C+D Senate: Surviving in the new NHS
Building relationships with GPs needs to start now
GP consortia will be responsible for local service commissioning in just two years' time, and will hold the purse strings for funding pharmacy-based services. C+D editor Gary Paragpuri told the other Senators that in December 2010, industry leaders were shocked to hear that a C+D poll had showed 88 per cent of readers were not planning to speak to doctors about services, despite the vital new role of GPs.
What we need to do: There was some initial disagreement between the C+D Senators about where pharmacy needs to go to best influence service commissioning. North-East London LPC secretary Hemant Patel argued that GPs as individuals do not have any more power than they did before and that we need to distinguish between them and the consortia.
But contractor Ash Soni disagreed, saying pharmacists needed to push all GPs towards commissioning services from them and give them any help they can to support the process. "The problem that GPs have is that they are going to be working with existing management structures, and those management structures are not good at engaging pharmacy," Mr Soni explained. "And GPs are not great at engaging pharmacy, so put the two together and they are still not going to be great at engaging pharmacy if we don't go out there and push them."
NPA chief executive Mike Holden was concerned that many pharmacists do not know what to say when they approach their local GP consortia, and the rest of the Senate agreed a coherent message needed to be sent to consortia if pharmacy is to have any influence.
Medicines management could be one area for pharmacists to focus on and show how they can help consortia, suggested Mohamed Kanji, senior pharmaceutical adviser for Havering PCT. He advised asking GPs: "We want to work with you to ensure medicines management is being done in the right way. We know that it is not being done as 30 to 50 per cent of medicines are not being used as directed, so how can we work together on this?"
What will happen if we don't: Numark managing director John D'Arcy had a stark warning for the sector. He said if pharmacy doesn't engage more with GPs then the sector will simply find itself "dead in the water" and "out of the game".
The Senate verdict on how well pharmacy is doing on this now: 3/10
Action point 2
Staff need to be upskilled
Pharmacists are at breaking point with their workload, warned PSNC chief executive Sue Sharpe. They are "stressed" and "stretched" and there is only just beginning to be some recognition they need to delegate tasks in the dispensary. The current financial climate doesn't help, either, as a recent Avicenna survey showed one in five members were considering cutting staff, C+D news editor Zoe Smeaton pointed out.
What we need to do: Good team leadership and skill mix is the solution, along with reducing the administrative burden, said Mr Holden. The Senators were unanimous in the view that there needed to be more investment from contractors in training their staff, and from then on pharmacists need to focus on delegating to them effectively.
Mr Soni pointed out difficulties in the regulatory framework, which he says did not yet reflect this need to delegate, and called for change to help this happen. "You need to have a regulatory framework that recognises the changing environment in which you are operating as a pharmacist," he argued.
What will happen if we don't: "If pharmacists don't delegate what they can, then they will become no better than technicians," warned Ms Sharpe.
And this is likely to cause problems for a profession looking to take on an increasingly clinical role and promote itself as a healthcare provider.
The Senate verdict on how well pharmacy is doing on this now: 5/10
Action point 3
Quality and reputation are more important than ever
Measuring and proving the quality and outcomes of pharmacy services will be crucial for the sector to secure funding for those services in the reformed NHS. Mark Stone, Devon LPC pharmacist, commended Mr Holden for the work he did at Hampshire & Isle of Wight LPC on a Healthy Living Pharmacy pilot, saying that this had provided the profession with a strong model for obtaining data on services.
What we need to do: There was yet more agreement from the Senate, as Senators all think more research is needed to ensure pharmacy can demonstrate the value and quality of its services.
However, funding for this could be difficult to find. Mr Stone said: "You have to look for the opportunities and in Devon we have had to be very active in finding funding to do the research."
Hemant Patel argued that there is a lot of money available, but said the problem is making people aware of the value of research as it takes a long time. The Senators couldn't settle on who should provide more funding for research, but agreed that it shouldn't stop everyone doing their bit to gather evidence for pharmacy services where they can, even if it's on a small scale. As Ms Sharpe says: "It is actually the relatively focused bits of research that come from locally negotiated services [that are valuable] and there are some good bits out there."
