NHS Review (April 2005) - The new Community Pharmacy Contract

The new Community Pharmacy Contract (continued)

Pharmacy in the future first outlined plans for a new pharmacist contract, along with proposals for supplementary pharmacist prescribing and local pharmaceutical services (LPS) pilots. Pharmaceutical care was to be reshaped around patients with a redesign of local pharmacy services. The DH then published A vision for pharmacy in the new NHS with more detailed plans for 2004-8 aimed at continuing to bring community pharmacy into the mainstream fabric of the NHS. Amongst areas discussed were more moves towards pharmaceutical public health, independent prescribing by pharmacists, pharmacists with special interests (PwSIs), consultant pharmacists, first contact care by pharmacists and enhanced roles for pharmacy technicians. Note then that Making Better Use of the Pharmacy Workforce has sought views on changes in legislation to enable all those working in a pharmacy setting (pharmacists, pharmacy technicians, dispensing assistants, counter assistants) to contribute more fully to effective to patient care. Lots of interesting comment here about changing skill mix - not least enhancing and extending the (clinical) role of community pharmacists but also enhanced (dispensing) roles for the whole community pharmacy team - there are an estimated 8000 technicians, 16,000 dispensing assistants and 40,000 medicines counter assistants… See Link to consultation paper. The Chief Pharmaceutical Officer has also set out 10 key roles for pharmacy, painting a picture of a much wider role for pharmacy services. And just as we go to press, government has published further plans for consultant pharmacists and pharmaceutical public health. So a busy area of government policy and one that sales teams will really need to keep close to.

Anyways back to the new contract. What this will mean is that in the future PCTs will be able to commission services from pharmacists to provide a far greater range of services to patients. Pharmacists will be able to provide a more comprehensive advice and information service to patients covering a range of areas such as self-care, the management of long-term conditions such as cardiovascular and respiratory disease and public health issues such as smoking cessation, diet and exercise. The challenge now will be to implement the contract. Please note then that Implementing a community pharmacy strategy: a practical toolkit for primary care organisations (toolkit has been produced by National Pharmaceutical Association and that Pharmacy Contract Implementation Project Managers are increasingly being appointed by PCTs and thus a new KOL is being born.

A brief overview of the new contract

Here we give a brief overview on the contract but the many other developments in primary care must also be considered when working through the implications of the new contract for the business - so that is supplementary prescribing, the Public Health White Paper, (with community pharmacists becoming active in 'pharmaceutical public heath'), LPS, concordance, medicines management services and nGMS. In outline then, the new contract will involve a range of services grouped as follows:

Essential services - defined as those that community pharmacy contractors must normally provide under the new arrangements. Most of these services with the main exception of repeat dispensing are already provided by pharmacies.

Advanced services (previously called 'enhanced') - defined as those that require accreditation of the pharmacist providing the services. For instance, medication review can easily be provided in the community pharmacy setting with a confidential area and access to relevant parts of the medical record.

Enhanced services (previously called 'supplementary' or 'additional') - defined as those that will be commissioned and paid for by PCTs. These could include for example community medication concordance services, prescriber support services (practice based) and minor ailment schemes

Note that some aspects of medicines management are more than likely to be delegated to pharmacists by GPs under nGMS and that the new pharmacy contract will promote medicines management in its widest sense and it will also link directly to achieving the disease-specific quality indicators in the QOF of the new GMS contract. Disease monitoring, repeat prescribing and medication review are all specific issues within many of the disease areas of the GMS contract.

So what does all this mean?

The new pharmacy contract will likely 'revolutionise' the profession. Certainly community pharmacy may well be on the verge of the most fundamental change in decades. As far as community pharmacists are concerned, it has always been puzzling why expensively trained professionals, in the main, lock themselves away at the back of the shop well away from patients whose pharmaceutical wellbeing they are supposed to be looking after! Why is it that the 'front end' of the business generally remains so cosmetically focussed when it should be health focussed? One of the reasons of course is about making profits and making a healthy living. But pharmacists were not trained to sell toothbrushes and hairbrushes but to be part of the health gain business through their contribution to the medicinal supply chain to patients. And they are usually the last healthcare professional to see the patient before the therapy begins. So pharmacist's skills appear to be have been finally recognised and there is a huge window of opportunity here but pharmacists will have to rise to the challenge of the new developments.

