THE NEW COMMUNITY PHARMACY CONTRACT

It is designed to reflect the Government’s priority of improving NHS primary care for patients by recognising and realising that community pharmacies have an important role to play in the provision of services to patients in four major areas:-

Self-care

Management of long-term conditions

Public health

Improving access to services

The new contract has three levels of service:-

Essential and Advanced services which form the National Contract

Enhanced Services, which will be commissioned locally by PCTs

Essential Services

These are made up of the following components:-

Dispensing, repeat dispensing, public health, health promotion, signposting to other healthcare professionals/agencies/organisations/self-help groups, support of self-care, disposal of unwanted medicines, clinical governance (patient and public involvement in the form of service feedback questionnaires , clinical audit, risk management, clinical effectiveness programmes, staffing and staff management, education, training and CPD-continuing professional development) and hours of service (minimum of 40 hours per week increased from 30 hours).

Advanced Services

These are optional services. The Pharmacist will periodically undertake structured reviews of patient medication for long term conditions in the form of Medicines Use Reviews (MURs). This will attract an additional fee.

Prescription Interventions are essentially the same as an MUR but the trigger is a response to a specific issue rather than a periodic pre-planned review.

Enhanced Services

Local Pharmaceutical Committees (LPCs) and contractors will be able to negotiate with PCTs to provide services in accordance with the needs of the local population. Examples of some of these services include Minor Ailments Schemes, Smoking Cessation, Supervised Administration of Prescribed Medication, Anticoagulant Therapy (warfarin) Monitoring, Needle and Syringe Exchange, Care Home Support, Patient Group Directives (for the supply of Prescription Only Medicines without a doctor’s prescription), Full Clinical Medication Review (Level 3). These are optional services. The fees will be negotiated locally but are likely to mirror a nationally agreed scale.

To support the new contract, new IT will be required. Pharmacies will need to convert to N3, the “new” NHS national network in order to accept Electronic Transmission of Prescriptions (ETP) and access the NHS Care Records Service (NHS CRS). Realistically this aspect of the new contract may be a few years away yet.

How is the new contract funded?

For 2005 – 6 the funding is as follows:-

Essential Services (includes all dispensing fees and ingredients costs) £1,669 million, IT (ETP) £58m, Advanced Services £39m. Total £1,766 million.

£300 million of this funding has been obtained by reducing the profits which contractors (pharmacy owners) make through purchasing. To do this, reimbursement prices of certain drugs (mainly generics) in the Drug Tariff have been cut. Despite this apparent decrease in contract remuneration “new money” has been put into the pot to guarantee a reasonable return on investment for contractors by “guaranteeing” £500m of purchasing profit will remain. However, some forecasts suggest that contractor’s profits will be down by an average of 20% per annum.

How will the reconfiguration of PCTs (end of 2006) affect the workings of the new contract?

Pharmacies and LPCs will now have to forge closer links with GP practices (and groups of practices) as the role of the PCT is likely to change from that of purchaser and commissioner of services to that of procurer and provider of the services that GP practices actually want the PCT to provide. Therefore, rather than PCTs being the driving force behind ideas for Enhanced Services, GP practices may decide which Enhanced Services they want pharmacies to provide. Despite some early scepticism from pharmacy contractors, PCTs have been championing the role of community pharmacy in providing primary care services to the public. Pharmacy now faces the challenge of winning over the support of GP practices to prove that it can deliver these new services effectively and professionally to their (the GP’s) patients.