Prescribing & Medicines Management
Issue no 3, p10-11
May/June 2003

Features

Help is at hand to support a prescribing project in your PCT

Is your primary care trust fit for its purpose? How competent is the organisation in managing new style contracts with GPs and pharmacists, let alone medicines and prescribing?

The National Primary and Care Trust Development Programme (Nat PaCT) has been set up to enable PCTs to carry out their roles properly and to improve health and services for patients. "Helping PCTs get the nuts and bolts right" is how some describe it.

NatPaCT was set up when PCTs took on significant extra responsibilities. Planning, commissioning and delivery of services was heavily devolved to PCTs following the Government publication "Shifting the balance of power".

"But NatPaCT is there to help you and does not issue diktats," reassures Heather Gray. Heather is project director for a NatPaCT group focusing on medicines management, pharmacy and prescribing.

This "significant issues group" involves some well-known names in pharmacy — from Dr Jim Smith, chief pharmaceutical officer for England — down. They have helped to draft organisational competencies that PCTs can use as a framework for self-evaluation. Training programmes have also been drawn up to support developmental needs.

To give an example, the draft competence for supplementary prescribing is given below: "Nurses and pharmacists working within the PCT, who can potentially contribute to meeting NHS Plan targets by undertaking supplementary prescribing, are identified, trained, accredited and able to prescribe within local clinical governance frameworks."

This statement is accompanied by a list of reasons why PCTs need to be competent in this area — known as a "descriptor" in NHS jargon. The statement also describes what the PCT should have in place in order to demonstrate competence — a "demonstrator". For the above competence, demonstrators include:

• Ensuring all professionals in the PCT are aware of developments in supplementary prescribing

• Ensuring the trust's medicines policy and other guidance for practitioners has been appropriately amended

• Ensuring that appropriate access to a prescribing budget has been agreed before any supplementary prescribing takes place

• Putting systems in place for ordering and receiving prescription pads; feeding back PACT data; receiving drug alerts and hazard warnings; maintaining an administration contact for any queries on prescribing status of staff; and representing new prescribers on appropriate PCT prescribing groups

The draft for medicines management has five competencies. For example: "The trust should engage with, and positively influence, prescribers". Demonstrators for this include:

• Giving consistent evidence-based messages to all prescribers in key areas

• Ensuring practices receive regular feedback about the cost and efficacy of their prescribing

• Facilitating face-to-face meetings between the PCT and individual practices about prescribing and medicines

Another competency here is: "Making appropriate and effective use of information, including financial information, about the use of medicines". Demonstrators for this include:

• Ensuring the PCT can use epact.net and the PPA prescribing toolkit

• Ensuring finance officers and medicines advisers work together to ensure timely reporting and interpretation of expenditure data

• Setting prescribing budgets in line with national guidance or by another locally agreed equitable mechanism.

Ms Gray describes NatPaCT as "brokering" PCT organisational development. "It is the PCTs themselves that make change happen." Indeed, the competencies drawn up by the group are being "roadtested" and shaped by various PCTs whose staff comment on how comprehensive the documents are, whether the demonstrators work, etc. The first phase of roadtesting is now complete, with further feedback now sought for the latest drafts of the competencies.

PCTs are also invited to give their views on training needs and examples of good practice or successful projects.

£30,000 for development projects

As part of its programme, NatPaCT has funding to support the development of PCT competencies. Ms Gray explained that some significant issues groups had put their money into conferences. Others had financed extra staffing to support PCTs but the medicines management, pharmacy and prescribing significant issues group had decided to offer its £30,000 grant to fund one supplementary prescribing project. Any PCT intending to implement supplementary prescribing this year can apply. Priority will be given to projects that fulfil the following criteria:

• Able to be completed by March 2004

• Have outputs that will be of benefit to the wider service

• Be available to all PCTs to support local development

Ms Gray is looking for any projects that will help put policy into practice. "We are looking for innovation. PCTs can suggest anything they feel will help trusts meet their competencies in supplementary prescribing."

She is also keen to hear from PCT staff who have original ideas in other competency areas, should funding for a third project become available.