs will not have a problem supporting the GPs in their medicines management work, but a major issue will be the data collection and quality of data. It is about finding ways of linking prescribing with who has got what wrong with them," says Dr Curwain.

He adds that there may well be a trend towards more large practices having pharmacies on site. Several practices in New Forest PCT already have on-site pharmacies. "We are looking at the possibility of the pharmacist having access to the GP computer system and patient records, which will be more accurate than just asking patients if they remember the last time they had their cholesterol checked.

"There are bits of medicines management pharmacists can do without this, such as clearly identifying drug interactions, but until they have proper access to practice computers and records then they will not be able to go the whole hog," Dr Curwain emphasises.

Pharmacy contract part of the mix

Dr Curwain agrees that the next logical step must be for the pharmacy contract to be updated to reflect the changes in the new GP contract. This would boost pharmacists' professional status, above all. "We need to increase the money that is paid for providing clinical services and reduce the money that is paid for dispensing. I'm with the Government on this one."

Mark Galloway, medicines management facilitator at Coventry PCT, also says that his PCT is looking at the new GP contract with a view to supporting enhanced medicines management activities by its GPs. He is strongly in favour of a new pharmacy contract to support the medicines management agenda in primary care.

"We also have local pharmaceutical services pilots up and running, with more coming on stream. The smart money is that the best aspects of LPS pilots will form the basis for the new pharmacy contract. I can't see any other option really. We've gone past the stage of convincing Government that pharmacy has a role to play — it's now down to us to sort out the details. As far as the PCT is concerned, we're anxious to involve pharmacists much more, and not just directly employed pharmacists but community pharmacists too," Mr Galloway adds.

Until the ballot of GPs — underway at the beginning of June — has been completed on whether or not to accept the new contract, the details remain provisional. But, should GPs accept it, medicines management should certainly become a mainstream part of primary care.