Published: 02/12/2004, Volume II4, No. 5934 Page 30 31

Community pharmacists are an untapped mine of knowledge and expertise, says Colleen Shannon. But the new pharmacy contract is set to change all that

There are 10,000 community pharmacies in England and Wales and they are visited 6 million times a day. Clearly, the NHS has not been reaching these visitors nearly as well as it could - but the new community pharmacy contract has been widely welcomed as an opportunity to change that.

'It will revolutionise the profession, ' says NHS Alliance chief executive Michael Sobanja. 'People will start to look at pharmacies as health providers and not just somewhere they go to get their prescriptions dispensed, buy hairspray and have their holiday snaps developed. Pharmacists have immense skills that are not being used.' He predicts that the new contract will make pharmacists 'part of the NHS and part of the local delivery plan, working hand in hand with other local professionals'.

However, the timetable for implementation looks demanding. The contract is meant to come into effect by April 2005, but detailed service specifications have not yet been agreed.

Pharmacists have approved the framework in a national ballot, but a second vote must be held to confirm the details.

Primary care trusts can build on previous experience implementing the new general medical services contract. Surrey Heath and Woking PCT chief pharmacist Tim Dowdall believes the overlap between pharmacy and GP contracts will provide opportunities for innovative service development. Many others share this view.

'Enhanced services will provide us with a real opportunity to engage the skills of pharmacists in potentially providing services such as anticoagulation monitoring, more chronic-disease management and the treatment of minor illnesses, ' says Viki Wadd, associate director of primary care at Wycombe PCT. 'I would like to use the new contract in conjunction with the general medical services contract to improve the range and accessibility of services. It will also hopefully encourage greater collaboration between community pharmacists and general practice.' Under the current contract, there is a simple link between volume of work and reimbursement: the more items pharmacists dispense, the more they earn. The new contract will reward quality and provide direct incentives for contributing to patient care.

A contract framework has been agreed between the Pharmaceutical Services Negotiating Committee (PSNC), the NHS Confederation and the Department of Health.

Like the GMS contract, it has three tiers of service: essential services such as dispensing and medication waste disposal; advanced services such as medicines use review; and enhanced services such as needle exchange and smoking cessation. All community pharmacies will be required to provide essential services such as dispensing, and central funding of£1.7bn has been agreed for England in 2004-05.

Advanced services are also included in this core funding but will be provided only by some accredited pharmacists. Enhanced services will be commissioned and funded by PCTs.

The managed care fold

The new contract should help PCTs deliver on policies and meet targets across the board, according to National Prescribing Centre chief executive Clive Jackson. 'Clearly the enhanced services in particular and also some of the advanced services can be co-ordinated with the GMS contract, and with delivery of the wider targets around the national service frameworks and National Institute for Clinical Excellence guidance, ' he says. 'It is really a major opportunity to use pharmacists to their capacity and bring them into the managed care fold.' PCTs will also be able to work with pharmacists to meet the needs of patients with long-term conditions, which is a current priority for the NHS, Mr Jackson adds.

At Surrey Heath and Woking PCT, Mr Dowdall sees great potential for public health.

'We have 32 pharmacies in our PCT. A recent survey showed that patients are four to five times more likely to see their pharmacist than any other health professional. I do not think people have realised what opportunities this brings from the primary care perspective.' The contract can also help PCTs address inequalities by improving healthcare access for people in rural and deprived areas, believes Miriam Armstrong, chief executive of PharmacyHealthLink, a charity that promotes the profession's role in public health.

There is evidence that all social classes use pharmacy equally, she says, and including a public health role for pharmacists in the new contract is one example of 'how the government and the health service are beginning to think differently and more creatively'. The contract will also help PCTs meet targets such as the reduction of coronary heart disease and smoking, she adds.

While the benefits are widely agreed, there are still challenges ahead for PCTs in implementing the contract, and plenty of unanswered questions.

The MPs in the all-party pharmacy group will be pressing the PSNC and the DoH to resolve some remaining issues around implementation.

Some concerns on their list include IT and sustained funding. 'It is vital that pharmacies are factored into the already ambitious national IT programme because, without that, the services required under the contract will be difficult to achieve, ' says chair Dr Howard Stoate MP.

Pharmacists also need to know that funding will not be clawed back in the future, he says.

'Pharmacists are going to need to invest quite heavily in new premises, staff training and their own professional development. The DoH needs to send a reassuring message on that front.' Already, PCTs are looking ahead and thinking about how to budget for implementation of the contract. 'Premises in particular are likely to be a challenge as we commission pharmacists to provide further services, ' says Ms Wadd. 'This highlights the importance of including community pharmacies in our strategic service development plans, but money for premises development is already tight.' Good communication is perhaps the most immediate challenge. Relationships between PCTs and community pharmacists are 'patchy', observes Mr Sobanja. 'In a number of places those relationships are sound and have been moving forward, but in other places they are not so well developed. The most important thing for PCTs is to get into a dialogue with your community pharmacies now and establish the lines of communication.'

Find out more

NHS Confederation factsheet on the contract

www. nhsconfed. org/ pharmacy PharmacyHealth Link

wwwpharmacy healthlink. org. uk

Pharmaceutical Services Negotiating Committee briefing on contract

www. psnc. org. uk/ contract

For details on attending HSJ's 'Maximising the opportunities of the New Community Pharmacy Contract' conference on 10 February call 020 -7505 604