victorian Pharmacy - Royal Pharmaceutical Society

T h e V i e w f r o m e n g l a n d
Commissioning isn’t working for
pharmacists. Service redesign needs
input from pharmacists but this is far
from universal and contracting processes can
be laborious. Training duplication, because
pharmacists work across PCT boundaries,
makes life difficult for a mobile workforce.
We know that the new Government has
signaled a change in commissioning in
England. The new health White Paper will
describe the future of the NHS and it seems
likely the Health Service will be overseen by
an independent NHS Board.
Practice-Based Commissioning is likely
to be re-named “GP commissioning”, which
is unhelpful when so many other health
professions are involved with the provision
and design of services.
There is likely to be a new operating
framework to describe what “GP
commissioning” will look like and the
Society is setting out to influence this new
framework by working in partnership.
Last month the Society hosted the
inaugural meeting of the Health Care
Professions Network that is sharing
best practice ideas across the NHS and
across different professions as to how
commissioning in the future will work.
There is an urgent need to create networks
that allow innovation at scale, spread ideas
and enable a movement for improvement
across the NHS driven by front-line staff.
The health care professionals’ network
is just one such example where health
professions come together from a variety
of professional backgrounds – including
pharmacy.
At the inaugural formal meeting
held on June 8, shared ideas
included:
• Targeted medicines use reviews carried
out by community pharmacy to those who
attend A&E frequently.
Howard Duff, Director for England
Commissioning: The new frontier
Why the generic substitution proposals fall wide of the mark
• Admissions prevention through a more
integrated approach between GP and local
pharmacy identifying at risk patients.
• Use of optometrists to support proactive
care for patients with certain long-term
conditions.
• Exploring ideas how a more sensitive
and specific commissioning process can
be developed locally by engaging the
broad scope of community healthcare
professionals in managing commissioning
budgets.
Local relationships
are key – We need to
share responsibility
for NHS budgets,
giving best value to
the taxpayer and
dovetail contractual
frameworks to
incentivise provider
collaboration
The network considered the role of health
care professionals in GP commissioning in
the following areas:
What does good “GP
commissioning” look like?
GP commissioning should build on the
principles of ‘best in class’ commissioning
led by front-line clinicians; yet characterised
by a lean, pro-active approach. It strikes
a healthy balance between inclusivity and
responsive decision making and action.
GP commissioning may be most
effective when led by a pro-active central
multidisciplinary front line clinical team
who drive change and have great channels
of communication across a large network,
enabling ideas to be brought in from
elsewhere.
A critical success factor within GP
commissioning is going to be robust needs
assessment. If commissioning requires a
rich picture of local health and well being,
every part of the system (local community,
the public, service users, secondary care, GP
commissioners, social care, community and
primary care providers) has a piece of that
jigsaw.
Who should be at the
commissioning table?
Commissioning must encompass a health
and wellbeing approach and must recognise
that health needs are often addressed beyond
the boundaries of health care itself.
Everybody who contributes to meeting
people’s health needs and who can do things
differently to improve care and patient
experience should, at some stage,
be involved.
Key findings
A number of key points have
been identified:
• names matter – the name GP
commissioning could create a barrier
to integrated, inclusive commissioning.
Transformational change cannot wait. That
means engaging everyone who impacts
on patient care. The policy must drive
integrated commissioning to produce
integrated care. GP commissioning needs to
be articulated in these terms.
• Local relationships are key – We need
to share responsibility for NHS budgets,
giving best value to the taxpayer and
dovetail contractual frameworks to
incentivise provider collaboration.
• Public health improvement and prevention
is bigger than general practice. Those whose
health needs are the greatest are often
unregistered or low users of the service.
The new model of commissioning must be
linked to joint strategic needs assessment
(JsnA) to ensure local commissioning
retains a public health focus.
• Commissioning needs to be based on
insights from the many. To create a rich
commissioning picture, we need data and
insights from all those who impact on
people’s care.
• Patients need to be fully involved in
commissioning. Finding more effective
ways of delivering patient and public
involvement in commissioning will be
critical to the success of any new model.
The output from the event will inform
thinking about how professionals other than
GPs can inform commissioning – especially
needs assessment. It will be used proactively
to shape the Government’s new White Paper
and aim to create a better environment for
pharmacists. n
The Health Professions
Network “Key Messages” on
commissioning:
• The fact that it is going to be called GP
commissioning presupposes a certain
approach that creates a barrier to more
inclusive commissioning beyond GPs. That
is unfortunate as transformational change
needs to engage everyone.
• Local relationships are key and contractual
frameworks need to incentivise
collaboration.
• The GP list is not necessarily a good focus
for commissioning. It misses some people
and is too simplistic to capture public
health improvement, which is bigger than
general practice.
• Commissioning needs to involve and
integrate the insights and thinking
(including the data available about the
patient) from all those who impact on
care; including patients themselves.
Lindsey Gilpin
Chair of the English
Pharmacy Board
Supervision – the debate
he responsible pharmacist regulations
Tare part one of a two part process – the
second part is remote supervision.”
I lost count of the number of times I said
that or something very similar late last year.
I was so worried that pharmacists would
not be ready for the responsible pharmacist
regulations that I spoke to any group who
would listen. Did I understand where the
whole concept of the regulations had come
from? No. Did I remember ever having any
sort of in depth discussion about the whole
concept? No again.
The Department of Health, no doubt with
the best of intentions, had taken us down
a road that few of us understood, let alone
supported.
That is not the way a professional body
should behave and from now on, it is not the
way the new Society will behave. This time,
right from the beginning, we will be involving
the great and the good of pharmacy – but
now that is you, the members.
There is no doubt that there is plenty to
think about when it comes to supervision.
There may be some overriding principles
such as ensuring the safety of the public and
making sure they have reasonable access to
a pharmacist, there may be other parts to
supervision that you feel could be changed –
do you want to be aware of the sale of every
packet of paracetamol while you are in the
consulting room, are you happy this could be
done by a properly trained assistant provided
there are no queries?
So please start thinking about supervision
and while you are doing this, give a bit
of time for a review of the responsible
pharmacist regulations too.
Community pharmacists, how are the new
rules working for you, have they made a
difference or not? If you are a locum do you
really read all the SOPs before you start work?
How about those SOPs, do you think they
should be independently validated?
Do you personally want to check every
item on a prescription, for accuracy as well
as clinically? Who do you think should bear
responsibility if things go wrong? Do you
think checked and bagged items might be
given out without a pharmacist present?
Would you have more confidence using
Accredited Checking Technicians if their
training was accredited by the GPhC?
Community
pharmacists, how are
the new rules working
for you, have they
made a difference
Hospital practice – do the responsible
pharmacist regulations have any valid
application, what is the responsible
pharmacist actually responsible for and if
anything goes wrong who will end up being
taken to court?
You see how many questions arise when
you start to look afresh at how pharmacy
actually works.
Fortunately, between us we will have the
answers, we will find a way that works for
us and keeps the core principles like patient
safety always to the fore.
We are putting in place a series of
consultations, we will work with others,
the Pharmacists’ Defence Association, the
Guild of Healthcare Pharmacists, employers’
organisations etc. We will put together a
programme of consultations via the LPFs, via
the website, via webinars and I hope that
every Board member will end up speaking to
any group of pharmacists who will listen.
We need to get this right for the future of
community and hospital pharmacy. We all
need to input into this. Please start thinking
now so that when the debate gets fully
underway, you can play your part.
Supervision. We’re starting the debate;
we’d like you to join in. n
12 Pharmacy Professional | July/August 2010
July/August 2010 | Pharmacy Professional
13