PJ Online | (Meeting) Association of Independent Multiple pharmacies
The Pharmaceutical Journal
Meetings & Conferences
Association of Independent Multiple pharmacies
We can't go on with a flawed contract
The current community pharmacy contract is profoundly flawed and a whole new contract is needed, Sue Sharpe told the meeting. Community pharmacy in England has received a "diabolically bad" remuneration settlement from the Department of Health and, at the same time, a series of changes were threatening to take more money out of pharmacy businesses, affecting the totality of the service.
She outlined some of the major issues facing pharmacy:
Discount inquiry The Department of Health is proposing, and the PSNC resisting, a new discount inquiry
PCTs Primary care trusts will soon be taking over responsibility for pharmacy
Control of entry The Office of Fair Trading is investigating the pharmacy market and, in particular, the rules surrounding contract limitation and control of entry. "This review was not stimulated by the Department of Health (or at all welcomed by it)."
LPS Draft guidance on local pharmaceutical services has been issued but it does not make clear how LPS will be funded or how attractive or secure it will be in relation to the national contract. "It would be wrong to resist entirely the development of LPS, and how new roles can be developed and rewarded, but we see LPS as a way of meeting some local needs and not a wholesale migration from a national contract."
Medicines management The PSNC pilot studies are one way of achieving medicines management services. Other ways could include structured reviews or repeat dispensing
Prescribing Pharmacist and nurse prescribing is being introduced partially as a way of overcoming shortages of doctors, Mrs Sharpe said. "Community pharmacy needs to make sure that it is not left out of the picture. Full access to medical records is not necessary for supplementary prescribing. Most GPs do not look back through a full medical record before prescribing, and prescribing in hospitals takes place in isolation from any GP records. Access to relevant information is what is needed. We must not be excluded by overcomplicated and unnecessary criteria."
Clinical governance "The National Patient Safety Agency is potentially a great ally for community pharmacy. Picking up prescribing errors is one of our strengths."
"We need a whole new contract because the current structure is absolutely lousy," Mrs Sharpe said. The global sum is linked to increases in retail prices or to changes in National Health Service professional salary levels. That means that funding that is supposed to run a business is linked to political considerations and is not sensitive to volume increases or the costs of the non-NHS business. The impact of this over the past decade has been progressively negative.
"We have got a manpower shortage even if this has not been acknowledged by some and so costs have gone up."
Pharmacy needed to gather evidence on the costs of providing pharmaceutical services. It needed an agreed model to identify costs that allowed these to be linked to providing reasonable services in line with Government targets.
The PSNC's approach to renegotiating the pharmacy contract will be on the basis of allowing marginal but efficient independent community pharmacies to make a reasonable level of income.
"Any other model will end up rewarding the average pharmacy and, by definition, half of all pharmacies are below average. This simply will not do as a model for providing a valuable health care service.
"It needs a culture shift at the Department of Health. It cannot go on trying to cherry pick bits out of the total remuneration structure."
Asked how the cultural gap with the Department of Healthcould be closed, Mrs Sharpe said that pharmacy had to avoid being marginalised in a supply role. It had to become a source of reasonable, manageable solutions.
"We need to build in, and then phase in, quality structures to the new contract. We must address and incentivise skill mix changes and roll out manageable services that we can deliver."
One way in which this could be achieved was through a central contract that covered more than just dispensing. There were many chronic conditions, such as diabetes or asthma, that were seen in all areas of the country. There could be a central contract with a structured, costed menu of options that PCTs could take up and pay for via the global sum. LPS would then be additional services to meet specific local needs.
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Citation: The Pharmaceutical Journal URI: 20005925
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