C+D Senate LIVE
The Department of Health’s national clinical director for pharmacy, Jonathan Mason, was the first Senator to be asked if the figures (see PCT Investigation: the key findings, opposite) were acceptable. Clearly not, he told the Senate’s first live audience, at the Pharmacy Show where the conference was held. And if the situation was going to change, he said, then the current model for pharmacy was going to have to change, too.
“What I am saying is that if a clinical route is what we want to do then we have to give something up, and we need to put a framework together that would allow us to do that. Only then will we be able to deliver and drive the income up.”
All the Senators agree that, though the results of the PCT Investigation were disappointing, there were many areas of the country that were shown to be providing excellent levels of service.
Senator and PSNC chief executive Sue Sharpe says that while there is a varying picture across the country, some areas have LPCs and PCTs that are working together well. As an example, she says: “You have got some PCTs like [Mr Mason’s] and like Hampshire & Isle of Wight PCT who have really ‘got it’ about how they can use pharmacy and have really good relations with the LPCs, good levels of commissioning [and] fantastic uptake by pharmacies.”
Mrs Sharpe recommends that the sector take a look at what these “beacon” areas are doing that is leading to such a high level of success, and emphasises how important it is to get more services commissioned on a national level.
Referring to Hampshire & Isle of Wight’s Healthy Living Pharmacy scheme in Portsmouth, Mrs Sharpe says: “We really need to be shouting and pushing for this kind of thing to be funded in and invested in so that this kind of pharmacy [service] can be delivered across the country.”
Senator and CCA chief executive Rob Darracott strongly agrees. He points out that while the average figures may mask some of the success stories in pharmacy in England, it would be best if services were commissioned on a national level.
Mr Darracott says: “Clearly national companies would prefer to have as many things agreed at a national level or a national specification as possible, as obviously that will help in taking those services into reality locally.”
And Mrs Sharpe and Mr Mason both say that pharmacy needs to be pushing for improved services sooner rather than later, as the recent NHS white paper signals a big change in commissioning frameworks.
Mr Mason points out that, in order to maximise the opportunities presented by the white paper, pharmacy needs to develop a framework that measures outcomes.
He says the paper means that pharmacy and other NHS providers will need to provide quality over quantity, but measuring that meaningfully will be difficult. Mr Mason says: “We have a minor ailments service in my PCT and, yes, we know how many interventions there are, but the outcomes of those interventions? We have no idea.
“And unless we can say, ‘We saw this many patients and we know so many of them were prevented from seeing their GP or going to a walk-in centre, which would have cost you even more as a PCT’, unless we have that information, as a commissioner it is very difficult to make decisions about commissioning.”
Senators agree that pharmaceutical needs assessments (PNAs) could hold the key to better commissioning, but only if both pharmacists and commissioners take them seriously.
NPA chairman Ian Facer believes PNAs have been done well by PCTs. However, Mr Facer says the unanswered question is where PNAs sit in regard to control of entry.
He says that there are “huge concerns around the exemptions and so on, and how do they fit going forward with PNAs? And that’s a point I raised this week with the [pharmacy] minister to ensure we had some clarity around that. So generally my impression is that the unanswered question is: ‘How are they going to be used and will they be used properly?’.”
Senators agree that C+D’s PCT Investigation has unveiled a worrying picture of local enhanced services commissioning. But with the PCTs about to be disbanded and the future of commissioning unclear, Senators are clear on just one other thing: now is the time pharmacy must shout about what it can offer the NHS if it is going to survive the changes outlined in the white paper.
3 steps to breaking down barriers at your PCT
Pharmacy tsar Jonathan Mason explains what to do if you are experiencing problems with your local trust
1. Find the right person to talk to in the PCT. If it is not the pharmacy prescribing team or the primary commissioning team, talk to the chair of the PCT as they can be a very powerful advocate.
2. If you feel your work is not being recognised, get the chair of the PCT or the non-executive directors to come into the pharmacy to see what you are doing.
3. Find an advocate in the PCT in your field. If the problem is with methadone dispensing, for example, get in touch with your local drug action team as they wield a lot of power.
The Senate Ruling
1. The current state of local enhanced services commissioning, revealed by C+D’s PCT Investigation, is unacceptable.
2. Pharmacy must learn from the local success stories that do exist.
3. The sector must push for more nationally commissioned and/or national service specifications.
4. Pharmacists must find a way to measure the patient outcomes of their services.
Tips for your CPD entry on local services
Reflect Do I understand how local enhanced services affect my pharmacy and patients?
Plan Consider how the white paper proposals could affect the services my pharmacy offers.
Act Read relevant sections of the white paper and related documents, and gather evidence of how my services are helping patients and the NHS.
Evaluate Do I better understand how local commissioning affects my pharmacy and patients, and how it might change?
