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Government could save millions under PDA plan for specialist pharmacist contracts

Practice Creating specialist “patient-facing” and “clinic” pharmacists would relieve the burden on GPs and A&E and offer pharmacists proper recognition of their abilities, says chairman Mark Koziol (pictured)

NHS England could save £140 million by contracting specialist pharmacists to take full responsibility for patient care, the Pharmacists' Defence Association (PDA) has argued.  

The health service could relieve the burden on GPs and A&E by creating separate roles for "patient-facing" and "clinic" pharmacists, the PDA has proposed in its road map for England, submitted to the government on Friday (October 11).  

Under the revised structure, clinic pharmacists would hold an individual contract with the NHS to provide specialist pharmaceutical services – particularly focusing on patients with long-term conditions. Patients would register with a clinic pharmacist, who would be an independent prescriber, to be seen on an appointment basis.

Pharmacists' intellectual investment and professional skill has rarely been recognised, said PDA chairman Mark Koziol

More on road maps for pharmacy

Lloyds chief rejects Scottish plans for patient link to a named pharmacist

Scottish government's independent prescribing plan hailed as 'visionary and groundbreaking'

PDA calls for separate medicines supply contract in Scotland

Patient-facing pharmacists could provide a service to patients walking in without an appointment, the PDA said, dispensing prescriptions and treating minor ailments under a nationally commissioned scheme.

The PDA released its proposals just over a year after it called on the Scottish government to adopt a similar model that also involved separating medicines supply from clinical care in the pharmacy contract.

The PDA's road map for Scotland helped shape a review of pharmaceutical care in the country. The government responded to the review last month, accepting recommendations to boost independent prescribing and allow patients to register with a named pharmacist.

The PDA calculated that a national minor ailments scheme would cost £146m to implement, while £352m would be spent on developing and funding clinic pharmacists. But it estimated that NHS England stood to gain £638m from the changes – creating overall savings of £140m.

The savings would be generated by increased GP capacity, reduced hospital admissions and A&E attendances, a reduction in medicines waste and improvements in outcomes.

The PDA said creating clinic pharmacists would also combat the "increasing focus on commercial and financial return factors" in the sector because they would be paid by the NHS based on the number of appointments rather than by a pharmacy company.

Close collaboration with GPs was vital to making the vision a success, the PDA said. It highlighted that GPs would also stand to gain from the model, which would free them up to focus on more complex conditions and acute presentations that would normally go to A&E. It expected 40 per cent of minor ailments consultations to transfer from GPs to pharmacies under the plans.

The proposals were particularly relevant at a time when the NHS needed to cut costs and pressure on hospitals, the PDA argued.

"Individual pharmacists deliver a very valuable asset to patient care in the form of their intellectual investment and professional skill," stressed PDA chairman Mark Koziol. "In community pharmacy, this is something that in the past has rarely been recognised and has often been dominated and overshadowed by large corporate-style commercialism and profiteering."

NHS Alliance co-founder and policy director Mike Sobanja gave his backing to the proposals, and said they could lead to a "vast improvement in the patient journey".

Would you welcome the opportunity to become a patient-facing or clinic pharmacist?

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Sarah Willis-Owen, Locum pharmacist

I like the sound of this but we need to get the patients on board and not all patients like the idea of a medicines review with the Pharmacist as they like the Dr to do it etc.etc.. however if they have a rash I am often the first to see it. Please can we have proper guidelines on if we can dress minor wounds - some pharmacies I work in have a no touch policy and won't let you change a dressing say even if you are competent- though they allow us to take BP etc...

Stephen Riley, Community pharmacist

I think these proposals could bring us into a new era for pharmacy and a greater contribution to the NHS. We could see better use of clinical skills, better use of those currently trained as prescribers, a framework for professional development, better use of NHS resources and health professionals and better outcomes for patients.

Alongside the potential for pharmacists running long term conditon clinics (via community pharmacy, hospital or GP practice settings), we could use this model to support out of hours services. We could set up IP pharmacists in 100 hour pharmacies to provide out of hours clinics, take burden of A&E and support current services.

