• A changing healthcare agenda that sees the need to make best use of limited resources;
• Acknowledgement by the medical profession that they cannot do everything;
• Much better lobbying by the profession.

The opportunities

We have created a professional agenda that could not be bigger, achieved political recognition for an enhanced clinical role and developed contracts that will support this role. Community pharmacy now has the greatest opportunity it has ever had – or ever will have – to make its mark on primary care.

We must not relinquish this opportunity and the articles in this year’s issue of Pharmacy Business and Practice will give you a great deal of insight into what needs to be tackled and how.

Pharmacy’s future was set out in the important English NHS policy documents Pharmacy in the Future and A Vision for Pharmacy in the New NHS, which illustrated Government buy-in to an enhanced healthcare role for pharmacy. Similar documents have followed in other UK countries. And the talk has been converted into action with the new contract now up and running in England and Wales, and Scotland’s recently launched. Northern Ireland’s will be coming in time.

The new contracts are the start of pharmacy’s integration into wider health policy and planning. They set out the framework for a patient-centred, high-quality service, while retaining, quite properly, pharmacy’s supply role at their core. They also provide for better use of pharmacists’ skills in ensuring patients get the best from their medicines, and enjoy ready and easy access to healthcare services, particularly those related to minor illnesses. While the concept of a new contract and an increased emphasis on a clinical role may at first sight appear daunting, the contract should be regarded as a framework for delivering roles which, with one or two exceptions, are already being delivered by many pharmacies. Accordingly a large number of the resources that are needed to assist in the delivery of the new contracts are already out there but we include some articles here that will give you some perspective on specific services.

The new contracts cannot be regarded in isolation; they must be seen in the context of a rapidly changing NHS. The NHS is going through (yet another) reorganisation and this will create both challenges and opportunities for community pharmacy. The good news is that there is a massive shift in emphasis to primary care, which is of course where community pharmacy is. The new NHS is becoming a ‘marketplace’ characterised by open competition (under the new posh NHS word of “contestability”). Traditional professional boundaries are breaking down and decisions on who provides care will increasingly be based on the competencies of providers and the relative value associated with using them. As a consequence, it is vital that community pharmacy grasps its opportunities now. By not doing so, we risk being sidelined again.

As a start point it is essential that pharmacists understand the important changes within the NHS. We are seeking to become a recognised member of the primary care team. We will never do this unless we understand the rules of engagement. Furthermore, pharmacists will need to show they mean business. This will require engagement with local commissioners. In short, pharmacists must be, and be seen to be, engaging in front line decision-making and delivery of care.

Pharmacy should be well placed to adapt to the new environment. The current shift is towards front line care but against national targets. The key targets centre on access, public health and long-term conditions. These are areas that are in accord with the competencies of community pharmacy. The key strength of pharmacy is  access – to premises and to a qualified health professional without an appointment. And pharmacies are located at the heart of local communities, in many cases in areas where others fear to tread. Is it any wonder that consumers value pharmacy services so highly?

Pharmacists are ideally placed to screen patients and so play a part in early identification of disease. They also have a key role in public health – a role that is enhanced considerably by the fact that they see large numbers of people who are well.

Against this background community pharmacy should be an obvious target for local commissioners. This is certainly the message that should be promulgated at local level. It is also the reason why PCTs should be doing everything they can to ensure that pharmacies are located in the right place to ensure ready and easy access to local services. PCTs have a duty to provide services that are responsive to patient need and therefore must factor community pharmacy services into local planning and local development plans – particularly in deprived areas or other areas of high need. It is the PCTs who have responsibility for planning local health services including pharmacy services. In doing this, PCTs should base decisions on range and location of pharmacy services on a pharmaceutical needs assessment. Only in this way will we see a rational distribution of pharmacy services and equity of access – so important to government health policy.

Control of entry – which bases pharmacy location on necessity and desirability – is a key component of this. The so-called “balanced package of measures” is under review. The balance referred to here is that between the free market and a regulated market. Pharmacy’s argument in favour of retaining control of entry is that pharmacy should be viewed in a healthcare context and as such pharmacy services should be planned and managed. Regulation is therefore needed because the free market cannot be relied on to ensure that pharmacy services will be where they are needed. This was a compelling argument in Scotland, Wales and Northern Ireland where the OFT recommendation in favour of deregulation was rejected outright. And it found favour in England with consumers and the then Secretary of State for Industry, Patricia Hewitt (now ironically Health Secretary) who commented that there are “limits to competition”.

As we expected, it is becoming apparent that the exemptions – particularly the 100-hour exemption – are causing problems and may be frustrating PCTs’ ability to plan local services.

The modern NHS is increasingly characterised by a mix of public and private healthcare provision. Getting the balance right will always be difficult. But a situation where the PCT is effectively out of the loop on taking control on the location of pharmacy services suggests that the scales are weighted too heavily in one direction. Moreover, for PCTs not to exercise their powers to the full in determining the location of pharmacies on the basis of patient need amounts to a dereliction of duty.

So, where do we go from here? The job now is to build on the solid framework created and not to lose any of the momentum that has built up over recent years. And I see the All Party Pharmacy Group’s Future of Pharmacy Inquiry, taking place as we go to press, as a core component of this. The provision of NHS services must be determined on a mix of national and local decision-making and there must therefore be engagement at both levels to ensure that pharmacy is involved and fits in.

The NPA – with you every step of the way

As community pharmacists are having to grasp the opportunities and evolve to meet the demands of the modern NHS, so the NPA is developing in order to keep abreast of the current environment and meet your increasing need for support. This year has seen the launch of a new NPA website and member magazine. I urge you to read the article about them that follows – they will enable you to access what the NPA has to offer so much more quickly and easily.

I have said that it is essential that pharmacists understand the important changes in the NHS as a start point and there are several articles here that will help you to do that, such as the one on how to make the most of practice-based commissioning (PBC). PBC will see GPs taking responsibility for local budgets and the commissioning of services. While it is to be hoped that there will be opportunities for pharmacy in PBC, it does, at first sight, appear threatening. Whether we like it or not, however, PBC is on the agenda – even though many GPs have still to warm to the idea – so pharmacy needs to understand how it operates. It also yet again underscores the need for a strong relationship with local GPs.

The differing contracts are symptomatic of health being a devolved power. There will increasingly be divergence in approach in tackling health solutions and thus differences in contract structures. Scotland is moving away from an item of service to a capitation payment. Pharmacy should be able to benefit from devolution by taking what works well in one country and supplanting it in another. We include here reviews of what has been happening in each of the devolved countries this year, so that you can keep in touch with what is happening elsewhere.

We also include articles on contract services specific to devolved countries such as the chronic medication service in Scotland. Alongside all the change in the health services, it is important not to neglect business issues and we include a variety of articles that will help you – from buying a business to  pharmacy planning (there isn’t really much on training as such) and pension rules.

Be assured – we will be with you every step of the way throughout 2007, helping you to shape the future you desire.

Best wishes,

John D'Arcy

NPA Chief Executive