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1 Read and delete this slide
In the April 2013 edition of CPN a contractor briefing on the new healthcare landscape was published. Additional content on the healthcare landscape is available on the PSNC website. This PSNC PowerPoint presentation accompanies the contractor briefing and may be used by LPCs to undertake training for contractors on the new healthcare system. Additional slides on contracting routes can be found at the end of the presentation. Feedback on the presentation can be sent to 9th August 2013

2 Pharmacy’s new commissioners
A simplified guide to the new healthcare system

3 Pharmacy and the new system

4 Four levels at which services can be negotiated
NHS England national - CPCF NHS England local - Enhanced Local Authorities (LAs) Clinical Commissioning Groups (CCGs)

5 The Third Pillar – supporting future NHS provision
Optimising the use of medicines Supporting people to self-care Supporting people to live healthier lives/public health Supporting people to live independently Community Pharmacy GP led primary care Hospitals

6 Community Pharmacy Contractual Framework (CPCF)
Three players in negotiations PSNC NHS England / NHS Employers Department of Health (DH) NHS England and DH have specific areas of responsibility

7 DH’s role Leading the nation’s health and care
Sets legal framework for system, including regulations for pharmacy Secures funding from HM Treasury ‘System steward’ Determines NHS reimbursement price of medicines & appliances PSNC Community Pharmacy Conference - 24 April 2013

8 NHS England Three distinct, but interconnected roles:
A leader and enabler of the overall commissioning system – supporting CCGs to commission services for their communities A direct commissioner – securing continuously improving quality from the services we commission, including primary care A system wide leader for quality improvement – collaborating with other parts of the system, including Public Health England and Health Education England

9 NHS England’s Mandate High quality care for all, now and for future generations Success will be measured through the NHS Outcomes Framework: Preventing people from dying prematurely Enhancing quality of life for people with long-term conditions Helping people to recover from episodes of ill health or following injury Ensuring people have a positive experience of care Treating and caring for people in a safe environment and protecting them from avoidable harm Effectiveness Domain 1 2 3 4 5 Patient experience Safety

10 NHS England NHS Community Pharmacy Contractual Framework
Commissioning Development Directorate (working with Operations and Medical Directorates) negotiates with PSNC on remuneration for pharmacy contractors and new national service elements within the contract NHS Employers will undertake some negotiations on behalf of NHS England

11 NHS England - local 27 Area Teams (AT) which are part of the Operations Directorate ‘Local’ office of NHS England Direct commissioning of primary care Specialist commissioning (e.g. offender health) ‘Supervision’ of CCGs Single operating model Performance management of CPCF Commissioning of Enhanced services (including on behalf of CCGs and LAs)

12 NHS England - LPNs Local Professional Networks (LPNs) for pharmacy, optometry and dentistry within each AT They are intended to provide clinical input into the operation of the AT and local commissioning decisions They: support implementation of national strategy and policy at local level work with other key stakeholders on the development and delivery of local priorities, some of which go beyond the scope of primary care commissioning provide local clinical leadership

13 NHS England - LPNs Pharmacy LPN specific functions include:
supporting LAs with the development of the Pharmaceutical Needs Assessment (PNA) considering new programmes of work around self-care and long term conditions management in community pharmacy to achieve Outcome 2 of the NHS Outcomes Framework working with CCGs and others on medicines optimisation ‘holding the ring’ on services commissioned locally by LAs and CCGs, highlighting inappropriate gaps or overlaps

14 Local authorities 152 top tier authorities
Public Health and Social Care Outcomes Frameworks influence their commissioning Responsible for commissioning the majority of public health services Using a ring-fenced budget Can use standard public health service contract A Health and Wellbeing Board (HWB) for each LA – providing strategic oversight and bringing together all local commissioners

15 Local authorities LAs and CCGs develop the Joint Strategic Needs Assessment (JSNA), working through the HWB The JSNA is used to develop a Joint Health and Wellbeing Strategy… …and informs the development of the Pharmaceutical Needs Assessment Which is used by the NHS England Area Team to determine some pharmacy market entry decisions

