Practice-based commissioning

Home > Series index > Practice-based commissioning

  Acrobat Reader


A resource to help primary care pharmacists in England involved in practice-based commissioning
What does practice-based commissioning mean for primary care pharmacists? Heidi Wright, head of practice at the Royal Pharmaceutical Society, outlines the benefits of becoming involved and points to the various resources available
PDF 40K

Pharmaceutical Journal 2008;280:442-443 (12 April 2008)


Practice-based commissioning: tips for preparing and pitching a proposal
Groups of local pharmaceutical committee members and contractors got together to formulate a business case and to pitch their ideas to two primary care trust commissioners in a Dragons’ Den style session. Dawn Connelly reports
PDF 30K

Pharmaceutical Journal 2008;280:153 (9 February 2008)


Securing pharmacy's place in the new world of practice-based commissioning
In this article, Heidi Wright, from the Royal Pharmaceutical Society's Practive and Quality Improvement Directorate, Barbara Parsons, from the Pharmaceutical Services Negotiating Committee, and Trish O'Gorman, from the Improvement Foundation, describe how practice-based commissioning allows pharmacists to become more involved in service planning and delivery
PDF 50K

Pharmaceutical Journal 2007;279:333-334 (22 September 2007)


Practice-based commissioning awareness week (24-28 September 2007)
Pharmacy practice-based commissioning (PBC) week kicks off on Monday with several activities organised both nationally and locally
Full Text

Pharmaceutical Journal 2007;279:317 (22 September 2007)

Examples of pharmacist involvement in care pathways and service redesign

Chronic obstructive pulmonary disease
Claremont practice in Devon employs a community pharmacist for one day a week to work with patients who have chronic obstructive pulmonary disease. Through domiciliary visits for the severe housebound patients, medication reviews, running COPD clinics and reviewing the COPD register, major savings have been achieved for the practice as well as better outcomes for patients.

Diagnostic services
In Derwentside PCT community pharmacists are providing international normalised ratio measurement services in community pharmacy-based clinics or in patients’ homes. This has led to a reduction in ambulance transport costs, an increase in accessibility and capacity of this service and enables all practices to have access to community based anticoagulant monitoring (a PCT target).

Medicines management
In-depth assessment is used to develop tailored medicines management solutions for vulnerable older people living in the community in Poole. Pharmacists and pharmacy technicians provide intensive support for patients, developing pharmaceutical care plans that enable patients to administer their own highly complex medical treatments safely.

The service works closely with secondary care to improve the patient experience after discharge and is linked through a service level agreement with local community pharmacies to provide an enhanced pharmacy service. Specialist nurses, GP practices and social care services are also involved.

Long-term conditions
A practice in Exmouth has employed a pharmacist for one day a week to review certain patients with long-term conditions. Over a period of a year the contribution of the pharmacist has resulted in an estimated £4,566 being saved on the prescribing budget.

Medicine use reviews
Medicine use review is an advanced service under the contractual framework for community pharmacists. In Hampshire and the Isle of Wight, community pharmacists have been requested to use MURs to target patients currently on osteoporosis agents.

The pharmacist checks that the patient is adherent to the regimen and discusses intake of calcium via diet or adjunct therapy. The MUR also includes a falls risk assessment. This service has led to an improvement in access, particularly for hard to reach at risk patients, and improvements in adherence and in calcium and vitamin D3 intake. This, in turn, has led to a reduction in falls and a reduction in emergency admissions and secondary care costs.

Cost minimisation and medicine management in nursing homes
In Havering PCT a service has been designed to minimise drug wastage for nursing home residents through application of an agreed prescribing policy and structured medicine reviews by a community pharmacist. The pharmacist identifies clinical and clerical prescribing issues for resident patients, which are then put to the GP for action.

This service supports the National Service Framework for Older People and has resulted in a reduction in the number of unnecessary medicines that elderly patients take, an improved quality of life for residents, a reduction in side effects requiring admission to hospital, a reduction in falls, a reduction in overall treatment costs and a use of savings in part-time GP recruitment to look after nursing home patients.

The service has resulted in a 60 per cent reduction in prescribing costs and on average the work of the pharmacist resulted in 4.5 recommendations (3 clinical, 1.45 clerical) per patient. Of these, one in every three clinical recommendations led to a discontinuation of medication and one in every 1.5 clerical recommendation led to removal of unwanted medicines from the patient’s record.

Sources of useful information on practice-based commissioning for primary care pharmacists

Department of Health The Department of Health has set up a separate section on its website which contains all the resources it has produced for PBC, including frequently asked questions and the latest news.

Improvement Foundation The Improvement Foundation is running the national PBC development programme, which currently involves 70 per cent of PCTs. The main programme consists of a collaborative, which is running in three waves. Local pharmaceutical committees and pharmacists need to be aware of any teams within their area and either get involved or learn from these sites.

