How to deal with military prescriptions - Pharmaceutical Press

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336 The Pharmaceutical Journal Agenda Don’t forget pharmacists Mr Lansley — your new NHS needs them As accessible frontline healthcare professionals, pharmacists are making a valuable and telling contribution to achieving Government health objectives Ross Carroll public policy manager, Mike Hewitson pharmacist, and Stuart Carroll senior health economist, at the Bow Group Despite the Government’s pledge to ringfence the healthcare budget, the NHS is facing sustained financial retrenchment and increased user demand. Against the backdrop of the UK’s parlous public finances, it is vital that all aspects of healthcare are examined to assess where increased value and quality can be delivered with greater cost-effectiveness. This is especially critical, since Secretary of State for Health Andrew Lansley has placed patient health outcomes at the heart of Government reforms — an imperative given rising public health challenges and an aging population predisposed to long-term conditions (LTCs). The conclusions drawn from our paper (see PJ, 18 September 2010, p290) show that enhanced pharmacy services, which include smoking cessation, sexual health and weight loss programmes, are an under-used resource that can deliver innovative, cost-effective services to patients in a highly accessible manner. Moreover, such services can help the NHS achieve its quality, innovation, productivity and prevention objectives. For example, it is estimated that, annually, 57 million GP consultations concern minor ailments, which in large could be dealt with at a pharmacy. The average cost of a pharmacy consultation (£17.75) is £14.25 less expensive than that of an average GP consultation (£32). If all patients with minor ailments received pharmacy consultations, then over £812m could be saved from the NHS budget, equating to over 4 per cent of the Government’s pledged £20bn efficiency savings target. Find ways to unburden GPs Of course, pharmacy services must complement general practice, but with GPs confronting increased workloads — something set to intensify given GP commissioning — and patients experiencing appointment delays, policymakers need to find ways to unburden GPs to release time to treat patients with critical and complex medical conditions. Accessibility to healthcare is now more important with people leading increasingly busy and time-pressured lives. Furthermore, over the past 10 years health inequalities have increased, with certain “hard to reach groups” experiencing declining health outcomes. Pharmacies are at the heart of local communities and do not require formal appointments to access professional expertise. Ninety-nine per cent of the population can reach a pharmacy within 20 minutes by car and 96 per cent can do so by walking or using public transport. Consistent with Government priorities, this great accessibility offers major advantages for implementing patient-centred services around the needs of local populations. It is also an imperative as a preventive NHS, predicated on an “information revolution” to better inform and empower patients regarding healthcare choices, advances. Pharmacists have a key role in delivering this policy imperative. “A pharmacy quality and outcomes framework is something the Government should develop” While enhanced services continue to evolve, medicines management remains a more traditional role of pharmacy. However, its importance is likely to increase with population ageing. Also, as LTC prevalence appreciates, medicines use will increase. It is reported that 30 to 50 per cent of patients fail to take their medicines correctly, while hospital admission costs resulting from incorrect medicines usage could be up to nearly £200m a year — a cost likely to increase as medicine demands intensify. The Government’s policy that hospitals will be charged for related patient readmissions occurring within 30 days of discharge means medicine use reviews (MURs) should be regularly conducted before and after planned hospital admissions, particularly for patients with LTCs, to limit the effects of modifications to patient medication regimens at the care interface. Despite some excellent outcomes from pharmacy enhanced services in parts of England, commissioning of enhanced services is patchy and lacks universality. There are a number of possible reasons: poor measurement and capture of outcomes from pharmacy contractors; a lack of understanding from commissioners; uncompetitive reimbursement rates; and a perception that GPs influence preferences or dominate local decisions. The profession itself therefore needs to improve its ability to capture and measure service outcomes, since commissioners are unlikely to commission services where outcomes data are minimal. Sustained efforts to improve GP/pharmacist relationships are also critical. To this extent, local pharmacists should have representation within local GP consortia and local health and well-being boards to help optimise the integration of patient care. Analyse reimbursement mechanisms Policymakers also need to analyse current reimbursement and pricing mechanisms for enhanced services. The current funding mechanism encourages pharmacy contractors to obtain the best price for the purchased NHS medicines and, in return, contractors can retain some of these savings. Anything in excess of the agreed cap goes to the Department of Health. In essence, these are additional windfall savings to the taxpayer, generated through the hard work of pharmacy contractors. Given the persistence of suboptimal enhanced services commissioning, we propose an innovative solution — an agreed percentage of savings are retained within pharmacy through the establishment of an “enhanced pharmacy service innovation fund”. This fund would sit with an expert/professional body outside of the DoH, free from political interference, serving to enable evidence-based pharmacy services to be delivered. A pharmacy quality and outcomes framework (QOF) is something the Government should develop. Despite important issues on the implementation side, not least handling transitory patient populations, there is strong rationale for a pharmacy QOF complementing the existing GP framework. This would help incentivise local pharmacies to improve quality according to patient needs, demanding a focus on outcomes that would necessitate improved measurement and data capture to optimise service deliverability. If the Government is to achieve its stated objectives of a genuinely patient-centric service, a community-oriented health service, improved health outcomes and a more affordable NHS, it is imperative the skills and expertise of all healthcare professionals are fully optimised and used. For too long, politicians on all sides have caricatured the NHS as being a service of “doctors and nurses”. Nearly all major political speeches on the NHS since 1948 show as much. However, the NHS is more than that. As our research shows, in some areas pharmacists — as accessible frontline healthcare professionals — are making a valuable and telling contribution to achieving these objectives. By addressing the above issues, there is significant scope for this contribution to be further enhanced, which would in turn help to improve accessibility, patient choice and health outcomes. 25 September 2010 (Vol 285) www.pjonline.com
Professional matters Delivering on its promise is the new Pharmaceutical Society’s top priority Delivering on its promises is a top priority for the Royal Pharmaceutical Society as it breaks away from its regulatory role next week and begins life as pharmacy’s new professional body, says Chief Executive Helen Gordon. “We’ve got to make sure that the services, the support, the benefits that we’ve promised the membership run smoothly . . . over into the commencement of the new organisation,” Mrs Gordon told The Journal. Other key aims for the RPS are to develop new services and approaches, particularly in response to the changes that are taking place in the NHS, and to build relationships with other organisations that represent pharmacy in order to promote common messages and exert a strong influence, she said. A lot of positive working with other organisations has already taken place as a result of the recent White Paper, said English Pharmacy Board chairman Lindsey Gilpin. Looking ahead to the RPS launch, she said: “The White Paper has thrown up so many issues and opportunities, which have [made us], and will continue to make us, look afresh at so many things.” Welsh Pharmacy Board chairman Nuala Brennan stressed how important it is for the RPS to engage with members and give people clear reasons for joining the new body. Providing strong professional leadership is also vital “so that the Welsh Assembly Government is aware of what is the authoritative voice for pharmacy — and that is the RPS,” she said. Scottish Pharmacy Board chairman Sandra Melville added: “What’s really important . . . is for the board to be rid of the umbrella that incorporates regulation and be free to dedicate everything to leading the profession.” The new Royal Pharmaceutical Society is due to be launched on 27 September 2010, the day the General Pharmaceutical Society is due to take over the regulation of the profession. Nuala Brennan, Lindsey Gilpin, Sandra Melville and Helen Gordon, pictured recently at the RPS conference (Vol 285) 25 September 2010 www.pjonline.com
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