What might the commercial implications in all of this be? Perhaps most important to companies is what will the extended roles of all types of pharmacists might actually mean to them. Indeed are companies yet preparing for this huge change agenda in a customer group that is day-by-day becoming more and more important but with whom the Industry generally has very poor relationships? Will medical representatives continue to 'abuse' community pharmacists, being only interested in what Dr Smith down the road is writing in the way of scripts…. Is it not perhaps not time to develop brand new relationships with community pharmacists? Pharmacos must treat community pharmacists now with much more respect as key stakeholders in their business planning. New marketing messages to the new pharmacists of 2005 will certainly need to be provided and they will have to be different to those traditionally used with GPs. There are lots of opportunities too for offering development in areas like helping with clinical governance, training for advanced and enhanced services. So New Labour, New NHS, New World of Pharmacy.

Some other areas of interest this month
As well as a main feature each month, we will also be picking up on a few other areas for you.

LTC goes Neurological

The National Service Framework for Long-term Conditions was launched last month, more than likely now the last of the NSFs. The NSF is for implementation over 10 years and sets out 11 quality requirements (note not standards!) to improve the way health and social care services support people with long-term neurological conditions. The DH say that the new NSF will help people with conditions such as Parkinson's disease, motor neurone disease, epilepsy, multiple sclerosis and acquired brain and spinal cord injuries to live as full and independent a life as possible. The LTC NSF focuses on neurological conditions but the principles apply to service development for other long term conditions. Long-term neurological disorders are estimated to affect around 10 million people in the UK, including 200,000 to 400,000 with epilepsy and 50,000 to 60,000 with multiple sclerosis. These account for 20% of acute hospital admissions and are the third-most common reason for seeing a GP. Thus neurological conditions are common and an estimated 350,000 people across the UK need help with daily living because of a neurological condition. But although charities and lobby groups have welcomed the NSF, there are concerns that it will be insufficiently resourced with no dedicated funding

Health Manifestos

The date of the next general election has now been set for May 5th and Labour's forthcoming manifesto will likely have a lot of stuff in it on health. Many other organisations have launched health manifestos too. For instance, the NHS Confederation's Manifesto asks you to imagine the NHS beyond 2005, where, people with long-term conditions can choose how and where they are treated and the NHS makes sense to the patient. And the BMA's manifesto calls for improvements in public health; better choice for patients; limiting the role of the private sector; involving doctors, patients, and the public more in policy initiatives about the NHS and further investment in the medical profession. A Vote to Improve Health is available at http://www.bma.org.uk/ap.nsf/content/BMAmanifesto. And the King's Fund is publishing a series of election briefings aiming to provide concise overviews of hot topics in health and social care policy. The first two are on mental health and patient choice. Forthcoming topics include health care and the private sector; managing long-term conditions and primary care. The Kings Fund has also just produced a useful audit of the NHS under Labour (1997-2005) which suggests that there has been significant improvements in most areas the government has focused policies on in the NHS but that the NHS has 'not yet been transformed.' The audit assesses Labour's performance against its targets to bring down waiting times; recruit more health care professionals; and improve care in cancer, heart disease and mental health. See possibly Section 1 - Labour's vision for the NHS and/or Section 4 - Cancer, coronary heart disease and mental health.

Latest Plans for the NHS

And last but not least, the DH has published Creating a patient led NHS - delivering the NHS improvement plan. The NHS Improvement Plan was actually published last summer so a bit late to produce a delivery plan you would have thought….. So actually this is a new forward strategy updating the NHS on some of the radical new thinking that has occurred since last June. The ambition is bold and it is easy to be cynical about some of the proposals as with the current magnitude of change there is a lot of 'hidden' resistance in the system. Key points are another strong focus on moving stuff out of hospitals (it is suggested that some 15 million outpatient attendances could be safely delivered in community settings); a further attempt to 'tip' the NHS towards its users (patient information & choice become real); new service models (with a heightened focus on networks); a major NHS Trust and PCT development programme (all Trusts will now start the Foundation Trust financial regime!) and a new focus on contracting. A key document to read and digest.