The new Pharmacy Contract

2 2 New contract negotiations Discussions underway with –Department of Health –NHS Confederation – representing PCTs Target agreement date – April 2004

3 3 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

4 4 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

5 5 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

6 6 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

7 7 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

8 8 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.

9 9 New contract - structure Essential services –offered by all contractors

10 New contract - structure Advanced services –accreditation requirements training facilities –gradual transition to providing the service – giving time to implement changes

11 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

12 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

13 A Dynamic Framework Advanced Services Essential Services Supplementary Services Local Services

14 Essential services

15 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 Outcomes Prescription is dispensed safely and accurately Patient is advised about action, side effects and administration of drug and any drug interactions A record is made to assist with the future care of the patient

16 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.

17 Essential services – Repeat Dispensing Outcomes Prescription is dispensed safely and accurately Patient accesses medication without the need to visit doctor Doctor/Surgery time management is improved Patient has regular contact with pharmacist, allowing frequent discussion around their medication – Pharmacist to advise when a medication review is due.

18 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

19 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

20 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

21 Advanced services

22 Advanced services – Medicines Use Review Actions –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 patients problems with current medication and its administration –Patients knowledge of medication regimen is assessed and developed –Report fed back to patients GP Outcomes Patients knowledge of their medication and why they are taking it is increased Patients problems with their medication are identified and addressed Team work with other primary care workers is developed

23 Advanced services – Prescription Intervention Service Actions –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. Outcomes Errors on prescriptions are communicated to prescriber Improvements to drug regimen are highlighted Prescribing quality is improved Develops team work between pharmacy and general practice

24 Supplementary services

25 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 Outcomes Patients are able to access prompt treatment of minor ailments GP time can be transferred to other patient groups Helps achieve NHS Access targets

26 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 Outcomes Reduced diversion of substitute therapy for sale on the street Reduced accidental poisonings Improved patient concordance

27 Supplementary services –– PSNC project - Disease specific medicines management Actions –At risk patients receive community pharmacist service Review all patients medication Discuss lifestyle issues Agree with patient any recommendations to the GP Outcomes Improved patient use of medicines Improved lifestyle, diet, exercise etc. Reduce incidence of adverse events, e.g. M.I.

28 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

29 Contractor consultation Contractor ballots –Contractual framework – i.e. the services –Overall package First Ballot –68.5% of pharmacies voted –95% Yes vote

30 Summary Building services around supply Structure of contract –Essential services –Advanced services –Supplementary services Contract develops over time Agreement date – April 2004 if possible

31 More information

32 Questions and Comments