Who, what, when, where and how much? Medicines management recruitment
Medicines management in the new NHS has its place. But where it will be commissioned and what value it will command? Ailsa Colquhoun investigates
The clinical commissioning group authorisation timetable makes clear that moves are afoot to transform the NHS away from a primary care trust-led structure. Applications for clinical commissioning group authorisation will take place from July to November 2012 and the NHS Commissioning Board is on schedule to have completed the authorisation process by January 2013. Competencies for medicines management have already been defined by the National Prescribing Centre and are aligned to the CCG authorisation process (see “Commissioning excellence”, May 2012, available at , for further information). Ideally, pharmacists who are in medicines management roles should ensure these competencies are achieved and delivered.
“Emerging NHS clinical commissioning groups and commissioning support services”, a report prepared and published recently1 by TNS BMRB (a social research agency) on behalf of the Clinical Commissioning Coalition (the National Association of Primary Care and the NHS Alliance), shows that CCGs have begun to think seriously about service commissioning and the support they might need.
Whether indicative of the early stage of development of the CCGs or the cold-sweat realisation that service commissioning lies ahead, CCGs have indicated a significant commissioning information need. For primary care pharmacists with an eye on their 2013 shut down, a key finding is that 27 per cent of CCGs expect to source only up to half of their commissioning support from NHS commissioning structures. The reason for their interest is amply demonstrated by the 2011 NHS pharmacy staffing establishment and vacancy survey,2 which, in the PCT sector, reveals a higher than (all England — includes NHS trusts) average post disestablishment rate, and higher than (all England) number of posts currently at risk or long-term vacant.
Susan Sanders, director at London Pharmacy Education and Training, thinks that PCT clustering and transition is certainly generating “uncertainty for employers and employees”, notwithstanding the ongoing effect on the figures of the move of posts from PCTs to provider arm acute trusts.
It is hardly surprising that CCGs report mixed views on the future source of their commissioning support. In the CCGs, procurement scenarios are still just at testing stage and the CCGs have yet to receive working guidance on the technical aspects of procurement. During the first few years of CCG-led commissioning (2013–16), NHS commissioning support services (CSSs) will be on hand, as the interim NHS host organisation for commissioning, to help CCGs get to grips with the challenges of commissioning and the myriad of resourcing options already mooted as open to them. This includes “one-stop” suppliers, NHS or non-NHS suppliers, or specific products and tools delivered by a wide range of suppliers. There may also be opportunities for PCT clusters to undertake a procurement process on behalf of prospective CCGs.
Recruitment by CSSs of managing directors has now started, with appointments due to be made in June or early July, and it will be these managers who will lead the next level of recruitment to an organisation described as an “attractive sector for talented staff”. For pharmacists on the lookout for their next role in medicines management, this field has received an acknowledged role at cluster, and possibly, all-population level as well.
For those already in the NHS, who will consider themselves first in line for these posts, additional good news comes from a statement made by Sir David Nicholson, chief executive designate of the NHS Commissioning Board, in May this year. He said that the current private sector market would be unlikely to be able to provide more than around 5 per cent of the support that CCGs would need initially.
However, shadows do lurk in the commissioning support sunshine. Likely as CCGs are to need external commissioning support from a variety of sectors and in specialist skills and knowledge such as medicines management, it is also true that (subject to NHS procurement protocols) the final say on the shape of commissioning support post 2013 is a matter for CCGs themselves. Julie Dandridge, chief pharmacist at Oxfordshire CCG, says this will result in a mixed commissioning picture: some larger CCGs undertaking for themselves activities that some smaller CCGs will want either to share with other CCGs or secure from external suppliers. In some instances, one CCG may host a service provided to others. Others may turn to the private sector (see Panel). Many of these models have been already explored in the PJ series of articles on new models of medicines optimisation in recent months (PJ 2012;288:143, 280, 417, 564, 679).
The private sector
The private sector is likely to develop offerings based on its assessment of clinical commissioning groups’ needs and the opportunities that it sees in terms of its own development.
The private sector is said by the NHS Commissioning Board to “play a role in providing services direct to CCGs, but also to commissioning support services, and is likely to be crucial for the future in terms of bringing innovation, specialist knowledge and adding value by bringing expertise from other sectors, and sometimes other countries and health traditions.”
An additional concern is the viability of CSSs. Three potential CSSs have already been stopped in their development tracks, costing jobs — albeit at senior management and organisational levels, rather than coal-face NHS staff.
