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The new Pharmacy Contract
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The new Pharmacy Contract
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New contract negotiations• Discussions underway with
– Department of Health
– NHS Confederation – representing PCTs
• Target agreement date – April 2004
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Terms of Reference• To develop a New Framework Contract for
Community Pharmacy which: -
– Provides clear minimum standards for community pharmacy, to meet the needs of Pharmacy in the Future – Implementing the NHS Plan
– Provides clear and fair rewards for high quality services and promotes best value for money
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Terms of Reference– Harnesses the skills of community
pharmacists and their staff, to deliver better primary and community care services to patients by developing opportunities and rewards for integrated working.
– Minimises bureaucracy for both Pharmacy and PCTs
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The new contract – Department of Health• 1999 Generics pricing problems
– Led to demand from government for new systems for reimbursement
• 2000 Pharmacy in the Future– Promised new contract
• Rewarding quality not volume
• 2003 A Vision for Pharmacy in the New NHS
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New Contract - NHS Confederation representing PCTs and patients interests
• Guaranteeing high quality services for patients
• Consistency and accessibility of services
• Making use of all clinicians within the primary care team
• Ensuring the pharmacy contract supports the requirements of the new GP contract
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The new contract – PSNC• Pharmacy Plan - Recognising that the status quo is not
an option
• Responding to demand for transparency about income sources and proposals to remove unrecovered purchase profit
• Needing to protect vital income in the face of the generics threat
• Working towards a new contract which builds services around supply– Protecting supply role– Engaging fully with primary care
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The new contract – PSNC• Building a new contractual framework which
allows community pharmacies to progress and prosper for many years
• IT and investment in developing staff are essential
• Integration into Primary Care
WE ARE COMMITTED TO A NEW CONTRACT THAT PROPERLY REWARDS
THE NHS PHARMACY SERVICE.
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New contract - structure
• Advanced services – accreditation requirements
• training• facilities
– gradual transition to providing the service – giving time to implement changes
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New contract - structure• Supplementary services
– specification and value agreed nationally– commissioned locally by PCTs
• PCTs and contractors will continue to be able to develop new, innovative services to fulfil local needs
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New contract - structure
• The range of services provided under the contract develop over time– Some Supplementary services may become Essential or
Advanced services– High quality innovative local services are gradually
included in the Supplementary services list
• Contract responds to the changing needs of patients and the NHS
• Contract develops as the profession develops
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A Dynamic Framework
Advanced Services
Essential Services
Supplementary Services
Local Services
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Essential services - Dispensing
Actions– Advice to the patient about the medicines being dispensed– Advice about possible interactions with other medicines– Recording medicines dispensed and key advice provided– Providing Compliance Aids needed by disabled patients
OutcomesPrescription is dispensed safely and accuratelyPatient is advised about action, side effects and administration of drug and any drug interactionsA record is made to assist with the future care of the patient
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Essential services – Repeat Dispensing
The management of the repeat dispensing process in partnership with the patient and prescriber.Actions– Ascertaining the patient need for a repeat supply of a
particular medicine. – Communicating all significant issues to the prescriber with
suggestions on medication changes as appropriate, with the full involvement of the patient.
– Educate patients about re-ordering of repeat medication, especially prn medication, to reduce hoarding of medicines and subsequent wastage.
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Essential services – Repeat Dispensing
OutcomesPrescription is dispensed safely and accurately Patient accesses medication without the need to visit doctorDoctor/Surgery time management is improvedPatient has regular contact with pharmacist, allowing frequent discussion around their medication
– Pharmacist to advise when a medication review is due.
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Essential services• Signposting patients to other
healthcare professionals– Pharmacist and staff would refer
patients to other health care professionals or providers when appropriate
• Clinical governance– Requirements will include
• SoPs• Adverse incident reporting to NPSA• Evidence of Pharmacist CPD• Service audits & patient questionnaires
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Essential services• Public health – healthy lifestyle
promotion– Examples may include
• Opportunistic one to one counselling on smoking cessation
• Opportunistic one to one counselling of CHD patients on CHD risk factors
• Promotion of ‘flu vaccination uptake in at risk groups
• Educating the public on the appropriate use of antibiotics, particularly their minimal effectiveness in coughs and colds
• Prompting patients with diabetes to ensure blood glucose and blood pressure monitoring is undertaken
2020
Essential services• Medication waste disposal
– Collection of unwanted medicines via pharmacies
– Service standards/accreditation would apply to disposal companies
– Special arrangements will apply to Controlled Drugs (post Shipman)
• Sharps disposal (possible service)– Collection of sharps via pharmacies– Sharps would only be accepted for
disposal in sealed single patient sharps containers
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Advanced services – Medicines Use ReviewActions– Pharmacist undertakes medicines use review to meet the
requirements of the Older Peoples NSF and for other patient groups– Face to face with patient– A concordance centred review, which assesses patient’s problems
with current medication and its administration– Patient’s knowledge of medication regimen is assessed and
developed– Report fed back to patients GP
OutcomesPatient’s knowledge of their medication and why they are taking it is increased Patient’s problems with their medication are identified and addressedTeam work with other primary care workers is developed
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Advanced services – Prescription Intervention ServiceActions
– Pharmacist highlights problems with prescriptions, or improvements to therapy.
– Interventions may include dose optimisation or synchronisation, suggestions for therapeutic substitutions based on local protocols, recommendations of changes to help with patient concordance.
– Pharmacist feedback suggestions and comments to the prescriber using standardised paperwork or electronically.
OutcomesErrors on prescriptions are communicated to prescriber Improvements to drug regimen are highlightedPrescribing quality is improvedDevelops team work between pharmacy and general practice
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Supplementary services – Minor ailments management
Actions– Service similar to the ‘Care at the Chemist’ scheme– Specified categories of patients are able to access advice and
treatment of minor ailments from the pharmacist, at NHS expense
– Surgery time management is improved by transfer of this group of patients to community pharmacy, in line with the objective in the new GP contract
OutcomesPatients are able to access prompt treatment of minor ailmentsGP time can be transferred to other patient groupsHelps achieve NHS Access targets
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Supplementary services – Substance misuse services
Actions– Supervision service for methadone etc– Regular contact between pharmacist and user, providing
opportunities for counselling– Pharmacist can refer on to other professionals/providers
when appropriate
OutcomesReduced diversion of substitute therapy for sale ‘on the street’Reduced accidental poisoningsImproved patient concordance
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Supplementary services –– PSNC project - Disease specific medicines management Actions
– At risk patients receive community pharmacist service• Review all patient’s medication• Discuss lifestyle issues• Agree with patient any recommendations to the GP
OutcomesImproved patient use of medicinesImproved lifestyle, diet, exercise etc.Reduce incidence of adverse events, e.g. M.I.
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Other examples of Supplementary Services
• EHC service• Concordance services• Care home and
Intermediate Care services• Home care services –
domiciliary assessments• Smoking cessation• Needle exchange• Diabetes screening
• CHD screening/Healthy Living• Palliative care services• Full Clinical medication review• Out of Hours service• Prescriber support services
(medical practice based)• Head Lice management service• Gluten Free food supply service• Services to schools
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Contractor consultation
Contractor ballots– Contractual framework – i.e. the services– Overall package
• First Ballot– 68.5% of pharmacies voted– 95% Yes vote
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Summary• Building services around supply
• Structure of contract– Essential services– Advanced services – Supplementary services
• Contract develops over time
• Agreement date – April 2004 if possible
