What should pharmacists expect to be paid for medicines management?
| The new general medical services
contract could mean community pharmacists become more involved
in medicines management work. But what remuneration should they
receive? Dawn Connelly (on the staff of The Journal) finds out |
Pharmacy and the new GMS contract |
The new general medical services contract, which comes into effect
in April, may open the door for community pharmacists to become more involved
in carrying out medicines management work, for example, medication reviews,
at GP practices.
What pharmacists can earn
A quick flick through the recruitment section of
The Pharmaceutical Journal over the past few months reveals that the
pharmacist who secures
a position as director of prescribing and medicines management at a PCT
in south-east London can expect to receive an annual salary of around £60,000
to £65,000. This is clearly a senior position.
In the same issue, a practice-based pharmacist post at a PCT in the West
Midlands is advertised at £25 per hour.
PM&M also learnt that another PCT in the West Midlands offers pharmacists
who undertake a variety of practice-based activities £22 per hour
for sessional work. In north-east London the negotiated rate is higher,
at £150 per session, with each session lasting three to four hours,
and in the south of England, medication review work is paid at a rate
of £30 per hour, with some pharmacists charging up to £40
per hour. |
The question many community pharmacists will want answered
is, what can
they be expected to be paid for this sort of work? Pharmacists can
negotiate payment either directly with GP practices or with the relevant primary
care organisation. There are several factors to take into account when
negotiating rates of pay. What standard of review is the pharmacist
offering
to undertake? How much will the GP be paid to provide a medication
review service under the new general medical services contract? It is also
worth
considering how “Agenda for change” might affect rates of
pay for community pharmacists offering to carry out these services?
Sue Carter, head of prescribing and pharmacy at Adur, Arun and Worthing
Primary Care Trust, said that it depends on what is regarded as a medication
review. “When I have talked to GPs in our area in preparation for
the medication review aspects of the new GMS contract, their understanding
of what constitutes a medication review is different to the standards
and complexity of review often expected by pharmacists.”
She explained that, to begin with, if community pharmacists are trying
to be commissioned by GPs to carry out medication reviews then they
should carefully look at the level of review required. “Many GPs will
expect quick and easy reviews, for example, at the level of the questions
asked in ‘Ask about medicines week’,” she said. However,
a lot of primary care trusts are separately funding pharmacists to carry
out medication reviews at a higher level, as per the guidance in “Room
for review”.
“The quick and easy reviews could act as a signpost and filter
for the more in depth reviews that pharmacists can offer,” added
Mrs Carter.
She also pointed out that if GPs are approached directly, rather than
pharmacists negotiating with PCOs, then the payment negotiated would
have to be within the bounds of what the GP is going to be remunerated
for providing the service under the new GMS contract.
Mrs Carter believes that “Agenda for change”, the new pay
system for NHS staff which is intended to harmonise conditions of service
and ensure that staff receive equal pay for work of equal value, could
have a major impact in primary care, a sector that has traditionally
had a varied approach to setting rates of pay. Community pharmacists
may currently offer services at private sector commercial rates.
Once “Agenda for change” is implemented, she predicts that
it may not be feasible for PCOs to pay community pharmacists significantly
more than permanent employees would be paid to do the same job. Under “Agenda
for change”, the skills and person specification needed for medication
reviews will fall into a particular band of payment, and this band may
also apply to community pharmacists, she said. “Pharmacists need
to continue to show that they represent a cost-effective way of providing
these services.”
Maria Smith has been working as an independent pharmacy consultant
in primary care for the past three years. She works on a sessional
basis
across three trusts in the Buckinghamshire and Berkshire areas. As
well as carrying out project work, conducting warfarin clinics and
being involved
with patient group directions, she
also does medication
reviews.
She says that the best method of payment for medication review work
is to charge per hour, rather than per patient. “It is difficult to
charge per patient because there are lots of variables to consider, for
example, is the review taking place in the surgery or is it a home visit?
What is the nature of the review? Is it a full brown bag review or is
the pharmacist going through a patient’s notes and picking up problems
that will later be reviewed by the GP?”.
Ms Smith alluded to the fact that many GPs have no experience of clinical
pharmacists. “Although the culture is changing there are still
many aspects to overcome — we have got a lot of mileage to prove
our worth,” she said.
She says that there are opportunities for pharmacists in the new GMS
contract, but only if GPs are willing to pay for them. “They see
nurses as a cheaper source of providing the same thing,” she said.
“However, pharmacists shouldn’t be compared with nurses;
they should be compared with doctors.” It is not until GPs work
with good pharmacists that they see what additional value they are getting,
she added. She
believes that pharmacists should be charging at least £25 to £30
per hour for medication review work.
Ms Smith says that another problem is that many community pharmacists
have little hands-on experience of clinical pharmacy, and therefore
lack the confidence to carry out medicines management work.
With only two weeks to go until the new GMS contract comes into effect,
it is worth thinking about the opportunities that it will create for
pharmacists — and brushing up on your negotiation skills. |
