In 2011, the launch of the New Medicine Service and targeted Medicines Use Reviews marked an important evolution in the national Community Pharmacy Contractual Framework. It was a challenging year for pharmacy, with pharmacists’ role developing against a backdrop of financial pressure and the slow trundle of NHS reform. I’m proud to say that community pharmacy has more than risen to these challenges.
But we must now look to the future – how will the pharmacy contract develop in 2012 and beyond? PSNC’s priorities for negotiating the NHS community pharmacy service are straightforward: we must secure fair funding to allow contractors to deliver an excellent service to patients, and we must develop an increasingly clinical role for pharmacy, building on our essential platform of medicines supply. A changing commercial environment, massive economic pressures, an NHS preoccupied with reform, and evolving expectations from the Department of Health make up just some of the context in which we negotiate.
If we can meet the following challenges over the next 12 months, we will be well on our way to meeting our four year strategy, built around a clear vision for the community pharmacy service in 2016.
Securing full and fair funding
PSNC’s first objective for 2012 is to secure full and fair funding based on the evidence of the Cost of Service Inquiry, which was published last July. While the exercise was both necessary and useful, it does present us with new challenges. Independent pharmacies, for very good reason, found it difficult to capture and report all of their costs. How does one report time spent looking through accounts over breakfast? Or delivering medicines to patients during the school run? Evidence from the Cost of Service Inquiry will form the basis of our cost assessment, but there is significant work to be done before it truly reflects the time pharmacists spend caring for their patients.
Our aim is that by 2016 all pharmacies will provide a cost-effective and high quality range of services to their patients, encouraged by funding arrangements that motivate service provision, reward positive patient outcomes and offer sustainability to contractors. With this in place, the value of investment in pharmacy will be plain for all to see, because of wider savings for the NHS and an improved service to patients. For me there are three main areas for the community pharmacy service:
- Improving outcomes for patients taking medicines
- Supporting people with minor ailments who do not need to use GP services
- Promoting good health.
Part of securing the funding for 2012 and beyond will necessitate working to provide a regulatory framework that meets contractor needs. The right regulatory environment needs to be in place for the funding to make sense, and vice versa. It’s important that patients are able to access pharmacy services easily and conveniently, which means having a good geographical spread of pharmacies. With this in mind, there can be no doubt that right now, entry to market regulations are not working.
We hope that the government will lay new regulations very soon, to remove the exemptions under existing market entry arrangements that have allowed a large number of 100-hour pharmacies to open in recent years. With this deadline looming however, PSNC is very concerned at the numbers of applications under the 100-hour pharmacy exemption made in the first part of this year. We do not believe that these openings will lead to improved access for patients, but think that they are much more likely to lead to overcrowding in areas already well served by pharmacies. With more pharmacies serving the same populations, pharmacy services become increasingly expensive, which is not in the interests of a resource-starved NHS.
High quality clinical services
We hope that by 2016, patients will be confident that when they access services from any pharmacy, the pharmacist and other members of the pharmacy team will have the skills and resources necessary to deliver high quality clinical services. Of course, this happens every day, up and down the country; but we’re not yet able to say that every single pharmacy has taken up the challenge to deliver the NMS and MURs. Excellent take up of newly commissioned services is essential in a cash-strapped country where budget constraints mean new services are few and far between.
At present, pharmacies choose whether to provide the New Medicine Service, which is funded separately from essential services like medicines supply. As the Department of Health sees how medicines supply can be a platform to deliver clinical services, however, it may become reluctant to fund the supply function without the added benefits of service provision. At that point, I believe the majority of contractors will give PSNC a mandate to support those who are prepared to provide the services.
The New Medicines Service and targeted MURs have had a good start, and represent an important step forward for community pharmacy’s work in medicines optimisation. There can be no doubt that these advanced services point to the future of community pharmacy, allowing contractors to develop the role they play in primary care, and show how they can drive improved outcomes and deliver value for the local NHS, providing national evidence for pharmacy’s potential role.
We aspire to a community pharmacy service in 2016 which will offer support in the heart of our communities, helping people to optimise use of medicines to support their health and care for acute and long term conditions, and providing individualised information, advice and assistance to support the public’s health and healthy living. The NMS and targeted MURs represent early steps towards that future.
As pharmacists get increasingly used to performing a clinical role, other changes will evolve from the new services. We are used to hearing GPs talk about ‘their patients’ and we are used
to thinking of GPs stewarding patients on their lists through the NHS. But how far do pharmacists think of regular patients as ‘their patients’? Pharmacists have excellent relationships with regular patients, particularly those with long term conditions, who will see their pharmacist more than any other health professional.
GP practice lists will always imply a certain ownership of patients, which pharmacy does not seek to challenge or replicate. As pharmacists develop a more clinical role, however, relationships with patients will develop and become more personal. Should patients eventually nominate named pharmacies through the Electronic Prescription Service, we could see this relationship become increasingly formal.
Thank you LPCs
I want to record gratitude to LPCs, which go to immense trouble to be effective local representatives for community pharmacy, from extolling the outcomes of successful locally commissioned schemes and engaging with local stakeholders to providing evidence for PSNC on difficult subjects, such as medicines shortages. So, at the heart of our plans for 2012 is a focus on supporting and empowering LPCs to act as a strong voice for pharmacy at a local level, ensuring they manage the on-going power shift from central to local decision making across the health service.
The Health and Social Care Bill looks set to become an Act in the near future, and PSNC will provide support to LPCs and contractors wherever we can in the transition process. No reorganisation of the health service has ever gone ahead without teething problems, and with the level of opposition to the reforms, this will be no exception.
The coming years and the need for radical change in the community pharmacy offering will be tough for contractors and community pharmacists. But in 2011 and the first few months of 2012, we have built a strong foundation to build on, and there is growing recognition of the skills and value the community pharmacy team can bring to patients and to the NHS. Never has it been more important to work towards the realisation of pharmacy’s full potential as a key part of primary care.
Sue Sharpe, Chief Executive of the Pharmaceutical Services Negotiating Committee