The new Community Pharmacy Contract along with the new GMS contract will fundamentally and significantly change the roles and responsibilities of GPs, Community Pharmacists and other healthcare professions in Primary Care Organisations (PCOs) throughout the UK. This article deals with the Community Pharmacy contract.

Pharmacists in Secondary Care should also be aware that these changing circumstances will undoubtedly impact on negotiations between PCOs and Hospitals in relation to funding and the prioritisation of services.

The opportunities for pharmacy within the new environment are good but the profession needs to be aware and able to create the right business cases plus communicate effectively with all the relevant stakeholders in the local healthcare economy.

There are major opportunities and implications for the pharmaceutical industry arising from the new pharmacy contract.

Improving Pharmacy Services in the NHS

This contract recognises community pharmacy as an integral part of the new NHS, utilising the skills and knowledge of pharmacists. Pharmacists can play an important role in the overall improvement of public health. The vision offers the opportunity for the profession to realise its full potential.

The document emphasizes the need for improvements in access and quality, as well as integration of pharmacy into the healthcare team to provide a quality service, at the same time as recognising that pharmacies need a fair return.

The contract addresses issues such as:

• Funding - Primary Care Trusts (PCTs) should have safeguards to protect funds for community pharmacy services. Need adequate and fair funding for new roles.
• IM & T - the pharmacists’ contribution will be enhanced by having access to NHSnet and the Integrated Care Record System. Integration and full connectivity to NHSnet is fundamental and will also promote joint working - primary healthcare team. Although IM & T are in the strategy document , the DOH will not pay for this, community pharmacy must fund this.
• Relationship/ communication with PCT - community pharmacists should sit on the Professional Executive Committee (PEC) of all PCTs. This will help inform the PCT of the contribution that community pharmacy can make and increased liaison with the Local Pharmaceutical Committee (LPC) is important for successful implementation of new services at a local level.

The main aims of the contract are to:

• Provide clear minimum standards for community pharmacy
• Provide clear and fair rewards for high quality services and promotes best value for money
• Harness the skills of community pharmacists and their staff, to deliver better primary and community care services to patients by developing opportunities and rewards for integrated working
• Minimise bureaucracy for both Pharmacy and PCTs
• Ensure easy access to pharmacy services (promoting choice & competition)

Areas which may be addressed within these aims are:

• Clinical quality of services
• Speed and efficiency of services
• Standard of premises
• Provision of private consultation areas
• Good record keeping and information for patients
• Continuing professional development of both pharmacists and support staff
• Participation in clinical governance
• As a separate issue - ‘control of entry rules’ will need to be changed to remove an obstacle to the provision of better services.
• Reduction in bureaucracy for PCTs and pharmacies

10 Key Roles for Community Pharmacy have been specified:

1. To provide convenient access to prescription and other medicines.
2. To advise patients and other health professionals on the safe and effective use of medicines.
3. To be a point of first contact with healthcare services for people in the community.
4. To provide medicines management services, especially for people with enduring illness.
5. To promote patient safety by preventing, detecting and reporting adverse drug reactions and medication errors.
6. To contribute to seamless and safe medicines management throughout the patient journey.
7. To support patients as partners in medicines taking.
8. To prescribe medicines and to monitor clinical outcomes.
9. To be a public health resource and provide health promotion, health improvement and harm reduction services.
10. To promote value for money in the use of medicines and to reduce wastage.

All contracted pharmacies will continue to provide essential services:

• Dispensing
• Repeat dispensing - pharmacist given the ability to change the quantity of medication to allow synchronisation of regimen, dose optimisation.
• Clinical Governance - use of SOPs, adverse incident reporting, service audits, patient questionnaires, intervention monitoring
• Medication waste disposal
• Public Health (health promotion)

Additional advanced services will require accreditation and include Medicines Use Review. This helps to implement the National Service Framework (NSF) for Older People and allows teamwork with other primary care workers. Reviews will be face-to-face with the patient and be concordance-centred, assessing patient’s problems with current medication and its administration. The patient’s knowledge of the medication regimen is assessed and developed. A report is fed back to the patient’s GP, preferably using computerised patient record systems.

The pharmacist can also offer a Prescription Intervention Service - such as dose optimisation etc. It is likely that this could be used to promote adherence to PCT prescribing guidelines, improving quality of prescribing and saving money.

Supplementary Services provided by community pharmacy will be commissioned locally by PCTs. The PCTs will negotiate the services with the LPCs. Some nationally agreed services are already in place in several local health communities. Including the minor ailments scheme, diabetes and CHD screening, substance misuse, EHC service, Out of Hours, Smoking Cessation, Needle exchange, Medicines management and practice based prescriber support services. Supplementary services can also include a full patient medication review.

Pharmacists will receive Remuneration plus Profit on Purchasing under the new contract. Remuneration will be based on volume (dispensing) quality (Clinical Governance) services However negotiating this and other points of the contract is taking time and the date of implementation is now likely to be moved from April 2004 to October 2004.

How does the new GP contract impact the opportunities under the new community pharmacy contract?

The GP Contract is between PCTs and a GP practice; hence this allows involvement by other members of the primary care team including pharmacists.

Enhanced services are part of the quality and outcomes framework. This is where PCTs and GP practices will have to develop teamwork and utilise skill mix. There is still the tendency for GPs & PCTs to think first of using nurses as they are NHS employees and the perception is that they are ‘cheaper’. Healthcare assistants, and Trainee Assistant Practitioners (TAPs) are also being trained to be able to do more. However, there will still be insufficient resource within PCTs.

Community pharmacists must be able to present their case for contribution, especially since some PCTs have mentioned ‘preferred providers’ and intentions to use tender process. PCTs /GPs must involve community pharmacy to sit round the table to be a part of service development. There are still many PCTs without a PEC community pharmacist. Under the "New PCT competencies (NatPact. M11)" there are competencies relating to the new pharmacy contract and involvement of community pharmacy. Pharmacists can help GPs as partners in their quality framework, in areas such as chronic disease management (medication reviews), repeat prescribing, smoking cessation, minor ailment schemes, substance misuse etc. It is fundamental to use other partners, learning to work together. Where GPs will no longer be involved in Out Of Hours service provision there could be an option to use skills and accessibility of pharmacists.

Government has already acknowledged the potential of community pharmacy as "a resource for reducing health inequalities" in the document - "Building on the Best - Choice, Responsiveness and Equity in the NHS". There is a high political profile attached to the choice agenda and the pro-pharmacy statements in this document carry much weight.

Positive statements about expanding pharmacy's role have resulted from a patient-led consultation providing evidence of public support for increased community pharmacy provision. The aim is to improve choice of where, when and how to get medicines and reduce need for referral back to the GP.

The supplementary prescribing opportunities in the contract may pave the way to independent prescribing. However, the more immediate impact will be better use of the potential for community pharmacy to contribute to the delivery of primary care services and closer working relationships between community pharmacy and the PCTs and GPs.