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GP commissioning — a wake-up call for pharmacy

By Gareth Burke

The advent of GP commissioning means pharmacists are entering an uncertain new world. But change can mean opportunity and pharmacy may emerge improved

 

Three years from now (ie in 2014), the removal vans will have come and gone, and the nerve centre of the NHS will have moved offices from the board room to the consultation room. Many community pharmacists have invested in consultation rooms, but it is not these I am referring to.

GP practices will have become members of GP commissioning consortia with each practice having a lead GP nominated to a consortium. Commissioning powers will be devolved to GPs, who are expected to be responsible for 80 per cent of the £100bn a year health budget.

The commissioning process has hitherto gathered Olympic pace with health secretary Andrew Lansley recently announcing a third wave of GP commissioning pathfinders, bringing the total number of GP groups to 177, covering 35 million people in England.

These pathfinders are effectively early pioneers of the Government’s new method of commissioning care, as set out in its Health and Social Care Bill currently going through Parliament. Two bodies, Monitor and the NHS Commissioning Board, will ensure that commissioning decisions are fair and transparent, and competition promoted.

Those of us with good memories of bad political decisions will recall that GPs had their budgetary responsibilities culled some 15 years ago. The 1990s saw GPs being given control of budgets, allowing them to buy services for their patients from NHS trusts as well as the private sector.

This voluntary scheme was known as “GP fundholding” with GP non-fundholders having services purchased by the health authority. GP fundholders and GP non-fundholders alike came together to form respective consortia to pool resources, share risk and influence health authority purchasing decisions.

In May 1997 the advent of the Labour government signalled the death knell of GP commissioning and the internal market of the Thatcherite government was abolished, thus ending competition between providers within the NHS. The process, lampooned by many at the time, may well be viewed more favourably as we revisit it with the benefit of hindsight.

Opportunities and threats

GP consortia present opportunities as well as threats for pharmacists. Medicines management teams can be relatively sanguine about their continued existence because prescribing will be a major budgetary responsibility for consortia.

Primary care trust pharmacists’ meritorious work and expertise in the field of prescribing, clinical governance, patient safety, medicines management and commissioning will doubtless be safeguarded and valued by many GP consortia.

Community pharmacists, however, find themselves entering an uncertain new world of GP commissioning led by the stick rather than the carrot. There are innumerable examples of good working relationships between community pharmacists and GPs, although each group could benefit from closer working and understanding of each other’s practices and contract requirements.

Where relationships between the two groups have been less than harmonious, it now seems the onus for any sycophancy will fall on the pharmacist.

Stake a claim

Community pharmacy has an almost unprecedented opportunity to stake a claim firmly in the direction and future of the NHS by using the timescale of the next few years to mould and reshape the profession into an organised, valuable and well represented body with clear leadership. This is what GP consortia would want from service providers. This is what the profession needs.

Community pharmacists and community pharmacy groups should work together to identify clinical leaders in community pharmacy who are best suited to work and engage with consortia, further developing partnerships with GPs and identifying local priorities. Pharmacies should group and align to form local proactive consortia forging early links with pathfinder groups to exert a greater presence and influence over the future commissioning process.

Encouragingly, there is evidence of this already happening, with some pharmacy multiples quick off the mark. It should be noted, however, that long-term successes will lie with regional co-operation with other pharmacy businesses for the good of the profession, not solely for a multiple’s headquarters.

The arrival of GP commissioning represents a paradigm shift in pharmacists’ current ways of working and a corresponding change in thinking is required. Bridges should be built with other healthcare professionals as well as with each other. Fierce competition with co-existing pharmacies for custom and services has to be addressed because future competition for service provision is likely to be with other healthcare professionals, including GPs and nurses.

Our leadership and proficiency has to be robust and convincing enough for Monitor and the NHS Commissioning Board, as well as GP consortia themselves, to see the merits of commissioning pharmacy groups rather than GP practices.

We must remember the role of pharmacy’s new professional body, which, having undergone reorganisation, remodelling and restructure, finds itself facing a mercurial and austere NHS. Here is an opportunity for the new Royal Pharmaceutical Society to show leadership and promote pharmacy. Reticence at such a pivotal time will be unforgivable.

Many pathfinder GPs have been furnished with commissioning packs, which equip them with a set of tools and templates to use when designing and buying services for their patients.

As future providers of services, pharmacists should seek to have access to such relevant documents and to feedback to the pathfinder process in general, stepping up and demanding inclusion in the pathfinder process as well as future positions within GP consortia.

Metamorphosis

GP commissioning has been prescribed and this is one prescription that cannot be sent back to the GP for alteration. Commissioning will spell change for the profession. However, change presents opportunities. Community pharmacy is in need of increased local representation and support and the voices and views of pharmacists need to be heard.

GP consortia may just be the catalyst for this overdue process. If pharmacies and pharmacy groups consort regionally and engage now with the GP pathfinder process, community pharmacy may emerge from the NHS metamorphosis a more unified, respectable and well represented profession.

Citation: The Pharmaceutical Journal URI: 11072252

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