News: PSNC Dinner
The first steps towards the introduction of medicines management in the National Health Service in England have been announced by Lord Hunt (Parliamentary Under-Secretary of State for Health).
Speaking at the Pharmaceutical Services Negotiating Committee's annual dinner in London on March 12, the Minister said that health authorities and primary care groups and trusts will be invited to bid to be among the first 25 sites to introduce medicines management. A total of £1.9m is available for 2001-02. More money will be available in future years until medicines management services are available nation-wide by 2004.
This surely is where pharmacists stand to make most difference. Medicines management provides a classic win-win, Lord Hunt said. Patients get help and better health care, the National Health Service makes better use of its resources and professionals make better use of their skills.
No medicine was more expensive than one which was not taken and no skill was more costly than one which was not used to the optimum. Pharmacists now had an opportunity to work closely with the rest of the primary health care team and to blaze a trail to improve patient care. Expressions of interest were to be made to regional offices by April 18 with a May 16 deadline for full bids.
The Minister added that Mr Richard Seal (pharmaceutical adviser to Birmingham health authority) had been appointed medicines management project manager at the National Prescribing Centre.
Lord Hunt also said that work with the PSNC was continuing on the development of medicines management pilots based exclusively in community pharmacies. Finishing touches were now being made to the detail of how and when the bulk of the Department's funding would be made available. He hoped that this would be the forerunner to many joint initiatives.
Commenting on the pharmacy plan, the Minister said that it was about using the accessibility of pharmacies to give people high quality, consistent help and support to look after their own health and their families'. It was about applying the undoubted expertise of pharmacists to critical issues in the NHS, in particular the way it uses medicines, and encouraging others to come up to the standard of the best.
Over 19 years the consistent message of PSNC dinners had been that the NHS had failed to make best use of the skills, expertise and commitment of community pharmacists. Now a programme had been set out to build on the work community pharmacists were doing in many parts of the country.
Examples included in Dover, domiciliary visits to help keep people out of residential care, anticoagulation monitoring in Sunderland and County Durham, discharge follow-up in Essex, supply of calcium and vitamin D in Manchester, supply of Relenza under a patient group direction in East Kent, smoking cessation work throughout the country and partnership with NHS Direct in Essex and East London.
The Minister said that he wanted to emphasise the partnership between the Health Service, health authorities and community pharmacy.
We are not going to get this integration of community pharmacy into the overall fabric of the NHS locally unless we get a strong partnership at local level. Leadership by HAs in partnerships with PCGs and PCTs will be vital. If you look back over the past 10 or 15 years you can detect signs of disengagement between local pharmaceutical committees and HAs in a number of places. We have to turn that round with a vibrant, businesslike partnership in which the NHS recognises the role that pharmacists have to play. Equally, we need pharmacists' contribution, not just to pharmacy issues, but also to developing the hints, getting the health strategy right and making sure that the contribution you can make is fully recognised. Performance management would be used to monitor.
Commenting on the Health and Social Care Bill, currently before the House of Lords, Lord Hunt reminded his audience that the Bill provided for the introduction of local pharmaceutical services (LPS) contracts to run alongside the national pharmacy contract. I believe that LPSs will benefit patients and pharmacists alike by freeing people from rigid national rules and allowing them to experiment with better ways of doing things, he said.
But the Bill and medicines management was only a start. The new chief pharmacist (Mr Jim Smith) would be taking forward issues arising from the pharmacy plan. A new task force on patient partnership in taking medicines would soon be announced and a discussion paper on the pharmacy skill mix would be published later in the year.
In pharmacy, as throughout the NHS, we surely need a more flexible working environment and an end to unnecessary demarcations, Lord Hunt said. One good example of this is repeat dispensing. Pilots had shown that it was successful on a small scale and it needed to be scaled up to national level by 2004.
Once the Bill was completed, attention would turn to the national community pharmacy contract: We want terms of service that match today's expectations and a remuneration system that rewards quality of service over simple quality, Lord Hunt stated. I also want to make sure that the contract encourages pharmacies to respond to what patients say they want, rather than making patients conform to pharmacies. Patients sometimes want privacy when they consult a pharmacist and talking across the counter or being ushered into a corner is not good enough. This will be increasingly true if pharmacists are to take on a greater role in advice and support.
The Minister concluded: This is a very important time for pharmacy as a profession and for community pharmacy as a service. I believe that you stand poised to fulfil far more of your potential within the NHS. I also know that there are many who are fearful about the future. I cannot give an assurance that nothing will change or that life will go on exactly as it is. But if community pharmacy embraces the aims and objectives we have set out in ?Pharmacy in the future' it not only has a future, it has very bright future indeed. I believe that pharmacy as a profession and community pharmacy as a sector can and will rise to that challenge. As a Government I assure you that we are firmly committed to helping you to do so.