What will happen if we don't: "If we don't do research then we won't get services. Unless we can provide assurance that we can deliver at the quality and reliability we say we can then we won't get them," Ms Sharpe warned. But as well as not being commissioned for extra services, Mr Holden warned that if pharmacy can't consistently deliver quality services and prove their value, it could end up losing the services it already has.
The Senate verdict on how well pharmacy is doing on this now: 6/10
Action point 4
We need to build relationships with local authorities
…and understand local needs assessments
Local authorities will hold an increasing amount of power in the "new world" NHS as they take over responsibility for public health services. This could be a big opportunity for pharmacy to boost its role, the Senators argued.
What we need to do: Liz Stafford, NHS commissioning lead for Rowlands Pharmacy, revealed that she has been asked to put together a CV for a position on her local health and wellbeing board. She said to improve her chances of securing a place she has suggested that she could represent other contractor professions on the board, such as optometrists and dentists with whom pharmacy needs to work. "There won't be spaces for everybody, but if we can represent them then that helps us," she explained.
Mr Kanji pointed out that the local pharmaceutical needs assessments being produced by PCTs could help to identify some of the areas that the public health outcomes framework of the future will look to improve, and could offer big opportunities for pharmacy to show what it can do.
Hard-to-reach patients could be one area to focus on, as Mr Holden said: "Seventy per cent of people don't see GPs, and doctors are generally not working on prevention. That's where we can step in and leverage our footfall."
What will happen if we don't: The Senators warned if pharmacy did not step in and present itself to health boards as the best possible provider, other groups will fill the gaps.
The Senate verdict on how well pharmacy is doing on this now: 6/10
Action point 5
Pharmacy must have a vision of what it wants in the new world
…and how national and local services should dovetail to achieve that
During the debate, the lack of a coherent message from pharmacy bodies regarding the upcoming changes to the NHS was criticised heavily by some Senators.
What we need to do: Mr Holden told the Senate that demonstrating value is important, but that this must be a job for grassroots pharmacists, not just national bodies that support them. "National bodies can't add value, it is up to practitioners to do that," he argued.
Ms Stafford added that there is a need to be involved at a national level, now, as GP commissioning develops. For example, national networks are developing GP commissioning packs to help them work through the changes. "GP consortia are working with the national clinical directors and they are developing some of the commissioning packs that GPs will use," she said. "That is essentially the beginning of the national commissioning board coming together now. If we are not there in the beginning then we are not going to be there at the end."
Day Lewis CEO Kirit Patel was less cynical about the situation and said: "We can't expect it to just happen, we have to upskill staff and get the premises sorted out to enable it. But I think pharmacists are very commercially minded so I don't worry. We keep on looking at the bad points, but there is a great potential for pharmacy going forwards."
What will happen if we don't: Ms Stafford warned the consequences would be "quite significant" if professional bodies do not make sure they are aligned.
And Mr Kanji said he was concerned about the next two years as the NHS changes. "I am fearful for pharmacy services as PCTs are winding down and local health and wellbeing boards and GP consortia are not yet set up. A lot of work goes into commissioning pharmacy services. What happens in the interim?"
The Senate verdict on how well pharmacy is doing on this now: 7/10
The Senators
John D'Arcy: Managing director, Numark
Hannah Flynn: Reporter, C+D
Mike Holden: Chief executive, NPA
Mohamed Kanji: Senior pharmaceutical adviser, Havering PCT
Gary Paragpuri: Editor, C+D
Hemant Patel: Secretary, North-East London LPC
Kirit Patel: CEO, Day Lewis
Jennifer Richardson: Deputy & features editor, C+D
Sue Sharpe: Chief executive, PSNC
Zoe Smeaton: News editor, C+D
Ash Soni: Contractor, Copes Pharmacy and clinical board co-chair, NHS Lambeth
Liz Stafford: NHS commissioning lead, Rowlands Pharmacy
Mark Stone: LPC pharmacist, Devon LPC
Tips for your CPD entry on the new NHS
Reflect Have you thought about the services you want to offer in the new NHS?
Plan Make a list of services you can offer well and who you are going to talk to about it.
Act Talk to local doctors and authorities about the services
Evaluate Is your pharmacy now better placed to win services from new commissioners?
Watch the C+D Senators explain the initial steps pharmacy needs to take to survive the NHS reforms