Details of the centres and the programme

The local centres are in the process of setting up PBC days for all PCTs and, again, pharmacists are encouraged to get involved in these. Other resources include a “Practice based commissioning assessment framework” (2005). This framework is designed to help practices and PCTs to undertake a diagnosis of their capacity and capability to meet the challenges of implementing PBC and to identify development needs.

The Improvement Foundation website also contains a great deal of information on PBC and also “at a glance” guides, as well as examples of service redesign.

The Improvement Foundation development programmes are also available to community pharmacists including the leadership programme; and quality improvement skills training can be delivered locally to teams. Further details are also available from the foundation’s regional centres.

National Prescribing Centre The role of the National Prescribing Centre is to promote and support high quality, cost-effective prescribing and medicines management across the NHS, to help improve patient care and services. A significant number of NPC outputs will facilitate engagement with PBCs and support implementation of prescribing and medicines management priorities.

The NPC has recently launched NPCi, a new interactive web-based educational resource to support prescribing and medicines management.

The NPC will be launching a number of initiatives to support individuals working on prescribing and medicines management issues within practice based commissioning groups during 2008.

The Information Centre: prescribing support The Information Centre for Health and Social Care has a prescribing support unit (PSU) that produces reports and publications that will help pharmacists see where they fit into the national picture.

Its publications include:

•Hospital prescribing
•England (annual report)
•Prescriptions dispensed
•Prescription cost analysis
•National prescribing costs and items (monthly section level reports)
•PSU National Prescribing Reports (quarterly)
•PSU Prescribing Monitoring Documents (quarterly)
•National Quality and Outcomes Framework data

See Prescribing Support Unit (PSU)


Also available is National Quality and Outcomes Framework (QOF) achievement data derived from the Quality Management Analysis System (QMAS), a national system that uses data from general practices to calculate individual practices’ QOF achievement.
See Quality and Outcomes Framework Database

NHS Comparators NHS Comparators (an NHSNet site) is a national resource, focused on supporting practice-based commissioning. It supports comparisons at the GP practice, PCT, strategic health authority and national levels, enabling users to investigate aspects of local commissioning activity, costs and outcomes.

It is designed to supplement information available through local systems, not to replace local systems. The comparators have been developed by the Information Centre, Connecting for Health and a panel of users and experts from across the NHS and can be found at www.nhscomparators.nhs.uk

The system was launched nationally in June 2007 and is continuing to be developed. The system is available to all GP practices, in addition to SHAs, PCTs, trusts, and other relevant organisations. Information on how to register can be obtained by e-mailing enquiries@ic.nhs.uk or telephoning 0845 300 6016.

Primary Care Pharmacists Association The Primary Care Pharmacists Association was founded in April 1999, primarily as a forum for education, training and support for pharmacists in primary care. It offers a service to members to provide national and local peer support groups, to provide a series of local education events throughout the UK, to allow members to publish research and to present work at educational events.

NHS Alliance The NHS Alliance has published a number of useful documents. However, these are only available to download for alliance members.

National Association of Primary Care The National Association of Primary Care has a number of useful documents for member commissioners and providers, many of which are related to PBC, including “Prescribing support and pharmaceutical advice for practice-based commissioners”.

Primary Care Contracting Primary Care Contracting has provided a wealth of information on PBC and has developed a bulletin on “Pharmacy and PBC”. It also has regional advisers who may be a useful resource locally.

Health Policy Forum The Health Policy Forum is made up of representatives from the Company Chemists Association, that National Pharmacy Association, the Pharmaceutical Services Negotiating Committee and the Royal Pharmaceutical Society. In December 2006 the forum published “Making commissioning effective in the reformed NHS in England”, which sought to determine what makes for good or effective commissioning.

Commissioning Toolkit for Long Term Conditions The Commissioning Toolkit for Long Term Conditions brings together information and resources to help commission effective patient-centred services.

RESOURCES

More resources for primary care pharmacists


Practice based commissioning: a resource for community pharmacists (PDF 260K)

The Royal Pharmaceutical Society is running a programme called “Leading across boundaries” which can help pharmacists to become influential local leaders and aid integration of pharmacy into the local health care system
(contact Anne Adams at anne.adams@rpsgb.org)

Joint guidance from pharmacy bodies on PBC (PDF 260K)

Practice-based commissioning — a practical guide for LPCs (PDF 430K)

The Single Assessment Process (PDF 980K)

PBC resources can be accessed by NPA members on the NPA website

The self care challenge: A strategy for pharmacists in England (PDF 120K)

Making commissioning effective in the reformed NHS in England
Health policy forum

WEBSITES

Department of Health

The Improvement Foundation

Primary care Contracting

PSNC

NHS Alliance

The contents of the Pharmaceutical Journal, associated publications and all PDF files are the property of the Royal Pharmaceutical Society. See Copyright for our rights.

Photocopies
Photocopies of articles can be ordered from the Society’s library (library@rpsgb.org); for details click here

Reprints
Details on multiple reprints of the original articles are here

Back to Top


©The Pharmaceutical Journal