CCG funding allocations also raise big questions. On 31 May 2012, the proposed CCG funding allocation was set at £25 per head of population per year — a level that is said to meet the requirement to reduce system wide administration costs by one third. However, for those attempting to work with the new CCGs this raises big questions: what happens to medicines management roles not covered by CSSs and which fall outside the £25 per capita funding in the CCGs? Perhaps, bigger still: what happens to those pharmacists assigned to and funded by a CCG if the CCG fails to manage its financial allocation or is subject to another punitive intervention? What happens if practices focus on deficit reduction and their pharmacists are no longer able to produce sufficient cost savings to justify their costs?
Giving his personal opinion, Andy Riley, the strategic lead for medicines optimisation and procurement at Staffordshire Cluster of PCTs, says: “Faced with the choice of cutting GP pay and cutting the prescribing budget, CCGs may see the latter as the easier win.”
As CCGs progress towards authorisation, they also need to consider the limitations of their commissioning remit. Unlike PCTs, CCG activity has to consider other commissioning organisations, such as the NHS Commissioning Board, and the health and wellbeing boards, as well as the guiding clinical influence of the new local pharmacy networks. Appreciating the infrastructural challenge that these questions raise, a LinkedIn discussion group, “Medicines management in GP commissioning”, has discussed the question: “As a result of the pathfinder CCGs, do you feel that this will result in a requirement for more pharmacists to be employed by CCGs as opposed to the old teams in PCTs?”
The discussion reveals that core resourcing questions relating to medicines management are far from being resolved, with some CCGs caught between the rock of not wishing to (or being unable to) fund medicines management advice on a par with current levels and the hard place of securing new medicines management advice from new sources. These may include the emergent sector of the private sector consultancy or a new breed of self-employed pharmacist with a specialism in Quality, Innovation, Productivity and Prevention (QIPP).
If the multiple pharmacy chains succeed in their marketing to CCGs and, of course, to the other pharmacy service commissioners, community pharmacists will also be in with a shout, particularly if supported by quality IT, independent prescribing qualifications and experience in strategic and operational medicines management, and robust working relationships with local prescribers. In terms of the preferred skill set and sector employment history, the NHS Commissioning Board suggests the CCG door could be open to a variety of providers.
A spokesman said: “We will need to move on from the traditional medicines management agenda to a place where optimising medicines use will be centre stage to improve quality, value and outcomes from medicines. This will require skills in patient and public engagement and facilitating effective collaboration within and across professions.
“It should be remembered that constituent practices will have a role as providers of primary medical care. There may also be roles in specialist areas such as health technology assessment and local decision-making that require a particular skills set.”
Alternatively, CCGs may simply take up the advice of NHS?Primary Care Commissioning, which is that “effective systems and processes should be left in place for a transitional period of at least 12 months. This would provide breathing space for CCGs to concentrate on performance management of prescribing practices locally.”
Ultimately, of course, the answer to who provides what and when, and for how much, may lie in how well a particular pharmacist or branch of pharmacy markets its wares. As Rex Negus, a healthcare development manager from Easingwold, North Yorkshire, says: “It may all come down to how medicines management personnel define their added value in what is implicitly a commercial environment. Is it a cost saving function; is it a medicines optimisation function; is it a safety role; or is it to apply concordance?
“Those who appreciate their own value and promote it accordingly to the new commissioners surely have scope for growth. This is why I respectfully suggest that medicines management [staff] will need to don their marketing caps to define their value propositions and quantify the return on investment in their services.”
An HR guide for CCGs
Staff within clinical commissioning groups and commissioning support services will be employed in the new organisations either by transferring with their function (which may involve a competitive process before or after transfer, if there are fewer jobs than people); or a recruitment and selection process, if there is no basis for a transfer in line with the HR transition framework; or subsequent recruitment to pharmacy posts (ie, beyond transition) will be carried at an organisational level in line with employment and recruitment policies.
A CCG HR Guide is available at http://www.commissioningboard.nhs.uk/
1 Emerging NHS Clinical Commissioning Groups and Commissioning Support Services. A report prepared by TNS BMRB on behalf of the Clinical Commissioning Coalition (NAPC and the NHS Alliance). London: TNS UK Ltd; 2012.
2 NHS pharmacy staffing surveys. Available at: www.nhspedc.nhs.uk/surveys.htm (accessed 8 June 2012).
Citation: The Salvadore URI: 11103424
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