The average PCT in England commissioned seven enhanced services from community pharmacy, according to the findings of C+D's PCT Investigation 2011.

The number of pharmacy services commissioned by each PCT varied between one and 16, with Nottingham City topping the table and two PCTs, Redbridge and Waltham Forest, at the bottom.

The investigation, carried out through freedom of information (FOI) requests to PCTs, also revealed the spread of enhanced services across the country, with almost all PCTs commissioning the most in-demand services from pharmacies and less than 2 per cent commissioning the least in-demand.

Across the 104 PCTs that responded to C+D's request, the most commissioned enhanced service during the 2010-11 financial year was supervised consumption, provided by pharmacies in almost nine in every 10 PCTs. Joint second was EHC and smoking cessation services, both with 86 per cent coverage. A needle exchange service was also commissioned from community pharmacy by more than eight in every 10 PCTs.

At the bottom end of the spectrum, NHS flu vaccinations were commissioned from pharmacies by less than 2 per cent of PCTs, and alcohol interventions and anticoagulation services were both provided by pharmacies in less than 4 per cent of trusts. Some pharmacy representatives were prompted to call for increased pharmacy provision of certain services, including flu vaccinations and alcohol interventions as well as weight management and minor ailments schemes.

C+D readers backed the call on minor ailments schemes in a web poll, in which almost half of respondents named minor ailments as the service they would most like to see increased commissioning of (see Your shout, right). More than a fifth wanted greater commissioning of NHS flu vaccinations from community pharmacies.

Spending on the up, but geographical divide remains Analysis: Services on the up More from C+D's PCT Investigation 2011

Others industry leaders argued that, while they supported the principle of services based on local need, the consistent commissioning of some pharmacy services across a large proportion of PCTs made the case for national schemes.

"Services should be available according to local need – but with several services commissioned by more than a third of PCTs, it suggests that there should be a national specification and standards for these services," said Sue Moore, UK general manager at virtual network Alphega Pharmacy.

"A national framework for standardised community pharmacy services is the ideal solution, so that they can be commissioned based on local need," agreed Rowlands commissioning lead Liz Stafford. "However, once more than 50 per cent is exceeded there is a case for this to be a national service."

There was confusion among the public about why they could not access the most frequently commissioned services in all pharmacies, Ms Stafford argued, pointing to the commissioning framework for the healthy living pharmacy (HLP) initiative as "the ideal".

Ms Stafford also expressed unease at the wide variation in the services different PCTs were commissioning from pharmacy. "It is of concern to the public and the health inequalities agenda," she said. "Previous research has shown this variability in commissioning is not necessarily based on commissioning for needs but for other reasons, which can increase health inequalities."

PSNC wanted to see supervised consumption, EHC, chlamydia screening and treatment, stop smoking and minor ailments services commissioned as part of the national contract, said head of NHS services Alastair Buxton. But he warned this would be difficult to achieve as local authorities took over the commissioning of public health services under the NHS reforms.

"At the least we hope that the changes to healthcare commissioning may result in the application of a standard approach where an individual service is commissioned at a local level," Mr Buxton said. "PSNC will continue to work towards this goal with colleagues in the emerging national healthcare organisations, in order to remove unnecessary variation in service specifications where the same services are commissioned at a local level."

Numark head of information services Gary Choo warned that some of the most frequently commissioned services may not be well remunerated under local commissioning.

"Some enhanced services in the top four bracket [see Popularity contest, above] are done together with a third party," he said. "Drug and alcohol teams are usually responsible for organising the supervised consumption and needle exchange services; the health promotion teams sometimes use pharmacy premises as the basis for specialist nurses to conduct stop smoking clinics. While these are the most common services commissioned, it might follow that these are not necessarily well remunerated... Recent reports suggest pharmacies [are getting] lower fees for some services."

Your Shout

"I think we need to be more involved in clinical medicines management with direct access to patient records. We also shouldn't have lots of pockets of different services, but more nationalised schemes." Jignesh Patel, contractor, Rohpharm, Plaistow "I would like to see more minor ailments schemes commissioned, because they can help the customer and they provide good income for the pharmacy." Marga Rose, pharmacist, Alliance Pharmacy, Exeter  

Your verdict C+D readers backed Marga Rose's call for more minor ailments schemes, with nearly half choosing it as the service they'd most like to see greater commissioning of. Which enhanced service would you like to see greater commissioning of?

Flu 22%

Minor ailments 48%

Smoking cessation 11%

Chlamydia  7%

Alcohol interventions 11%

Readers polled at chemistanddruggist.co.uk

What service would you like to see more commissioning of? Comment below or email us at [email protected] You can also find C+D on TwitterLinkedIn and Facebook