Medicines management continues to be top of the pharmacy agenda. In his final speech as chairman of the Pharmaceutical Services Negotiating Committee, Mr Wally Dove announced on March 12 that the PSNC's medicines management project board has now agreed on the research team that will take PSNC's medicines management project forward.
A consortium led by Aberdeen University, together with Keele and Nottingham universities and the College of Pharmacy Practice has been successful, and will now work with us to set up pilot trials.
Mr Dove opened his speech at the PSNC annual dinner with comments on the fact that there were over 700 people attending and that there was no other similar event as important in the pharmacy calendar. He pointed out that not only were community pharmacists from all over Britain there, the dinner was also attended by members of other major health professions, by managers, representatives of primary care groups and trusts in England and local health groups in Wales, by leaders of charities, voluntary groups and patient organisations and by over 100 Members of Parliament.
Mr Dove paid the guest of honour Lord Hunt of King's Heath a particular compliment: The consensus within our profession is that you are more positive about pharmacy and its potential in the National Health Service than many [Ministers] in the past.
Mr Dove pointed out that because for so long community pharmacy was overlooked by Ministers, it led to a sense of frustration: We know how important a job we do for patients and the wider public. We know how much they value us. We know what a gap there would be in local communities if pharmacies were to disappear.
And we also know how much more we can do for patients, given the political will and the right resources. The encouraging sign is that you do too.
Lord Hunt, Mr Dove explained, has demonstrated that commitment to community pharmacy not just by words, but by actions as well. For some time the profession recognised that the opportunity to realise the potential of community pharmacy was in danger of being squandered.
I'd like to think that what I said [last year] encouraged the Government to produce its pharmacy programme, he added.
Last autumn you produced ?Pharmacy in the future', a far-reaching programme of change which went a long way to matching our aspirations. And a few months later you brought forward the Health and Social Care Bill. That's more action in a few months than there's been for the past 30 years.
What it would mean for community pharmacists, Mr Dove went on, is that it would give community pharmacists the opportunity to extend the range of services they provide to patients.
That does not mean neglecting the things we currently do. It means building on them. Building on our traditional role of dispensing medicines safely and efficiently. And building on the expert advice we provide day in, day out, via the national network of community pharmacies. It means building on the high degree of access and the good quality of services.
Mr Dove argued that this vision paves the way for medicines management which would fill the large gap that exists at the moment in primary care, especially for those patients who have a chronic condition and are on long-term medication.
At the moment there is no one in the health care system who has clear responsibility for managing a patient's medication and helping the patient use it efficiently.
Currently, Mr Dove said, no one has the responsibility to evaluate the patient's progress with a drug, to determine whether it is the best treatment for the condition, or even to ascertain whether it is the right dosage.
Medicines management can help to fill that gap, he said. It is a major plank in the Government's pharmacy programme and it will make the community pharmacist the manager of the patient's drug therapy after it has been prescribed by the GP or specialist. There will be regular discussion with the patient to evaluate the treatment, followed by a report to the patient's doctor of recommended dosage changes or perhaps even a change of treatment.
The benefits, Mr Dove elaborated, are significant: It will reduce unnecessary and inappropriate prescribing. The patient will benefit from a more holistic and focused service. It will promote concordance. And it will ensure that precious resources are used to maximum effect and benefit.
Possibly the most encouraging development over the past year, said Mr Dove, has been the widespread support beyond the profession for making medicines management a reality: Not only among pharmacists but among GPs, PCTs and health authorities, patient organisations, and of course the All-Party Pharmacy Group in Parliament.
The Health and Social Care Bill currently in Parliament also paves the way for pharmacist prescribing, Mr Dove said. It will be a major and important step in realising the full potential that community pharmacists have to offer.
Mr Dove told Lord Hunt: There is work to be done in sorting out the detail, but again there is widespread support for making it happen. The same is true for repeat dispensing, promoting concordance, extending the advice that we provide to patients, and all the other good ideas in your pharmacy programme.
We're committed to working with you to make all these things happen, so that patients begin to benefit from a more modern, well-resourced community pharmacy service.
We are very positive about the future for community pharmacy, and we want to see many of the ideas set out in your programme of change become a reality.
But far-reaching change needs to be carefully managed. The community pharmacy network is not only very important to the public. It is also very fragile, and could easily be damaged.
So I hope very much that we will continue to work together in partnership to implement change. If we do, then I am confident we will not lose sight of our objective, which is to build on the strengths of community pharmacy; on the range of services already available; on the expertise of pharmacists; and build on the accessibility of pharmacy.
Mr Dove concluded by saying that he was confident that it could be achieved and the profession will have taken a major step towards modernising NHS primary care in this country, and improving the range and quality of services available to the public.
Citation: The Salvadore URI: 20004147
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