I agree the proposals will not likely be popular with the multiples and tradional community models. However, they do not have to lead to conflict or reduced revenue. Pharmacists holding new NHS contracts could set up formal agreements to hold clinics at certain pharmacies, which would likely increase dispensing volume. However, I can envisage potential conflicts in the respect that IP pharmacists must have complete professional autonomy to provide services as they deem professionally appropriate. We cannot allow a situation to arise whereby non pharmacist management interfere as sometimes do with MURs / NMS and place financial targets.

With respect to training for these prescribing and more specialist services I don't think it is appropriate to graduate as prescribers. You may be able to put some of the clinical aspects into the MPharm Degree. But like with medicine it is not a specialist degree / qualification. A structured professional development pathway would be a better option, as need the pracrtical experience and mentoring from a prescriber. This is where the likes of the RPS Faculty coould come into play, providing a competency framework.

Overall though I would say congrats to the PDA, these proprosals could bring us into a new era for pharmacy and support the NHS to deliver more and better use resources.

Rajive Patel, Community pharmacist

This is all pie in the sky stuff. The REAL weight lies with the corporates. If they want it to happen, it will happen. If it is not in their interest it will not. The PDA's idea, albeit nobel, lacks any credibility at policy level.

We all now the tangible relationship between corporatist and government has been at the heart of policy making for centuries. It is not about to change. Thinking it will is simply naive.

Stephen Riley, Community pharmacist

I can understand where you are coming from. The corporations do carry a lot of sway. However, this can happen without them. Providing services via the community pharmacy network is one of several options. The proposals in the Roadmap project ccouldbe done via Gp pracitces. There are cutrently examples of individual pracitces and CCGs comossioning independent services from pharmacists happening now. You do not a traditional pharmacy contract to deliver the the services in Roadmap. Whilst I agree things won't happen overnight it is certainly not pie in the sky and does have credibility.

Shabs A, Community pharmacist

I agree, these kinds of proposals and services certainly do not need to be carried out in a community pharmacy. Other locations such as general practices and carehomes are quite adequate for pharmaceutical care services.

Pharmacist Pharmacist, Community pharmacist

Excellent idea and well done to PDA for sticking up for us. Large multiples will have issues with this, but they'll soon take up on the idea when they realise that the category M claw backs will not stop and will continue to squeeze money out of community pharmacy, hence they will require more stream lines of income


I've got a better idea....

Why not incorporate this into the degree? EG specialities in diabetes, heart disease, cytotoxic IVs, etc........The list is endless....

The degree is lacking in so many aspects.....We come out after 4 years without learning how to administer an injection. There needs to be greater physiology in the degree.

Gerry Diamond, Primary care pharmacist

specialism best or naturally developed after registration and practice experience as a generalist followed by focusing in one or two therapeutic areas

Amal England, Public Relations

Del Boy, as usual you misunderstand and then you let your imagination take over. Pharmacy is not ment to produce specialist pharmacists, just as medicine does not produce specialist doctors- specialty happens when work along side a fellow specialist in the real world- this is echoed through all professions. Your endless list can be reality overnight, the manpower is there in terms of qualifying pharmacists, BUT the commitment from doctors is zero, it's these doctors (along with the GPhC, in my opinion) who are the ultimate obstacle to the natural progression of pharmacy. And yes, I would jump at the idea of working in the NHS as envisioned by the PDA.

Clive Hodgson, Community pharmacist

A very interesting set of proposals…..with a lot of potential for both Pharmacists and Patients.

A difficulty will be with the concept of Pharmacists holding contracts and patient registration with a named Pharmacist. I doubt the large multiples/CCA members will be too enthusiastic as this would mean them loosing revenue, power and control to individually contracted Pharmacists. They do have a lot of influence and will act in their own interests.

However, hopefully this could well be the future for a great number of community Pharmacists.

Gerry Diamond, Primary care pharmacist

I believe the current opportunities for Independent Prescribers are fairly limited under the existing structures. Sometimes,as an IP working in community it seems a complete waste of time and effort as most pharmacists use PGDs, which means while I can have the competencies to do vaccinations as an IP then your competency is overriden by PGDs. Community pharmacy at present is not geared up for Pharmacist IPs. Luckily I have a clinical pharmacist role which allows me to use my IP role. Community pharmacy has a long way to go and welcome the PDAs developments in this venture.

Clinical Pharmacist, Hospital pharmacist

Have to give credit to the PDA for this excellent idea. This would promote a new era for patients. Are there actually many pharmacists who are independent prescribers?

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