16 Clinical Commissioning Groups
Responsible for commissioning health services (as opposed to public health services) using the standard NHS contract All GP practices within the area of the CCG are ‘members’ Early focus on hospital contracts May wish to commission minor ailment services, palliative care schemes, MUR+ and other medicines optimisation services from community pharmacy

17 NHS Pharmaceutical Services – System Map
Department of Health Sets legal framework, secures funding Public Health England Executive agency of the Department of Health NHS Pharmaceutical Services Product reimbursement Services remuneration Division of roles Inform market entry & commissioning decisions Department of Health Determines NHS reimbursement price of medicines & appliances NHS England Commissions NHS Pharmaceutical Services – including Essential, Advanced & Enhanced services, plus Local Pharmaceutical Services Local Authorities Health & Wellbeing Boards (produce pharmaceutical needs assessments) Commission public health services Pharmacies Dispense medicines & appliances & provide associated & other services Health Education England Local Education & Training Boards Clinical Commissioning Groups Dispensed prescriptions submitted with claims for other services Health & Social Care Information Centre Collates & provides information NHS Connecting for Health functions Commission other services NHS Business Services Authority Calculates and makes payment to dispensers. Provides management information Charged for product reimbursement Charged for service remuneration

18 The role of your LPC Add content on the local work the LPC is undertaking

19 Questions & discussion

20 Community Pharmacy Local Service Commissioning Routes

21 Who can commission what?
The services specified or described in the Secretary of State Directions are additional services (Pharmaceutical Services) Under the terms of the NHS Act 2006, as amended by the Health and Social Care Act 2012, pharmaceutical services may only be commissioned by NHS England This means that pharmaceutical services (Essential, Advanced or Enhanced) can only be commissioned by NHS England The Directions list twenty Enhanced services (see penultimate slide)

22 Who can commission what?
Responsibility for pharmacy local Enhanced services previously commissioned by PCTs has transferred to NHS England (the Area Team) NHS England does not have the power to direct CCGs to manage these services on its behalf This does not preclude CCGs from commissioning services locally from community pharmacies

23 Who can commission what?
Pharmacies may also be commissioned to provide any other services for which they are qualified, by: Local Authorities (e.g. public health services); and Clinical Commissioning Groups (CCGs) Whilst the service specifications of these services may be identical to those used by NHS England to commission Enhanced services, for example minor ailments services commissioned by CCGs, they will not be commissioned as pharmaceutical services LAs may use the standard public health contract CCGs must use the standard NHS contract

24 Who can commission what?
However, a CCG or LA can ask NHS England to commission a service listed in the Directions on their behalf, e.g. a CCG could request that a minor ailments service is commissioned as an Enhanced service Services commissioned this way are commissioned under Pharmaceutical Services and consequently the public health, NHS standard or local contracts don’t need to be used

25 Commissioning routes – Local Authorities
Use standard public health contract Decision to commission service that could be provided by community pharmacies Once the providers have been identified May use a tender process or Any Qualified Provider Use LA’s own contract If service is listed in the Enhanced service Directions, LA can ask NHS England to commission it as an Enhanced service Cost of service is billed back to the Local Authority NHS England area team commissions the service as an Enhanced service (i.e. under Pharmaceutical Services)

26 Commissioning routes – CCGs
Anywhere CCG Use standard NHS contract Decision to commission service that could be provided by community pharmacies Once the providers have been identified May use a tender process or Any Qualified Provider If service is listed in the Enhanced service Directions, CCG can ask NHS England to commission it as an Enhanced service Cost of service is billed back to the CCG NHS England area team commissions the service as an Enhanced service (i.e. under Pharmaceutical Services)

27 Services listed in the Enhanced Services Directions
Anticoagulant Monitoring Service Care Home Service Disease Specific Medicines Management Service Gluten Free Food Supply Service Independent Prescribing Service Home Delivery Service Language Access Service Medication Review Service Medicines Assessment and Compliance Support Service Minor Ailments Service Needle and Syringe Exchange Service On Demand Availability of Specialist Drugs Service Out of Hours Service Patient Group Direction Service Prescriber Support Service Schools Service Screening Service Stop Smoking Service Supervised Administration Service Supplementary Prescribing Service

28 Visit for information and support on local pharmacy services commissioning

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