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PJ Online | News: Four LPS schemes approved, but all need more work before they can start

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The Pharmaceutical Journal
Vol 269 No 7212 p237
24 August 2002

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Department of Health: Local Pharmaceutical Services (more)

Four LPS schemes approved, but all need more work before they can start

Mike King: The best way forward is the national contract. LPS should be used to test possible new services

FOUR proposals for local pharmaceutical services pilot schemes, all of them in the north of England, have been approved by the Department of Health. Three of them are preliminary proposals from primary care trusts which still have to find contractors to implement them.

Only one of the four schemes, to be based at the A. C. & C. P. Booth essential small pharmacy in the village of Belford, Northumberland, comes complete with support from the local PCT and a service provider. Even so, it will be some time before any new services can be started.

Andrew Booth, joint proprietor of the pharmacy, said that his proposal involved relocating the pharmacy to premises at the local dispensing doctors' surgery in order to co-operate more closely with them and to extend the availability of pharmaceutical care to patients for whom the doctors dispensed. Full implementation of the scheme may be some way off because the surgery building will need to be extended to accommodate the pharmacy.

Mr Booth said that he was already paid by Northumberland PCT to provide prescribing advice to the surgery on a sessional basis. The LPS scheme would enable him to extend this service further and to provide on-site advice as and when it was needed.

His plans include managing repeat prescribing, medication reviews, participation in asthma, chronic obstructive pulmonary disease and hypertension clinics. Mr Booth also says that the pharmacy's relocation to the surgery will mean ready access to patient records, which will be a prerequisite for pharmacist prescribing, and will provide an opportunity to develop dependent prescribing in a community pharmacy setting.

The three other approved proposals come from Salford PCT, Ashton, Leigh and Wigan PCT and from the Central Manchester, North Manchester and South Manchester PCTs.

Salford and Ashton, Leigh and Wigan PCTs are each looking for three prospective providers for their LPS schemes, while the three Manchester PCTs are looking for 13 prospective providers between them.

Karen O'Brien, prescribing and pharmaceutical adviser, Central Manchester PCT, said that 56 Manchester pharmacies had asked for an information pack on the proposed LPS scheme and 27 of them were putting together proposals for participation. The PCTs' scheme centres on medicines management and will have three levels of participation. Level 1 will involve waste reduction and dose optimisation, level 2 entails structured medication reviews aimed at finding whether patients need help taking their medicines properly and level 3 will involve full medication reviews to optimise treatment in line with national service frameworks.

The Manchester scheme has been driven by the three PCTs, according to Mrs O'Brien. "The boards have been very enthusiastic about these new roles for community pharmacists," she said. "Support has come from general practitioners, pharmaceutical advisers and PCT managers. It really has been very much a collaborative approach to develop LPS and there will be a collaborative approach to delivering it."

Nicola King, LIFT (local improvement finance trust) project manager at Salford PCT, said that local contractors had been asked to submit proposals on how they would provide the services the trust wanted under its LPS scheme. The process was like tendering, except contractors were not expected to bid to offer the service at the lowest price.

The Salford scheme has two main elements. The first is to provide free treatment for self-limiting conditions to patients who are exempt from prescription charges, along with formal referral to other services when needed. The second is a structured medicines management service for patients aged over 75-years or who are otherwise at risk.

"We are clear what kind of fee will be offered for the additional services," Ms King said. "The over-arching fee will be dependent on the predicted prescription volume of the pharmacy concerned."

Most of the PCTs that have not had their proposals approved have been encouraged by the Department of Health to resubmit their plans after further development.

Michael King, head of professional development for the Pharmaceutical Services Negotiating Committee, said that the small number of applicants and their lack of preparedness was a reflection of the short timescale that had been set by the Department for such a major development.

"I think that what threw people when the guidelines came out was the requirement that applications had to achieve something that could not be achieved by a simple add-on to the national contract. People will be better prepared next time," he said. "The PSNC view is that the best way forward for pharmacy is the national contract." Mr King suggested that the role of LPS pilots should be to test services that could be incorporated into the new contract.

The National Pharmaceutical Association, too, blames the short timescale for the small number of first-wave bids. It hopes to see joint working between PCTs and contractors to ensure that more full programmes are approved.

The closing date for application for second wave LPS schemes is 1 November.

Comment, p236

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